Prevalence of metabolic syndrome in children with and without obesity

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However, in the child population, in the last decade, the increase has been 3 times greater.<a class="elsevierStyleCrossRefs" href="#bib0275">1,2</a> Recently, the World Health Organization (WHO) reported over 42 million children aged below 5 years with overweight.<a class="elsevierStyleCrossRef" href="#bib0285">3</a> In Mexico, the combined prevalence of overweight and obesity in children aged 5–11 years is 34.4%, representing approximately 5,664,870 of grade schoolers affected.<a class="elsevierStyleCrossRef" href="#bib0290">4</a> The main risk associated with obesity in childhood and adolescence is the presence of clinical–metabolic alterations that include hypertension, hyperglycaemia and atherogenic dyslipidaemia and that, grouped together, constitute the metabolic syndrome (MS),<a class="elsevierStyleCrossRefs" href="#bib0295">5,6</a> considered a predictor of insulin resistance, type 2 diabetes (DM2) and cardiovascular disease (CVD).<a class="elsevierStyleCrossRefs" href="#bib0305">7–9</a> Currently, the MS has become one of the main health issues in the paediatric population.<a class="elsevierStyleCrossRef" href="#bib0320">10</a> The increase in the prevalence of MS, particularly in children, is associated with the combined phenomena of urbanization, diet, sedentary life, environmental factors and genetic predisposition.<a class="elsevierStyleCrossRefs" href="#bib0325">11,12</a> Some studies have determined the prevalence of MS in child population with obesity, reporting figures of 30%,<a class="elsevierStyleCrossRef" href="#bib0335">13</a> and 50% in children with a higher-grade obesity.<a class="elsevierStyleCrossRef" href="#bib0340">14</a> Thus, among children and adolescents with obesity, the described prevalence is 30% and 50%.<a class="elsevierStyleCrossRef" href="#bib0345">15</a> The variability in the prevalence described in child population is attributed to population differences and to the lack of clearly defined diagnosis criteria, promoting the use of several cut-off values to determine the alteration of the parameters that constitute it.<a class="elsevierStyleCrossRef" href="#bib0350">16</a> In the Mexican child population, little is known regarding the prevalence of MS and the combination of components that define it, due to the fact that each component independently represents a risk factor for CVD, their identification being important to implement control measures. The purpose of this study was to determine the prevalence of MS, its main components and combinations in a sample of Mexican children with and without obesity.Subjects, material and methodsA cross-sectional study approved by the Ethics and Research Committee of the Universidad Autónoma de Guerrero was performed. The study included 225 children selected during the year 2008 from 3 primary education schools, located in the urban area of the city of Chilpancingo, all of them born in the state of Guerrero, Mexico. The sample included 117 boys and 108 girls aged from 6 to 12 years, 106 of which were obese and 119 of which had normal weight. The written informed consent was obtained from every parent or tutor, and the procedures were carried out in accordance with the ethics guidelines of 2008 set forth in the Declaration of Helsinki.Clinical and anthropometric measurementsAll children were submitted to the anthropometric assessment determining body weight, in light clothing and without shoes, using a body composition monitor (Tanita BC-553, Arlington, USA). The height was measured with a portable stadiometer (Seca, Hamburg, Germany). The body mass index (BMI) was calculated as weight (kg)/height (m2). The waist circumference was measured in duplicate passing by the navel and the edge of the iliac crest, using an anthropometric tape with an accuracy of ±0.1cm (Seca 201, Hamburg, Germany). The classification of obesity was performed using the Centres for Disease Control and Prevention<a class="elsevierStyleCrossRef" href="#bib0355">17</a> growth charts from the year 2000, determining normal weight in children with a BMI between the 5 and 85 percentiles, and with obesity those with a BMI percentile≥95. Blood pressure was measured in the child's right arm in sitting position and at rest for at least 5min, using a sphygmomanometer (Riester CE 0124, Jungingen, Germany). Two consecutive readings were taken for each child, with at least one minute between each reading and the average of the readings was registered and used in the subsequent analysis. Altered systolic and diastolic blood pressure was determined by the presence of percentile≥95 values, in accordance with age and gender, considering the National High Blood Pressure Education Programme Working Group on High Blood Pressure in Children and Adolescents<a class="elsevierStyleCrossRef" href="#bib0360">18</a> data.Biochemical determinations and definitionsBlood samples were collected by venous puncture after one night fasting. Total cholesterol, triglycerides, cholesterol joined to high density lipoproteins (HDL), cholesterol joined to low density lipoproteins (LDL) and glucose values were determined from a serum sample using a semi-automatic equipment (COBAS MIRA, Roche Diagnostics).In this study, the definition of MS was performed considering 3 items of the criteria set forth for children and adolescents aged from 10 to 16 years by the International Diabetes Federation (IDF): glucose≥100mg/dl, triglycerides≥150mg/dl, HDL cholesterol<40mg/dl, and 2 items of the criteria proposed by the WHO: obesity, defined by a BMI≥95 percentile, and altered blood pressure≥95 percentile.<a class="elsevierStyleCrossRefs" href="#bib0365">19,20</a>Statistical analysisThe statistical analysis was performed with the STATA v9.2 software. The descriptive statistic was generated for all the variables. The nominal qualitative ones were expressed as proportions and the differences were calculated using the chi square test. Continuous variables with normal distribution were expressed as mean±standard deviation, and those without normal distribution, as median and 5 and 95 percentiles. The differences among groups were determined through the Student's t test and the Mann–Whitney U test, respectively. MS frequencies and its components were defined as percentages. The p<0.05 values were considered statistically significant.ResultsThe current study included 225 children (119 with normal weight and 106 with obesity); the mean age in both groups was of 9 years and the proportion of boys and girls participating was similar. Children with obesity, in comparison with those of normal weight, showed a significant increase of metabolic, clinical and anthropometric measurements (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). In accordance with the criteria set forth in this study, both groups showed altered metabolic parameters (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). In children with normal weight, the main metabolic alterations were observed in the following measurements: fasting glucose (26.9%), total cholesterol (19.3%) and HDL cholesterol (11.7%). On the other hand, children with obesity showed alterations in the following measurements: HDL cholesterol (44.3%), triglycerides (40.6%), fasting glucose (40.6%) and total cholesterol (39.6%). Blood pressure increase was presented only in the group of children with obesity (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The prevalence of MS in children with obesity was of 44.3% (47 children), and in the normal weight group, of 0.84% (one child) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). In this study, the prevalence of MS by sex did not show significant differences (22.2% in girls versus 20.5% in boys, p=0.75).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Taking into account the number of metabolic components present, 62.1% of the children with normal weight was metabolically healthy, 31.9% presented one altered metabolic component, and 5.04%, 2 components. In the group of children with obesity, 31.1% did not present any clinical–metabolic alteration, 24.5% presented, besides obesity, one altered metabolic component, 26.4% 2 metabolic components, 15.1% 3 metabolic components, and 2.83% 4 metabolic components. None of the children showed alterations in the 5 assessed components (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>In this study, the main combinations of clinical–metabolic components that define MS were determined in the child population subject to study. In the obese children group, obesity/triglycerides/HDL cholesterol was the main combination (34.0%), followed by obesity/glucose/triglycerides/HDL cholesterol (29.8%) and obesity/glucose/HDL cholesterol (14.9%). In children with normal weight, the combination that defined MS was the presence of glucose/HDL cholesterol/triglycerides (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>Discussion and conclusionPrevious studies have demonstrated that the increase of childhood obesity is related to a high cardiometabolic risk during childhood and adolescence,<a class="elsevierStyleCrossRef" href="#bib0375">21</a> and the development of heart disease 25 years later,<a class="elsevierStyleCrossRef" href="#bib0380">22</a> while in the adult population, the presence of MS components independent of obesity is associated with the development of CVD.<a class="elsevierStyleCrossRefs" href="#bib0385">23,24</a> Therefore, the presence of MS components during childhood predisposes to the increase in morbidity and mortality due to CVD. Although the metabolic components in the adult population have been established, the pattern that defines MS in child population remains contradicting. This study has observed the alteration of the clinical–metabolic parameters associated with obesity. Similarly, other studies have determined the association of childhood obesity with metabolic alterations, which are strong determinants of the lipidic profile, insulin values, MS and DM2.<a class="elsevierStyleCrossRefs" href="#bib0395">25,26</a>For the Mexican adult population, high MS numbers have been reported: 36.8% in accordance with the National Cholesterol Education Programme Adult Treatment Panel III (ATP III) criteria, 41.6% in accordance with the American Heart Association/National Heart, Lung and Blood Institute, and 49.8% considering the IDF.<a class="elsevierStyleCrossRef" href="#bib0405">27</a> The high prevalence of MS found in this study (44.3%), in children with obesity, may be indicating that if obese children do not reduce their weight, they may remain with MS throughout adolescence and adulthood, becoming a part of the aforementioned statistics. For that reason, it is important to perform interventions in their lifestyles in order to reduce their weight and improve their metabolic conditions.Studies performed in large child and adolescent populations describe lower prevalences of MS than the one found in our population, and they vary depending on the criteria employed in their definition. In North America, the III National Health and Nutrition Examination Survey described a prevalence of MS of 32.1% in adolescent population with obesity.<a class="elsevierStyleCrossRef" href="#bib0410">28</a> Taking into account Cook et al. criteria, the prevalence of MS was of 27%,<a class="elsevierStyleCrossRef" href="#bib0365">19</a> in accordance with ATP III criteria, it was of 26.1%,<a class="elsevierStyleCrossRef" href="#bib0415">29</a> dramatically increasing in children with a higher grade of obesity, reaching prevalences of up to 50% in accordance with Weiss et al. criteria.<a class="elsevierStyleCrossRef" href="#bib0340">14</a> On the other hand, in Latin American obese children, the prevalence described nears 36%,<a class="elsevierStyleCrossRefs" href="#bib0420">30,31</a> in Korean children and adolescents, it was of 37.5%,<a class="elsevierStyleCrossRef" href="#bib0430">32</a> and in Chinese obese children, it was of 33.1%.<a class="elsevierStyleCrossRef" href="#bib0435">33</a>Even though the prevalences are high in most of the countries, the prevalences of MS described in other studies in Italian obese prepubescents,<a class="elsevierStyleCrossRef" href="#bib0440">34</a> Portuguese,<a class="elsevierStyleCrossRef" href="#bib0445">35</a> Asian<a class="elsevierStyleCrossRef" href="#bib0450">36</a> children and children from Qatar<a class="elsevierStyleCrossRef" href="#bib0455">37</a> are significantly lower. Even though obesity is a stimulating factor for the occurrence of MS in child population, children with normal weight also develop metabolic alterations. In our population, 0.84% of the children with normal weight showed MS, a lower prevalence than the one referred to in normal-weight Korean adolescents (1.61%)<a class="elsevierStyleCrossRef" href="#bib0460">38</a> and in Chinese child population (2.3%).<a class="elsevierStyleCrossRef" href="#bib0435">33</a> This evidences that the variability of criteria and cut-off values employed in the definition of MS has an influence over the reported prevalences. Racial ethnic origin,<a class="elsevierStyleCrossRef" href="#bib0465">39</a> genetic factors and dietary and lifestyle habits seem to be determining factors in its development.<a class="elsevierStyleCrossRefs" href="#bib0470">40,41</a> There is evidence that shows that the criteria set forth for the definition of MS in the US child population are not applicable to all populations.<a class="elsevierStyleCrossRef" href="#bib0435">33</a> Other authors have considered, for MS diagnosis, the left ventricular mass index as a sensitive and specific parameter in paediatric and adolescent population,<a class="elsevierStyleCrossRef" href="#bib0480">42</a> as well as the determination of the pancreatic β cells function, since insulin sensitivity decreases in subjects in transition from tolerant to intolerant to glucose and from intolerant to DM2,<a class="elsevierStyleCrossRef" href="#bib0485">43</a> as well as the use of obesity cut-off values based on the z-score, that could help provide comparable data at international level in children and adolescents.<a class="elsevierStyleCrossRef" href="#bib0490">44</a>This study assessed MS individual characteristics: elevated triglycerides, low HDL cholesterol and altered fasting glucose were the most frequent metabolic abnormalities in the child population. Likewise, in another study performed in Mexican children, dyslipidaemia was one of the characteristics frequently associated with MS.<a class="elsevierStyleCrossRef" href="#bib0495">45</a> The high prevalence of low HDL cholesterol shown in this study is one of the alterations frequently described in medical literature.<a class="elsevierStyleCrossRefs" href="#bib0295">5,26,37,38,46–49</a> It has been determined that hypertriglyceridaemia has an important racial ethnic influence, being higher in non-Hispanic and Hispanic whites, in comparison with the African American population, which is also reflected in the MS rate referred to in ethnic groups.<a class="elsevierStyleCrossRefs" href="#bib0505">48,50</a> The presence of metabolic alterations in both study groups is important since their persistence constitutes an independent factor predictor of diabetes and future CVD.<a class="elsevierStyleCrossRefs" href="#bib0520">51–53</a>As far as we know, this is the first study providing evidence of the heterogeneity in the development of MS in the Mexican child population, showing the presence of varied patterns of components that define MS in obese and normal-weight children, being the predominant combinations obesity/triglycerides/HDL cholesterol (34.0%), obesity/glucose/triglycerides/HDL cholesterol (29.8%) and obesity/triglycerides/HDL cholesterol (14.9%). Moreover, 38% of the children with normal weight showed metabolic alterations, being the most frequent one altered fasting glucose, followed by low HDL cholesterol and an increase of triglycerides. Some authors have determined the frequency of multiple MS components but they do not define specifically which components constitute it. Liu et al. demonstrated that Chinese grade schoolers with overweight and obesity have in average 1.75–2.08 MS components.<a class="elsevierStyleCrossRef" href="#bib0435">33</a>Getting to know the main MS component groups could help establish intervention strategies mainly based on the modification of lifestyles and the integration of multidisciplinary groups including patients and families, and not on the use of pharmacological measures,<a class="elsevierStyleCrossRefs" href="#bib0535">54,55</a> in such a way that the institutions responsible for issuing health policies at country level may be aware of the magnitude of the problem, to direct actions towards the most susceptible groups and be able to assess whether prevention or control strategies are effective, taking into account, for assessment purposes, the MS components most frequently present in the child population. Besides the fact that early intervention will help reduce morbidity and mortality rates in young and adults. In conclusion, 44.3% of grade schoolers with obesity presented MS, being dyslipidaemia the strongest determinant of this syndrome. Even though the prevalence is low in children with normal weight, one third of them present at least one of the syndrome components, which recommends an immediate intervention to control or revert these alterations.Conflict of interestThe authors declare that there are no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres577877" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec594566" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres577876" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Fundamento y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec594565" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Subjects, material and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Clinical and anthropometric measurements" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Biochemical determinations and definitions" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion and conclusion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-06-27" "fechaAceptado" => "2013-10-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec594566" "palabras" => array:4 [ 0 => "Metabolic syndrome" 1 => "Prevalence" 2 => "Obesity" 3 => "Children" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec594565" "palabras" => array:4 [ 0 => "Síndrome metabólico" 1 => "Prevalencia" 2 => "Obesidad" 3 => "Niños" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Background and objectiveChildhood obesity is considered the main risk factor for the development of metabolic syndrome (MetS) during childhood, adolescence and adulthood. This study aimed to determine the prevalence of MetS components and its main defining combinations in a sample of school children with and without obesity. Patients and methodsA total of 225 children aged 6–12 years, 106 obese and 119 with normal weight were included. MetS was defined by the presence of 3 or more of the following: obesity as a body mass index≥95th percentile, fasting glucose≥100mg/dl, triglycerides≥150mg/dl, high density lipoproteins cholesterol (HDL-c)<40mg/dl and systolic and diastolic blood pressure≥95th percentile. ResultsWe found MetS components in both groups. Most frequent abnormalities in the obese group included increased levels of HDL-c, triglycerides, fasting glucose and total cholesterol, while increased levels of glucose and total cholesterol, and lower HDL-c levels predominated in the normal weight group. The prevalence of MetS in the obese group was 44.3% and, in normal weight children, it was 0.84%. The 3 main components that defined the MetS in the obese group were obesity/triglycerides/HDL-c (34.0%), obesity/glucose/triglycerides/HDL-c (29.8%) and obesity/glucose/HDL-c (14.9%), while the only combination observed in the normal weight group was glucose/HDL-c/triglycerides. ConclusionA percentage of 44.3 of obese school children had MetS, and dyslipidemia showed to be strong determinants of MetS. Although the prevalence of MetS was low in children with normal weight, one third of them showed one of the components of MetS." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Fundamento y objetivoLa obesidad infantil es el principal factor de riesgo para el desarrollo de síndrome metabólico (SM) durante la infancia, adolescencia y vida adulta. El objetivo de este estudio fue determinar la prevalencia de los componentes del SM, y de las principales combinaciones que lo definen, en una muestra de niños escolares con y sin obesidad. Pacientes y métodosUn total de 225 niños con edades entre 6 y 12 años, 106 con obesidad y 119 con peso normal, fueron incluidos. El SM fue definido por la presencia de 3 o más de los siguientes componentes: índice de masa corporal≥percentil 95, glucosa en ayunos≥100mg/dl, triglicéridos≥150mg/dl, colesterol unido a high density lipoproteins (HDL, «lipoproteínas de alta densidad»)<40mg/dl, presión arterial sistólica y diastólica≥percentil 95. ResultadosEn ambos grupos analizados se encontraron componentes del SM. En el grupo con obesidad, el colesterol HDL, los triglicéridos, la glucosa en ayunos y el colesterol total fueron las alteraciones más frecuentes; en los de peso normal predominó el incremento en los valores de glucosa, colesterol total y disminución de colesterol HDL. La prevalencia de SM en niños con obesidad fue del 44,3%, y en niños de peso normal, del 0,84%. Las 3 principales combinaciones que definieron el SM en niños obesos fueron: obesidad/triglicéridos/colesterol HDL (34,0%); obesidad/glucosa/triglicéridos/colesterol HDL (29,8%) y obesidad/glucosa/colesterol HDL (14,9%); en el grupo con peso normal: glucosa/colesterol HDL/triglicéridos. ConclusiónEl 44,3% de los niños escolares con obesidad presentaron SM; las dislipidemias mostraron ser fuertes determinantes del SM. Aunque en los niños con normopeso la prevalencia es baja, la tercera parte presentó al menos uno de los componentes del SM." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Fundamento y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Guzmán-Guzmán IP, Salgado-Bernabé AB, Muñoz Valle JF, Vences-Velázquez A, Parra-Rojas I. Prevalencia de síndrome metabólico en niños con obesidad y sin ella. Med Clin (Barc). 2015;144:198–203." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "HDL cholesterol: cholesterol joined to high density lipoproteins; LDL cholesterol: cholesterol joined to low density lipoproteins; BMI: body mass index; BP: blood pressure.Data expressed as mean±standard deviation or as median (percentile 5–percentile 95). The p<0.05 values are considered statistically significant." "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">Normal weight (n=119) \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">Obesity (n=106) \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" title="table-entry " align="left" valign="top">Age (years)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (6–12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (6–11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.70 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Gender<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Boys \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">57 (47.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60 (56.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Girls \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62 (52.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">46 (43.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Weight (kg)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27.8 (19.2–39.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42.55 (27.4–63.9) \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></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Height (cm)<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">130.11±10.58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">135.47±11.35 \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" title="table-entry " align="left" valign="top">BMI (kg/m2)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16.3 (13.9–19.08) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23.1 (18.8–29.1) \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></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Waist circumference (cm)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62 (52–73) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">79 (64.5–94) \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" title="table-entry " align="left" valign="top">Systolic BP (mmHg)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">90 (80–108) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">101 (90–123) \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" title="table-entry " align="left" valign="top">Diastolic BP (mmHg)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54 (45–61) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60 (50–77) \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" title="table-entry " align="left" valign="top">Fasting serum glucose (mg/dl)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">95 (72–112) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">98 (83–112) \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></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total cholesterol (mg/dl)<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">171.3±30.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">187.8±29.8 \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></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Triglycerides (mg/dl)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">68 (25–150) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">138 (57–204) \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" title="table-entry " align="left" valign="top">HDL cholesterol (mg/dl)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64 (34–101) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40.5 (23–83) \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" title="table-entry " align="left" valign="top">LDL cholesterol (mg/dl)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">95.3 (53.4–158.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">102.2 (63.5–180.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab943100.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Mann–Whitney U test." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Chi square test." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "Student's t test." ] ] ] "descripcion" => array:1 [ "en" => "Anthropometric, clinical and metabolic characteristic in Mexican children." ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "HDL cholesterol: cholesterol joined to high density lipoproteins; BP: blood pressure.p<0.05 values were considered statistically significant." "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">Total(n=225), n (%) \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">Normal weight(n=119), n (%) \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">Obesity(n=106), n (%) \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" title="table-entry " colspan="5" align="left" valign="top">Glucose (mg/dl)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">150 (66.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87 (73.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63 (59.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.03<a class="elsevierStyleCrossRef" href="#tblfn0020">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">≥100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 (26.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (40.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \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">Triglycerides (mg/dl)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><150 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">176 (78.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">113 (95.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63 (59.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001<a class="elsevierStyleCrossRef" href="#tblfn0020">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">≥150 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 (21.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (5.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (40.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \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">Total cholesterol (mg/dl)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><200 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">160 (71.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96 (80.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 (60.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001<a class="elsevierStyleCrossRef" href="#tblfn0020">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">≥200 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65 (28.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (19.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 (39.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \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">HDL cholesterol (mg/dl)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">≥40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">164 (72.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">105 (88.25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 (55.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001<a class="elsevierStyleCrossRef" href="#tblfn0020">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61 (27.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (11.75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 (44.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \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">Systolic BP (mmHg)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><95 Percentile (<117mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">219 (97.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">119 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 (94.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.010<a class="elsevierStyleCrossRef" href="#tblfn0025">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">≥95 Percentile (≥117mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (2.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (5.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \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">Diastolic BP (mmHg)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><95 Percentile (<80mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">222 (98.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">119 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">103 (97.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.10<a class="elsevierStyleCrossRef" href="#tblfn0025">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><95 Percentile (≥80mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (1.33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (2.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \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">Metabolic syndrome</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">177 (78.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">118 (99.16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 (55.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001<a class="elsevierStyleCrossRef" href="#tblfn0025">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 (21.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 (44.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab943103.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "a" "nota" => "Chi square test." ] 1 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "b" "nota" => "Fisher's exact test." ] ] ] "descripcion" => array:1 [ "en" => "Prevalence of metabolic syndrome components in Mexican children." ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "MS: metabolic syndrome." "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">Number of MS components \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Prevalence</th></tr><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">Total(n=225), n (%) \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">Normal weight(n=119), n (%) \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">Obesity(n=106), n (%) \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 " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">107 (47.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74 (62.18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 (31.13) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 (28.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 (31.93) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (24.52) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (15.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (5.04) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (26.41) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (7.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (15.09) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (1.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (2.83) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab943102.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Prevalence of the number of metabolic syndrome components in Mexican children." ] ] 3 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "HDL cholesterol: cholesterol joined to high density lipoproteins; DBP: diastolic blood pressure; SBP: systolic blood pressure; MS: metabolic syndrome.The data shown represent the proportions of the different combinations of components that constitute the metabolic syndrome in children with normal weight and obesity." "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">Component 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">Normal weight(n=119), n (%) \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">Obesity(n=106), n (%) \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">MS in the obesity group(n=47), n (%) \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 " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74 (62.18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 (31.13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Glucose \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 (24.37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (13.21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">HDL cholesterol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (6.72) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (5.66) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Triglycerides \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (4.72) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">SBP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.94) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">HDL cholesterol+triglycerides \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (2.52) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (15.09) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (34.04) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Glucose+HDL cholesterol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1.68) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (6.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (14.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Glucose+triglycerides \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (3.77) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (8.51) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Glucose+SBP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.94) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (2.13) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Glucose+HDL cholesterol+triglycerides \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (13.21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (29.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Glucose+HDL cholesterol+SBP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.94) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (2.13) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Glucose+SBP+DBP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.94) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (2.13) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Glucose+HDL cholesterol+triglycerides+SBP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1.89) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (4.26) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">HDL cholesterol+triglycerides+SBP+DBP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.94) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (2.13) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => 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Prevalence of metabolic syndrome in children with and without obesity

Prevalencia de síndrome metabólico en niños con obesidad y sin ella

Iris Paola Guzmán-Guzmána,

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pao_nkiller@yahoo.com.mx

Corresponding author.

, Aralia Berenice Salgado-Bernabéa, José Francisco Muñoz Valleb, Amalia Vences-Velázqueza, Isela Parra-Rojasa

a Unidad Académica de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, Mexico

b Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The prevalence of obesity has increased worldwide and in every age group&#46; However&#44; in the child population&#44; in the last decade&#44; the increase has been 3 times greater&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">1&#44;2</span></a> Recently&#44; the World Health Organization &#40;WHO&#41; reported over 42 million children aged below 5 years with overweight&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">3</span></a> In Mexico&#44; the combined prevalence of overweight and obesity in children aged 5&#8211;11 years is 34&#46;4&#37;&#44; representing approximately 5&#44;664&#44;870 of grade schoolers affected&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">4</span></a> The main risk associated with obesity in childhood and adolescence is the presence of clinical&#8211;metabolic alterations that include hypertension&#44; hyperglycaemia and atherogenic dyslipidaemia and that&#44; grouped together&#44; constitute the metabolic syndrome &#40;MS&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">5&#44;6</span></a> considered a predictor of insulin resistance&#44; type 2 diabetes &#40;DM2&#41; and cardiovascular disease &#40;CVD&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">7&#8211;9</span></a> Currently&#44; the MS has become one of the main health issues in the paediatric population&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">10</span></a> The increase in the prevalence of MS&#44; particularly in children&#44; is associated with the combined phenomena of urbanization&#44; diet&#44; sedentary life&#44; environmental factors and genetic predisposition&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">11&#44;12</span></a> Some studies have determined the prevalence of MS in child population with obesity&#44; reporting figures of 30&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">13</span></a> and 50&#37; in children with a higher-grade obesity&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">14</span></a> Thus&#44; among children and adolescents with obesity&#44; the described prevalence is 30&#37; and 50&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">15</span></a> The variability in the prevalence described in child population is attributed to population differences and to the lack of clearly defined diagnosis criteria&#44; promoting the use of several cut-off values to determine the alteration of the parameters that constitute it&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">16</span></a> In the Mexican child population&#44; little is known regarding the prevalence of MS and the combination of components that define it&#44; due to the fact that each component independently represents a risk factor for CVD&#44; their identification being important to implement control measures&#46; The purpose of this study was to determine the prevalence of MS&#44; its main components and combinations in a sample of Mexican children with and without obesity&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Subjects&#44; material and methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">A cross-sectional study approved by the Ethics and Research Committee of the Universidad Aut&#243;noma de Guerrero was performed&#46; The study included 225 children selected during the year 2008 from 3 primary education schools&#44; located in the urban area of the city of Chilpancingo&#44; all of them born in the state of Guerrero&#44; Mexico&#46; The sample included 117 boys and 108 girls aged from 6 to 12 years&#44; 106 of which were obese and 119 of which had normal weight&#46; The written informed consent was obtained from every parent or tutor&#44; and the procedures were carried out in accordance with the ethics guidelines of 2008 set forth in the Declaration of Helsinki&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Clinical and anthropometric measurements</span><p id="par0015" class="elsevierStylePara elsevierViewall">All children were submitted to the anthropometric assessment determining body weight&#44; in light clothing and without shoes&#44; using a body composition monitor &#40;Tanita BC-553&#44; Arlington&#44; USA&#41;&#46; The height was measured with a portable stadiometer &#40;Seca&#44; Hamburg&#44; Germany&#41;&#46; The body mass index &#40;BMI&#41; was calculated as weight &#40;kg&#41;&#47;height &#40;m<span class="elsevierStyleSup">2</span>&#41;&#46; The waist circumference was measured in duplicate passing by the navel and the edge of the iliac crest&#44; using an anthropometric tape with an accuracy of &#177;0&#46;1<span class="elsevierStyleHsp" style=""></span>cm &#40;Seca 201&#44; Hamburg&#44; Germany&#41;&#46; The classification of obesity was performed using the <span class="elsevierStyleItalic">Centres for Disease Control and Prevention</span><a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">17</span></a> growth charts from the year 2000&#44; determining normal weight in children with a BMI between the 5 and 85 percentiles&#44; and with obesity those with a BMI percentile<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>95&#46; Blood pressure was measured in the child&#39;s right arm in sitting position and at rest for at least 5<span class="elsevierStyleHsp" style=""></span>min&#44; using a sphygmomanometer &#40;Riester CE 0124&#44; Jungingen&#44; Germany&#41;&#46; Two consecutive readings were taken for each child&#44; with at least one minute between each reading and the average of the readings was registered and used in the subsequent analysis&#46; Altered systolic and diastolic blood pressure was determined by the presence of percentile<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>95 values&#44; in accordance with age and gender&#44; considering the <span class="elsevierStyleItalic">National High Blood Pressure Education Programme Working Group on High Blood Pressure in Children and Adolescents</span><a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">18</span></a> data&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Biochemical determinations and definitions</span><p id="par0020" class="elsevierStylePara elsevierViewall">Blood samples were collected by venous puncture after one night fasting&#46; Total cholesterol&#44; triglycerides&#44; cholesterol joined to <span class="elsevierStyleItalic">high density lipoproteins</span> &#40;HDL&#41;&#44; cholesterol joined to <span class="elsevierStyleItalic">low density lipoproteins</span> &#40;LDL&#41; and glucose values were determined from a serum sample using a semi-automatic equipment &#40;COBAS MIRA&#44; Roche Diagnostics&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In this study&#44; the definition of MS was performed considering 3 items of the criteria set forth for children and adolescents aged from 10 to 16 years by the <span class="elsevierStyleItalic">International Diabetes Federation</span> &#40;IDF&#41;&#58; glucose<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; triglycerides<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>150<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; HDL cholesterol<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; and 2 items of the criteria proposed by the WHO&#58; obesity&#44; defined by a BMI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>95 percentile&#44; and altered blood pressure<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>95 percentile&#46;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">19&#44;20</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0030" class="elsevierStylePara elsevierViewall">The statistical analysis was performed with the STATA v9&#46;2 <span class="elsevierStyleItalic">software</span>&#46; The descriptive statistic was generated for all the variables&#46; The nominal qualitative ones were expressed as proportions and the differences were calculated using the chi square test&#46; Continuous variables with normal distribution were expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#44; and those without normal distribution&#44; as median and 5 and 95 percentiles&#46; The differences among groups were determined through the Student&#39;s <span class="elsevierStyleItalic">t</span> test and the Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test&#44; respectively&#46; MS frequencies and its components were defined as percentages&#46; The <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 values were considered statistically significant&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">The current study included 225 children &#40;119 with normal weight and 106 with obesity&#41;&#59; the mean age in both groups was of 9 years and the proportion of boys and girls participating was similar&#46; Children with obesity&#44; in comparison with those of normal weight&#44; showed a significant increase of metabolic&#44; clinical and anthropometric measurements &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; In accordance with the criteria set forth in this study&#44; both groups showed altered metabolic parameters &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; In children with normal weight&#44; the main metabolic alterations were observed in the following measurements&#58; fasting glucose &#40;26&#46;9&#37;&#41;&#44; total cholesterol &#40;19&#46;3&#37;&#41; and HDL cholesterol &#40;11&#46;7&#37;&#41;&#46; On the other hand&#44; children with obesity showed alterations in the following measurements&#58; HDL cholesterol &#40;44&#46;3&#37;&#41;&#44; triglycerides &#40;40&#46;6&#37;&#41;&#44; fasting glucose &#40;40&#46;6&#37;&#41; and total cholesterol &#40;39&#46;6&#37;&#41;&#46; Blood pressure increase was presented only in the group of children with obesity &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The prevalence of MS in children with obesity was of 44&#46;3&#37; &#40;47 children&#41;&#44; and in the normal weight group&#44; of 0&#46;84&#37; &#40;one child&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; In this study&#44; the prevalence of MS by sex did not show significant differences &#40;22&#46;2&#37; in girls versus 20&#46;5&#37; in boys&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;75&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Taking into account the number of metabolic components present&#44; 62&#46;1&#37; of the children with normal weight was metabolically healthy&#44; 31&#46;9&#37; presented one altered metabolic component&#44; and 5&#46;04&#37;&#44; 2 components&#46; In the group of children with obesity&#44; 31&#46;1&#37; did not present any clinical&#8211;metabolic alteration&#44; 24&#46;5&#37; presented&#44; besides obesity&#44; one altered metabolic component&#44; 26&#46;4&#37; 2 metabolic components&#44; 15&#46;1&#37; 3 metabolic components&#44; and 2&#46;83&#37; 4 metabolic components&#46; None of the children showed alterations in the 5 assessed components &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">In this study&#44; the main combinations of clinical&#8211;metabolic components that define MS were determined in the child population subject to study&#46; In the obese children group&#44; obesity&#47;triglycerides&#47;HDL cholesterol was the main combination &#40;34&#46;0&#37;&#41;&#44; followed by obesity&#47;glucose&#47;triglycerides&#47;HDL cholesterol &#40;29&#46;8&#37;&#41; and obesity&#47;glucose&#47;HDL cholesterol &#40;14&#46;9&#37;&#41;&#46; In children with normal weight&#44; the combination that defined MS was the presence of glucose&#47;HDL cholesterol&#47;triglycerides &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion and conclusion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Previous studies have demonstrated that the increase of childhood obesity is related to a high cardiometabolic risk during childhood and adolescence&#44;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">21</span></a> and the development of heart disease 25 years later&#44;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">22</span></a> while in the adult population&#44; the presence of MS components independent of obesity is associated with the development of CVD&#46;<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">23&#44;24</span></a> Therefore&#44; the presence of MS components during childhood predisposes to the increase in morbidity and mortality due to CVD&#46; Although the metabolic components in the adult population have been established&#44; the pattern that defines MS in child population remains contradicting&#46; This study has observed the alteration of the clinical&#8211;metabolic parameters associated with obesity&#46; Similarly&#44; other studies have determined the association of childhood obesity with metabolic alterations&#44; which are strong determinants of the lipidic profile&#44; insulin values&#44; MS and DM2&#46;<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">25&#44;26</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">For the Mexican adult population&#44; high MS numbers have been reported&#58; 36&#46;8&#37; in accordance with the <span class="elsevierStyleItalic">National Cholesterol Education Programme Adult Treatment Panel III</span> &#40;ATP III&#41; criteria&#44; 41&#46;6&#37; in accordance with the <span class="elsevierStyleItalic">American Heart Association&#47;National Heart</span>&#44; <span class="elsevierStyleItalic">Lung and Blood Institute</span>&#44; and 49&#46;8&#37; considering the IDF&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">27</span></a> The high prevalence of MS found in this study &#40;44&#46;3&#37;&#41;&#44; in children with obesity&#44; may be indicating that if obese children do not reduce their weight&#44; they may remain with MS throughout adolescence and adulthood&#44; becoming a part of the aforementioned statistics&#46; For that reason&#44; it is important to perform interventions in their lifestyles in order to reduce their weight and improve their metabolic conditions&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Studies performed in large child and adolescent populations describe lower prevalences of MS than the one found in our population&#44; and they vary depending on the criteria employed in their definition&#46; In North America&#44; the <span class="elsevierStyleItalic">III National Health and Nutrition Examination Survey</span> described a prevalence of MS of 32&#46;1&#37; in adolescent population with obesity&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">28</span></a> Taking into account Cook et al&#46; criteria&#44; the prevalence of MS was of 27&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">19</span></a> in accordance with ATP III criteria&#44; it was of 26&#46;1&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">29</span></a> dramatically increasing in children with a higher grade of obesity&#44; reaching prevalences of up to 50&#37; in accordance with Weiss et al&#46; criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">14</span></a> On the other hand&#44; in Latin American obese children&#44; the prevalence described nears 36&#37;&#44;<a class="elsevierStyleCrossRefs" href="#bib0420"><span class="elsevierStyleSup">30&#44;31</span></a> in Korean children and adolescents&#44; it was of 37&#46;5&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">32</span></a> and in Chinese obese children&#44; it was of 33&#46;1&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">33</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Even though the prevalences are high in most of the countries&#44; the prevalences of MS described in other studies in Italian obese prepubescents&#44;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">34</span></a> Portuguese&#44;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">35</span></a> Asian<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">36</span></a> children and children from Qatar<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">37</span></a> are significantly lower&#46; Even though obesity is a stimulating factor for the occurrence of MS in child population&#44; children with normal weight also develop metabolic alterations&#46; In our population&#44; 0&#46;84&#37; of the children with normal weight showed MS&#44; a lower prevalence than the one referred to in normal-weight Korean adolescents &#40;1&#46;61&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">38</span></a> and in Chinese child population &#40;2&#46;3&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">33</span></a> This evidences that the variability of criteria and cut-off values employed in the definition of MS has an influence over the reported prevalences&#46; Racial ethnic origin&#44;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">39</span></a> genetic factors and dietary and lifestyle habits seem to be determining factors in its development&#46;<a class="elsevierStyleCrossRefs" href="#bib0470"><span class="elsevierStyleSup">40&#44;41</span></a> There is evidence that shows that the criteria set forth for the definition of MS in the US child population are not applicable to all populations&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">33</span></a> Other authors have considered&#44; for MS diagnosis&#44; the left ventricular mass index as a sensitive and specific parameter in paediatric and adolescent population&#44;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">42</span></a> as well as the determination of the pancreatic &#946; cells function&#44; since insulin sensitivity decreases in subjects in transition from tolerant to intolerant to glucose and from intolerant to DM2&#44;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">43</span></a> as well as the use of obesity cut-off values based on the <span class="elsevierStyleItalic">z</span>-<span class="elsevierStyleItalic">score</span>&#44; that could help provide comparable data at international level in children and adolescents&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">44</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">This study assessed MS individual characteristics&#58; elevated triglycerides&#44; low HDL cholesterol and altered fasting glucose were the most frequent metabolic abnormalities in the child population&#46; Likewise&#44; in another study performed in Mexican children&#44; dyslipidaemia was one of the characteristics frequently associated with MS&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">45</span></a> The high prevalence of low HDL cholesterol shown in this study is one of the alterations frequently described in medical literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">5&#44;26&#44;37&#44;38&#44;46&#8211;49</span></a> It has been determined that hypertriglyceridaemia has an important racial ethnic influence&#44; being higher in non-Hispanic and Hispanic whites&#44; in comparison with the African American population&#44; which is also reflected in the MS rate referred to in ethnic groups&#46;<a class="elsevierStyleCrossRefs" href="#bib0505"><span class="elsevierStyleSup">48&#44;50</span></a> The presence of metabolic alterations in both study groups is important since their persistence constitutes an independent factor predictor of diabetes and future CVD&#46;<a class="elsevierStyleCrossRefs" href="#bib0520"><span class="elsevierStyleSup">51&#8211;53</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">As far as we know&#44; this is the first study providing evidence of the heterogeneity in the development of MS in the Mexican child population&#44; showing the presence of varied patterns of components that define MS in obese and normal-weight children&#44; being the predominant combinations obesity&#47;triglycerides&#47;HDL cholesterol &#40;34&#46;0&#37;&#41;&#44; obesity&#47;glucose&#47;triglycerides&#47;HDL cholesterol &#40;29&#46;8&#37;&#41; and obesity&#47;triglycerides&#47;HDL cholesterol &#40;14&#46;9&#37;&#41;&#46; Moreover&#44; 38&#37; of the children with normal weight showed metabolic alterations&#44; being the most frequent one altered fasting glucose&#44; followed by low HDL cholesterol and an increase of triglycerides&#46; Some authors have determined the frequency of multiple MS components but they do not define specifically which components constitute it&#46; Liu et al&#46; demonstrated that Chinese grade schoolers with overweight and obesity have in average 1&#46;75&#8211;2&#46;08 MS components&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">33</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Getting to know the main MS component groups could help establish intervention strategies mainly based on the modification of lifestyles and the integration of multidisciplinary groups including patients and families&#44; and not on the use of pharmacological measures&#44;<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">54&#44;55</span></a> in such a way that the institutions responsible for issuing health policies at country level may be aware of the magnitude of the problem&#44; to direct actions towards the most susceptible groups and be able to assess whether prevention or control strategies are effective&#44; taking into account&#44; for assessment purposes&#44; the MS components most frequently present in the child population&#46; Besides the fact that early intervention will help reduce morbidity and mortality rates in young and adults&#46; In conclusion&#44; 44&#46;3&#37; of grade schoolers with obesity presented MS&#44; being dyslipidaemia the strongest determinant of this syndrome&#46; Even though the prevalence is low in children with normal weight&#44; one third of them present at least one of the syndrome components&#44; which recommends an immediate intervention to control or revert these alterations&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare that there are no conflicts of interest&#46;</p></span></span>"
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          "identificador" => "xres577877"
          "titulo" => "Abstract"
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            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Background and objective"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Patients and methods"
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          "identificador" => "xpalclavsec594566"
          "titulo" => "Keywords"
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          "titulo" => "Resumen"
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            0 => array:2 [
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              "titulo" => "Fundamento y objetivo"
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            1 => array:2 [
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              "titulo" => "Pacientes y m&#233;todos"
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              "titulo" => "Conclusi&#243;n"
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          "titulo" => "Palabras clave"
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          "titulo" => "Introduction"
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          "titulo" => "Subjects&#44; material and methods"
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            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Clinical and anthropometric measurements"
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              "titulo" => "Biochemical determinations and definitions"
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              "identificador" => "sec0025"
              "titulo" => "Statistical analysis"
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          "titulo" => "Results"
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          "titulo" => "Discussion and conclusion"
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          "titulo" => "References"
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    "fechaRecibido" => "2013-06-27"
    "fechaAceptado" => "2013-10-24"
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          "clase" => "keyword"
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          "identificador" => "xpalclavsec594566"
          "palabras" => array:4 [
            0 => "Metabolic syndrome"
            1 => "Prevalence"
            2 => "Obesity"
            3 => "Children"
          ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
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          "palabras" => array:4 [
            0 => "S&#237;ndrome metab&#243;lico"
            1 => "Prevalencia"
            2 => "Obesidad"
            3 => "Ni&#241;os"
          ]
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      ]
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Childhood obesity is considered the main risk factor for the development of metabolic syndrome &#40;MetS&#41; during childhood&#44; adolescence and adulthood&#46; This study aimed to determine the prevalence of MetS components and its main defining combinations in a sample of school children with and without obesity&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A total of 225 children aged 6&#8211;12 years&#44; 106 obese and 119 with normal weight were included&#46; MetS was defined by the presence of 3 or more of the following&#58; obesity as a body mass index<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>95th percentile&#44; fasting glucose<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; triglycerides<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>150<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; high density lipoproteins cholesterol &#40;HDL-c&#41;<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and systolic and diastolic blood pressure<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>95th percentile&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We found MetS components in both groups&#46; Most frequent abnormalities in the obese group included increased levels of HDL-c&#44; triglycerides&#44; fasting glucose and total cholesterol&#44; while increased levels of glucose and total cholesterol&#44; and lower HDL-c levels predominated in the normal weight group&#46; The prevalence of MetS in the obese group was 44&#46;3&#37; and&#44; in normal weight children&#44; it was 0&#46;84&#37;&#46; The 3 main components that defined the MetS in the obese group were obesity&#47;triglycerides&#47;HDL-c &#40;34&#46;0&#37;&#41;&#44; obesity&#47;glucose&#47;triglycerides&#47;HDL-c &#40;29&#46;8&#37;&#41; and obesity&#47;glucose&#47;HDL-c &#40;14&#46;9&#37;&#41;&#44; while the only combination observed in the normal weight group was glucose&#47;HDL-c&#47;triglycerides&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A percentage of 44&#46;3 of obese school children had MetS&#44; and dyslipidemia showed to be strong determinants of MetS&#46; Although the prevalence of MetS was low in children with normal weight&#44; one third of them showed one of the components of MetS&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background and objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Patients and methods"
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          2 => array:2 [
            "identificador" => "abst0015"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Fundamento y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La obesidad infantil es el principal factor de riesgo para el desarrollo de s&#237;ndrome metab&#243;lico &#40;SM&#41; durante la infancia&#44; adolescencia y vida adulta&#46; El objetivo de este estudio fue determinar la prevalencia de los componentes del SM&#44; y de las principales combinaciones que lo definen&#44; en una muestra de ni&#241;os escolares con y sin obesidad&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Un total de 225 ni&#241;os con edades entre 6 y 12 a&#241;os&#44; 106 con obesidad y 119 con peso normal&#44; fueron incluidos&#46; El SM fue definido por la presencia de 3 o m&#225;s de los siguientes componentes&#58; &#237;ndice de masa corporal<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>percentil 95&#44; glucosa en ayunos<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; triglic&#233;ridos<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>150<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; colesterol unido a <span class="elsevierStyleItalic">high density lipoproteins</span> &#40;HDL&#44; &#171;lipoprote&#237;nas de alta densidad&#187;&#41;<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; presi&#243;n arterial sist&#243;lica y diast&#243;lica<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>percentil 95&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En ambos grupos analizados se encontraron componentes del SM&#46; En el grupo con obesidad&#44; el colesterol HDL&#44; los triglic&#233;ridos&#44; la glucosa en ayunos y el colesterol total fueron las alteraciones m&#225;s frecuentes&#59; en los de peso normal predomin&#243; el incremento en los valores de glucosa&#44; colesterol total y disminuci&#243;n de colesterol HDL&#46; La prevalencia de SM en ni&#241;os con obesidad fue del 44&#44;3&#37;&#44; y en ni&#241;os de peso normal&#44; del 0&#44;84&#37;&#46; Las 3 principales combinaciones que definieron el SM en ni&#241;os obesos fueron&#58; obesidad&#47;triglic&#233;ridos&#47;colesterol HDL &#40;34&#44;0&#37;&#41;&#59; obesidad&#47;glucosa&#47;triglic&#233;ridos&#47;colesterol HDL &#40;29&#44;8&#37;&#41; y obesidad&#47;glucosa&#47;colesterol HDL &#40;14&#44;9&#37;&#41;&#59; en el grupo con peso normal&#58; glucosa&#47;colesterol HDL&#47;triglic&#233;ridos&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El 44&#44;3&#37; de los ni&#241;os escolares con obesidad presentaron SM&#59; las dislipidemias mostraron ser fuertes determinantes del SM&#46; Aunque en los ni&#241;os con normopeso la prevalencia es baja&#44; la tercera parte present&#243; al menos uno de los componentes del SM&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0025"
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            "titulo" => "Pacientes y m&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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            "titulo" => "Conclusi&#243;n"
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    "NotaPie" => array:1 [
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Please cite this article as&#58; Guzm&#225;n-Guzm&#225;n IP&#44; Salgado-Bernab&#233; AB&#44; Mu&#241;oz Valle JF&#44; Vences-Vel&#225;zquez A&#44; Parra-Rojas I&#46; Prevalencia de s&#237;ndrome metab&#243;lico en ni&#241;os con obesidad y sin ella&#46; Med Clin &#40;Barc&#41;&#46; 2015&#59;144&#58;198&#8211;203&#46;</p>"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">HDL cholesterol&#58; cholesterol joined to <span class="elsevierStyleItalic">high density lipoproteins</span>&#59; LDL cholesterol&#58; cholesterol joined to <span class="elsevierStyleItalic">low density lipoproteins</span>&#59; BMI&#58; body mass index&#59; BP&#58; blood pressure&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Data expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation or as median &#40;percentile 5&#8211;percentile 95&#41;&#46; The <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 values are considered statistically significant&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Normal weight &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>119&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;years&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;6&#8211;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;6&#8211;11&#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;70&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="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">Gender</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Boys&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57 &#40;47&#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">60 &#40;56&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Girls&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62 &#40;52&#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">46 &#40;43&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Weight &#40;kg&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#46;8 &#40;19&#46;2&#8211;39&#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">42&#46;55 &#40;27&#46;4&#8211;63&#46;9&#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="left" valign="top">130&#46;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">135&#46;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;35&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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">BMI &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;3 &#40;13&#46;9&#8211;19&#46;08&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#46;1 &#40;18&#46;8&#8211;29&#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></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Waist circumference &#40;cm&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62 &#40;52&#8211;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79 &#40;64&#46;5&#8211;94&#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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Systolic BP &#40;mmHg&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90 &#40;80&#8211;108&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">101 &#40;90&#8211;123&#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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Diastolic BP &#40;mmHg&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54 &#40;45&#8211;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60 &#40;50&#8211;77&#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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Fasting serum glucose &#40;mg&#47;dl&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95 &#40;72&#8211;112&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">98 &#40;83&#8211;112&#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></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Total cholesterol &#40;mg&#47;dl&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">171&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">187&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>29&#46;8&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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Triglycerides &#40;mg&#47;dl&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68 &#40;25&#8211;150&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">138 &#40;57&#8211;204&#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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">HDL cholesterol &#40;mg&#47;dl&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64 &#40;34&#8211;101&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&#46;5 &#40;23&#8211;83&#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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">LDL cholesterol &#40;mg&#47;dl&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&#46;3 &#40;53&#46;4&#8211;158&#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">102&#46;2 &#40;63&#46;5&#8211;180&#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">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">HDL cholesterol&#58; cholesterol joined to high density lipoproteins&#59; BP&#58; blood pressure&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 values were considered statistically significant&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="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">Total&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>225&#41;&#44; n &#40;&#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">Normal weight&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>119&#41;&#44; n &#40;&#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">Obesity&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>106&#41;&#44; n &#40;&#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"><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" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Glucose &#40;mg&#47;dl&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">150 &#40;66&#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">87 &#40;73&#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">63 &#40;59&#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">0&#46;03<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;33&#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">32 &#40;26&#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">43 &#40;40&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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">Triglycerides &#40;mg&#47;dl&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">176 &#40;78&#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">113 &#40;95&#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">63 &#40;59&#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<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49 &#40;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">6 &#40;5&#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">43 &#40;40&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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">Total cholesterol &#40;mg&#47;dl&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">160 &#40;71&#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">96 &#40;80&#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">64 &#40;60&#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">0&#46;001<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65 &#40;28&#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">23 &#40;19&#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">42 &#40;39&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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">HDL cholesterol &#40;mg&#47;dl&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">164 &#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="char" valign="top">105 &#40;88&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59 &#40;55&#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<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61 &#40;27&#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">14 &#40;11&#46;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;44&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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">Systolic BP &#40;mmHg&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;95 Percentile &#40;&#60;117<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">219 &#40;97&#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">119 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100 &#40;94&#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;010<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;95 Percentile &#40;&#8805;117<span class="elsevierStyleHsp" style=""></span>mmHg&#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;2&#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">0 &#40;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">6 &#40;5&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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">Diastolic BP &#40;mmHg&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;95 Percentile &#40;&#60;80<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">222 &#40;98&#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">119 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">103 &#40;97&#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;10<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;95 Percentile &#40;&#8805;80<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;1&#46;33&#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 &#40;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">3 &#40;2&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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">Metabolic syndrome</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">177 &#40;78&#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">118 &#40;99&#46;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">59 &#40;55&#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<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48 &#40;21&#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">1 &#40;0&#46;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;44&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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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="left" valign="top" scope="col">Number of MS components&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Prevalence</th></tr><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">Total&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>225&#41;&#44; n &#40;&#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">Normal weight&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>119&#41;&#44; n &#40;&#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">Obesity&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>106&#41;&#44; n &#40;&#37;&#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  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">107 &#40;47&#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">74 &#40;62&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33 &#40;31&#46;13&#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  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64 &#40;28&#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">38 &#40;31&#46;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;24&#46;52&#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  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;15&#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">6 &#40;5&#46;04&#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 &#40;26&#46;41&#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  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;7&#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">1 &#40;0&#46;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;15&#46;09&#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  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#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">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;2&#46;83&#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  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">HDL cholesterol&#58; cholesterol joined to <span class="elsevierStyleItalic">high density lipoproteins</span>&#59; DBP&#58; diastolic blood pressure&#59; SBP&#58; systolic blood pressure&#59; MS&#58; metabolic syndrome&#46;</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">The data shown represent the proportions of the different combinations of components that constitute the metabolic syndrome in children with normal weight and obesity&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Component 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">Normal weight&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>119&#41;&#44; n &#40;&#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">Obesity&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>106&#41;&#44; n &#40;&#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">MS in the obesity group&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>47&#41;&#44; n &#40;&#37;&#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  " align="left" valign="top">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74 &#40;62&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33 &#40;31&#46;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Glucose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;24&#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">14 &#40;13&#46;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">HDL cholesterol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;6&#46;72&#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;5&#46;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Triglycerides&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#46;84&#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;4&#46;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">SBP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;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">1 &#40;0&#46;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">HDL cholesterol<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>triglycerides&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;2&#46;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;15&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;34&#46;04&#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  " align="left" valign="top">Glucose<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>HDL cholesterol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;1&#46;68&#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 &#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="char" valign="top">7 &#40;14&#46;9&#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  " align="left" valign="top">Glucose<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>triglycerides&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#46;84&#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 &#40;3&#46;77&#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 &#40;8&#46;51&#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  " align="left" valign="top">Glucose<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>SBP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;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">1 &#40;0&#46;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#46;13&#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  " align="left" valign="top">Glucose<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>HDL cholesterol<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>triglycerides&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#46;84&#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;13&#46;21&#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;29&#46;8&#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  " align="left" valign="top">Glucose<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>HDL cholesterol<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>SBP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;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">1 &#40;0&#46;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#46;13&#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  " align="left" valign="top">Glucose<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>SBP<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DBP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;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">1 &#40;0&#46;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#46;13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">HDL cholesterol<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>triglycerides<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>SBP<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DBP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;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">1 &#40;0&#46;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#46;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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