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Prevalencia de hipovitaminosis D y factores asociados en la edad infantojuvenil
Prevalence of hypovitaminosis D and associated factors in Spanish population of school children and adolescents
Teodoro Durá-Travéa,b,c,
Autor para correspondencia
tduratra@cfnavarra.es

Autor para correspondencia.
, Fidel Gallinas-Victorianob, María Jesús Chueca-Guindulainb,c, Sara Berrade-Zubirib,c, Paula Moreno-Gónzalezb, María Malumbres-Chacónb
a Departamento de Pediatría, Facultad de Medicina, Universidad de Navarra, Pamplona, España
b Unidad de Endocrinología Pediátrica, Complejo Hospitalario de Navarra, Pamplona, España
c Instituto de Investigación Sanitaria de Navarra (IdisNA), Pamplona, España
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Adem&#225;s de su conocido papel biol&#243;gico en el metabolismo &#243;seo&#44; la vitamina<span class="elsevierStyleHsp" style=""></span>D parece cumplir un amplio espectro de funciones biol&#243;gicas relacionadas con la proliferaci&#243;n&#44; diferenciaci&#243;n y metabolismo celulares&#44; lo que justificar&#237;a el inter&#233;s de la monitorizaci&#243;n de su contenido org&#225;nico&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Los niveles s&#233;ricos de 25-OH<span class="elsevierStyleHsp" style=""></span>Vit<span class="elsevierStyleHsp" style=""></span>D &#40;calcidiol&#41;&#44; dada su prolongada vida media &#40;2-3<span class="elsevierStyleHsp" style=""></span>semanas&#41;&#44; est&#225;n considerados como el mejor indicador de las reservas org&#225;nicas de vitamina<span class="elsevierStyleHsp" style=""></span>D<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">2&#44;5-7</span></a>&#46; Se han descrito distintos factores que podr&#237;an estar asociados a la hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D en sujetos sanos&#44; tales como el sexo&#44; la edad&#44; la raza&#44; las horas de exposici&#243;n solar y&#47;o el uso de filtros solares&#44; las caracter&#237;sticas geogr&#225;ficas &#40;latitud&#44; estaci&#243;n del a&#241;o&#44; clima&#41;&#44; el lugar de residencia habitual&#44; la situaci&#243;n nutricional&#44; etc&#46;&#44; aunque existen controversias entre los distintos autores<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">8-15</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El objetivo del presente trabajo es estudiar la prevalencia de hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D entre escolares y adolescentes residentes de una regi&#243;n del norte de Espa&#241;a &#40;Navarra&#41;&#44; as&#237; como analizar diferentes factores presuntamente asociados a la hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Material y m&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Se trata de un estudio descriptivo transversal realizado en una muestra de conveniencia de 602 sujetos con edades comprendidas entre 3&#44;1 y 15&#44;4<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; Entre enero y diciembre del a&#241;o 2014 se les realiz&#243; una valoraci&#243;n cl&#237;nica y una extracci&#243;n sangu&#237;nea para estudio anal&#237;tico en la Unidad de Endocrinolog&#237;a Pedi&#225;trica del Complejo Hospitalario de Navarra&#46; De cada uno de ellos se registraron las siguientes variables&#58; sexo&#44; edad&#44; peso y talla&#44; lugar de residencia habitual y estaci&#243;n del a&#241;o en que se realiz&#243; el estudio&#46; Los participantes fueron divididos en dos grupos etarios&#58; grupo escolar &#40;estadio<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">i</span> de Tanner&#41; y grupo adolescente &#40;estadios<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">ii</span>-<span class="elsevierStyleSmallCaps">iv</span> de Tanner&#41;&#46; El lugar de residencia habitual fue clasificado como urbano o rural si la localidad de procedencia ten&#237;a m&#225;s o menos de 10&#46;000 habitantes&#44; respectivamente&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se trataba de sujetos sanos y de raza cauc&#225;sica e hijos de padres cauc&#225;sicos de origen espa&#241;ol&#44; residentes en la Comunidad de Navarra&#46; Los participantes incluidos en el estudio proced&#237;an de las consultas externas de las distintas subespecialidades pedi&#225;tricas del hospital&#44; y no se les hab&#237;an apreciado patolog&#237;as cr&#243;nicas que pudieran condicionar el crecimiento&#44; la composici&#243;n corporal&#44; la ingesta de alimentos o la actividad f&#237;sica&#46; Los criterios de exclusi&#243;n fueron&#58; recibir tratamiento con anticonvulsivantes o corticoides y tomar suplementos de vitamina<span class="elsevierStyleHsp" style=""></span>D o calcio&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Valoraci&#243;n cl&#237;nica</span><p id="par0030" class="elsevierStylePara elsevierViewall">Las valoraciones de peso y talla fueron realizadas en ropa interior y descalzos&#46; El peso se midi&#243; con una b&#225;scula A&#241;o-Sayol con un intervalo de lectura de 0 a 120<span class="elsevierStyleHsp" style=""></span>kg y una precisi&#243;n de 100<span class="elsevierStyleHsp" style=""></span>g&#44; y la talla con un estadi&#243;metro de pared Holtain de 60 a 210<span class="elsevierStyleHsp" style=""></span>cm&#44; con un intervalo de precisi&#243;n de 0&#44;1<span class="elsevierStyleHsp" style=""></span>cm&#46; Se ha calculado el &#237;ndice de masa corporal &#40;IMC&#41; con la f&#243;rmula&#58; peso &#40;en kilogramos&#41;&#47;talla<span class="elsevierStyleSup">2</span> &#40;en metros&#41;&#46; Los valores de los Z-score de los IMC se calcularon con el programa Aplicaci&#243;n Nutricional de la Sociedad Espa&#241;ola de Gastroenterolog&#237;a&#44; Hepatolog&#237;a y Nutrici&#243;n Pedi&#225;trica &#40;disponible en <a id="intr0005" class="elsevierStyleInterRef" href="http://www.gastroinf.es/nutritional/">http&#58;&#47;&#47;www&#46;gastroinf&#46;es&#47;nutritional&#47;</a>&#41;&#44; tom&#225;ndose como referencia las tablas de crecimiento de Ferr&#225;ndez et al&#46; &#40;Centro Andrea Prader&#44; Zaragoza&#44; 2002&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Seg&#250;n el valor del IMC &#40;Z-score&#41; se establecieron las siguientes situaciones nutricionales&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">Normalidad&#58; si el valor de IMC &#40;Z-score&#41; oscilaba entre &#8722;1&#44;0 &#40;percentil 15&#41; y &#43;1&#44;0 &#40;percentil 85&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Sobrepeso&#58; si era superior a &#43;1&#44;0 &#40;percentil 85&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">Obesidad&#58; si era superior a &#43;2&#44;0 &#40;percentil 97&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Obesidad severa&#58; si era superior a &#43;3&#44;0 &#40;percentil 99&#41;&#46;</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Estudio anal&#237;tico</span><p id="par0060" class="elsevierStylePara elsevierViewall">Se determinaron en ayunas las concentraciones plasm&#225;ticas de calcio y f&#243;sforo mediante metodolog&#237;as estandarizadas&#46; El calcidiol y la hormona paratiroidea &#40;PTH&#41; se determinaron por quimioluminiscencia&#46; Para definir el status de vitamina<span class="elsevierStyleHsp" style=""></span>D se han aplicado los criterios de la <span class="elsevierStyleItalic">US Endocrine Society</span><a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">9&#44;16</span></a>&#58; deficiencia de vitamina<span class="elsevierStyleHsp" style=""></span>D cuando los niveles eran inferiores a 20<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#59; insuficiencia de vitamina<span class="elsevierStyleHsp" style=""></span>D cuando los niveles oscilaban entre 20 y 29<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#44; y suficiencia de vitamina<span class="elsevierStyleHsp" style=""></span>D cuando los niveles alcanzaban o superaban los 30<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#46; Se defini&#243; como hiperparatiroidismo secundario cuando los niveles s&#233;ricos de PTH superaban los 65<span class="elsevierStyleHsp" style=""></span>pg&#47;ml<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">13&#44;17</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">An&#225;lisis estad&#237;stico</span><p id="par0065" class="elsevierStylePara elsevierViewall">Los resultados se expresan como porcentajes &#40;&#37;&#41; y medias &#40;M&#41; con sus desviaciones est&#225;ndar &#40;DE&#41;&#46; El an&#225;lisis estad&#237;stico &#40;estad&#237;stica descriptiva&#44; t de Student&#44; ANOVA&#44; chi al cuadrado y regresi&#243;n log&#237;stica m&#250;ltiple&#41; fue realizado mediante el programa inform&#225;tico Statistical Packages for the Social Sciences versi&#243;n 20&#46;0 &#40;Chicago&#44; Illinois&#44; EE&#46;<span class="elsevierStyleHsp" style=""></span>UU&#46;&#41;&#46; La significaci&#243;n estad&#237;stica fue asumida cuando el valor de p era inferior a 0&#44;05&#46;<elsevierMultimedia ident="fig0005"></elsevierMultimedia></p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Resultados</span><p id="par0070" class="elsevierStylePara elsevierViewall">De la totalidad de extracciones realizadas&#44; los valores medios plasm&#225;ticos de calcidiol y PTH eran de 27&#44;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;74<span class="elsevierStyleHsp" style=""></span>ng&#47;ml y 33&#44;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;39<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#44; respectivamente&#46; En ning&#250;n caso se observaron valores de hipo&#47;hipercalcemia o hipo&#47;hiperfosforemia&#44; siendo los valores medios de calcio y f&#243;sforo de 9&#44;99<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;59<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;intervalo&#58; 8&#44;9-10&#44;6&#41; y 4&#44;60<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;59<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;intervalo&#58; 3&#44;5-5&#44;9&#41;&#44; respectivamente&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se expone la distribuci&#243;n de los posibles factores asociados a hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D analizados &#40;sexo&#44; grupo de edad&#44; tipo de residencia&#44; estaci&#243;n del a&#241;o en que realiz&#243; el estudio y situaci&#243;n nutricional&#41; correspondientes a la totalidad de la muestra&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se exponen y comparan los valores medios de las caracter&#237;sticas cl&#237;nicas y determinaciones bioqu&#237;micas en relaci&#243;n con los factores asociados a la hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D analizados&#46; En las mujeres los valores medios de PTH eran significativamente superiores&#44; mientras que en los varones lo eran los valores medios de f&#243;sforo&#46; No exist&#237;an diferencias significativas en la edad&#44; IMC &#40;Z-score&#41;&#44; calcio y calcidiol entre ambos sexos&#46; En los adolescentes los valores medios del IMC &#40;Z-score&#41; y PTH eran significativamente superiores&#44; mientras que en los escolares lo eran los valores medios de f&#243;sforo y calcidiol&#46; No se detectaron diferencias significativas en los valores medios de calcio entre ambos grupos de edad&#46; En el entorno rural los valores medios de calcio y calcidiol eran significativamente superiores&#44; mientras que en el entorno urbano eran superiores los valores medios de PTH&#46; No exist&#237;an diferencias significativas respecto a la edad&#44; IMC &#40;Z-score&#41; y f&#243;sforo entre ambos entornos residenciales&#46; Los valores medios de calcidiol m&#225;s bajos correspond&#237;an a la primavera &#40;26&#44;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;25<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#41; y alcanzaban su m&#225;ximo nivel en el verano &#40;34&#44;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;05<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#41;&#44; mientras que los valores medios de PTH m&#225;s bajos correspond&#237;an al verano &#40;26&#44;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;06<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#41; y alcanzaban su m&#225;ximo nivel en oto&#241;o &#40;37&#44;88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;21<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#41;&#46; No exist&#237;an diferencias significativas en los valores medios de la edad&#44; IMC &#40;Z-score&#41;&#44; calcio y f&#243;sforo entre las estaciones del a&#241;o&#46; En el grupo con obesidad severa los valores medios de calcidiol y PTH eran significativamente inferiores y superiores&#44; respectivamente&#44; respecto a las otras situaciones nutricionales &#40;normal&#44; sobrepeso y obesidad&#41;&#46; No exist&#237;an diferencias significativas en los valores medios del calcio y f&#243;sforo entre las diferentes situaciones nutricionales&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">De la totalidad de extracciones realizadas&#44; en 236 casos &#40;39&#44;6&#37;&#41; los niveles de calcidiol superaban los 30<span class="elsevierStyleHsp" style=""></span>ng&#47;ml &#40;suficiencia de vitamina<span class="elsevierStyleHsp" style=""></span>D&#41;&#44; en 266 &#40;44&#44;6&#37;&#41; oscilaban entre 20 y 29<span class="elsevierStyleHsp" style=""></span>ng&#47;ml &#40;insuficiencia de vitamina<span class="elsevierStyleHsp" style=""></span>D&#41; y en 94 &#40;15&#44;8&#37;&#41; eran inferiores a 20<span class="elsevierStyleHsp" style=""></span>ng&#47;ml &#40;deficiencia de vitamina<span class="elsevierStyleHsp" style=""></span>D&#41;&#46; En el 5&#44;7&#37; del total&#44; los niveles de PTH estaban en rango de hiperparatiroidismo&#46; Este valor porcentual era del 2&#44;3&#37; entre los sujetos con suficiencia de vitamina<span class="elsevierStyleHsp" style=""></span>D&#44; increment&#225;ndose significativamente &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41; en las situaciones de insuficiencia &#40;6&#44;6&#37;&#41; y deficiencia de vitamina<span class="elsevierStyleHsp" style=""></span>D &#40;11&#44;6&#37;&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> se exponen y comparan la prevalencia de los distintos status del calcidiol en relaci&#243;n con los factores asociados a la hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D analizados&#46; No exist&#237;an diferencias significativas de la prevalencia de los distintos status de calcidiol en relaci&#243;n con el sexo&#46; Sin embargo&#44; en el grupo de adolescentes y en el entorno urbano la prevalencia de deficiencia de vitamina<span class="elsevierStyleHsp" style=""></span>D era significativamente superior respecto a los escolares y el entorno rural&#44; respectivamente&#46; En invierno&#44; primavera y oto&#241;o la prevalencia de deficiencia de vitamina<span class="elsevierStyleHsp" style=""></span>D era significativamente superior respecto al verano&#46; Asimismo&#44; los sujetos con una situaci&#243;n nutricional de obesidad severa presentaban una prevalencia de deficiencia de vitamina<span class="elsevierStyleHsp" style=""></span>D significativamente superior respeto al resto de situaciones nutricionales&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> se exponen los resultados del an&#225;lisis de regresi&#243;n log&#237;stica de los factores asociados con la hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D &#40;deficiencia e insuficiencia&#41;&#46; Se observa que el sexo femenino&#44; la adolescencia&#44; las estaciones de primavera&#44; oto&#241;o e invierno&#44; el entorno urbano y la obesidad severa se asociaban significativamente con la deficiencia y&#47;o insuficiencia de vitamina<span class="elsevierStyleHsp" style=""></span>D &#40;a excepci&#243;n del sexo femenino y la primavera&#44; que tan solo se asociaba con la insuficiencia de vitamina<span class="elsevierStyleHsp" style=""></span>D&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discusi&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">Seg&#250;n los criterios aplicados para definir la normalidad del status de vitamina<span class="elsevierStyleHsp" style=""></span>D&#44; en el 39&#44;6&#37; de las determinaciones bioqu&#237;micas realizadas el contenido org&#225;nico de vitamina<span class="elsevierStyleHsp" style=""></span>D podr&#237;a considerarse como suficiente&#44; mientras que en el 44&#44;6 y el 15&#44;8&#37; restantes presentar&#237;an una insuficiencia o deficiencia de vitamina<span class="elsevierStyleHsp" style=""></span>D&#44; respectivamente&#46; Es decir&#44; el 60&#44;4&#37; de la poblaci&#243;n analizada presentar&#237;a un contenido org&#225;nico de vitamina<span class="elsevierStyleHsp" style=""></span>D por debajo de lo deseable y&#44; por tanto&#44; con riesgo para la salud&#46; Estos resultados&#44; aun pudiendo considerarse como cifras de hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D relativamente elevadas para una poblaci&#243;n considerada sana&#44; son relativamente moderados respecto a otros estudios publicados<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">10&#44;12&#44;13&#44;17-21</span></a>&#44; probablemente debido a que en este estudio sus participantes eran exclusivamente de origen cauc&#225;sico&#44; ya que es bien conocido que el mayor grado de pigmentaci&#243;n cut&#225;nea de distintas etnias supone un mayor riesgo de hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">12&#44;13&#44;17</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Los valores de calcidiol &#8212;aunque no significativos&#8212; eran superiores en los varones&#44; mientras que los de PTH eran significativamente superiores en las mujeres&#44; pero no exist&#237;an diferencias significativas en la prevalencia de hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D entre ambos sexos&#44; siendo los datos publicados al respecto contradictorios<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">11&#44;19&#44;22&#44;23</span></a>&#46; No obstante&#44; en el an&#225;lisis de regresi&#243;n log&#237;stica se constataba que la hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D&#44; y m&#225;s concretamente en grado de insuficiencia&#44; se asociaba significativamente con el sexo femenino&#46; En los adolescentes &#40;grupo puberal&#41; los valores de calcidiol eran significativamente inferiores a los de los escolares&#44; pero tanto los de PTH como la prevalencia de deficiencia de vitamina<span class="elsevierStyleHsp" style=""></span>D eran significativamente superiores en este grupo etario&#44; lo que coincide con los resultados aportados por otros autores<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">13&#44;24</span></a>&#46; Adem&#225;s&#44; en el an&#225;lisis de regresi&#243;n log&#237;stica se corroboraba que la hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D&#44; tanto en grado de insuficiencia como de deficiencia&#44; se asociaba significativamente con el grupo de mayor edad&#46; Este hallazgo podr&#237;a resultar cuanto menos inquietante dado que la adolescencia es un periodo clave para el crecimiento&#44; desarrollo y formaci&#243;n &#243;sea&#44; donde los requerimientos de vitamina<span class="elsevierStyleHsp" style=""></span>D se incrementan y una deficiencia en este periodo de la vida podr&#237;a afectar a la adquisici&#243;n de una masa &#243;sea normal&#46; Los residentes en un entorno urbano presentaban valores de calcidiol significativamente inferiores a los que resid&#237;an en un entorno rural&#44; mientras que tanto los de PTH como la prevalencia de deficiencia de vitamina<span class="elsevierStyleHsp" style=""></span>D eran significativamente superiores en el entorno urbano&#46; Estos hallazgos podr&#237;an estar relacionados con los distintos estilos de vida inherentes a cada entorno residencial&#44; ya que presumiblemente en un entorno rural sus residentes gozar&#237;an de un mayor tiempo de exposici&#243;n solar&#44; tal y como ha sido se&#241;alado por distintos autores<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">13&#44;14</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">En este trabajo se advierte que&#44; simult&#225;neamente a las variaciones estacionales del calcidiol&#44; tienen lugar unas variaciones de PTH relativamente as&#237;ncronas&#44; lo que probablemente permitir&#237;a mantener los niveles de calcio constantes a lo largo de todo el a&#241;o&#46; Los m&#225;ximos niveles de calcidiol se correspond&#237;an con los meses de mayor insolaci&#243;n &#40;verano&#41; y eran significativamente menores en el resto de estaciones del a&#241;o&#59; en cambio&#44; los niveles de PTH eran m&#237;nimos en los meses estivales y se incrementaban significativamente durante el resto del a&#241;o&#46; Esta estacionalidad ha sido apreciada en los cinco continentes<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">10&#44;13&#44;17&#44;19&#44;25-27</span></a>&#46; Dadas las caracter&#237;sticas geogr&#225;ficas y&#47;o clim&#225;ticas de Navarra &#40;alta latitud geogr&#225;fica y elevada frecuencia de precipitaciones y&#47;o nubosidad&#41;&#44; resultar&#237;a f&#225;cilmente comprensible la alta prevalencia de hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D durante los meses m&#225;s fr&#237;os del a&#241;o&#44; en contraste con una m&#237;nima prevalencia de hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D durante la &#233;poca estival&#46; El an&#225;lisis de regresi&#243;n log&#237;stica mostraba una asociaci&#243;n entre la hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D y las estaciones de primavera&#44; oto&#241;o e invierno para la insuficiencia&#44; y con el oto&#241;o e invierno para la deficiencia&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">A medida que se incrementaba el IMC &#40;Z-score&#41; los valores de calcidiol disminu&#237;an y los de PTH aumentaban significativamente&#44; de tal manera que los sujetos con obesidad severa presentaban unos valores m&#237;nimos de calcidiol y m&#225;ximos de PTH respecto al resto de situaciones nutricionales&#46; Es decir&#44; parece existir una clara tendencia a presentar una deficiencia de vitamina<span class="elsevierStyleHsp" style=""></span>D en la condici&#243;n de obesidad severa<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">11&#44;15&#44;24&#44;28</span></a>&#44; habiendo sido se&#241;alada esta eventualidad como un factor de riesgo metab&#243;lico y&#47;o cardiovascular <a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">2&#44;9&#44;11&#44;14&#44;29&#44;30</span></a>&#46; Aunque no existe una explicaci&#243;n concluyente al respecto&#44; se ha sugerido que en los sujetos obesos esta circunstancia podr&#237;a deberse a factores ambientales &#40;menor exposici&#243;n solar como consecuencia de un estilo de vida sedentario&#44; dietas inadecuadas&#44; etc&#46;&#41;&#44; pero actualmente se postula un hipot&#233;tico &#171;secuestro&#187; o excesivo almacenamiento de la vitamina<span class="elsevierStyleHsp" style=""></span>D en el tejido adiposo<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">2&#44;5-8&#44;10&#44;12&#44;30</span></a>&#46; Los autores no suelen distinguir entre obesidad y obesidad severa&#44; tal y como se ha realizado este trabajo&#44; y este detalle podr&#237;a ser de inter&#233;s pr&#225;ctico&#44; dado que en el an&#225;lisis de regresi&#243;n log&#237;stica se constataba que la hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D&#44; tanto en grado de insuficiencia como de deficiencia&#44; se asociaba significativamente con la situaci&#243;n nutricional de obesidad severa&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Este estudio tiene una serie de limitaciones dado su car&#225;cter transversal&#59; adem&#225;s&#44; no se han recogido datos relacionados con las horas de exposici&#243;n solar y&#47;o el uso de filtros solares&#46; Tampoco se ha realizado una encuesta nutricional que permitiera conocer la ingesta diet&#233;tica de calcio y de vitamina<span class="elsevierStyleHsp" style=""></span>D&#44; pero la experiencia indica que en nuestro medio el consumo de l&#225;cteos est&#225; por debajo de las raciones recomendadas y el de pescado es pr&#225;cticamente testimonial<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">31</span></a>&#44; y tan solo el aporte de suplementos diet&#233;ticos de vitamina<span class="elsevierStyleHsp" style=""></span>D podr&#237;a condicionar los resultados obtenidos&#44; pero tampoco representa una pr&#225;ctica habitual en nuestro medio&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">De los resultados obtenidos se podr&#237;a considerar que en nuestro medio existe una alta prevalencia de hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D en la poblaci&#243;n infantojuvenil&#44; lo que representa potencialmente un grave problema de salud p&#250;blica&#44; pudi&#233;ndose considerar al sexo femenino&#44; la etapa puberal&#44; las estaciones de oto&#241;o&#44; invierno y primavera&#44; la residencia habitual en un entorno urbano y la obesidad severa como factores asociados a la hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D&#46; Por tanto&#44; teniendo presente la dificultad para mantener un contenido org&#225;nico suficiente de vitamina<span class="elsevierStyleHsp" style=""></span>D&#44; deber&#237;an estar espec&#237;ficamente contemplados en los Programas de Atenci&#243;n a la Poblaci&#243;n Infantil y Adolescente que se desarrollan en el &#225;mbito de la atenci&#243;n primaria su prevenci&#243;n&#44; detecci&#243;n y&#44; en su caso&#44; tratamiento y control evolutivo&#46; Es decir&#44; los equipos de atenci&#243;n primaria&#44; y m&#225;s concretamente los pediatras&#44; deber&#237;an incluir en su cartera de servicios una serie de medidas preventivas &#8212;aparte de la profilaxis reglada de 400<span class="elsevierStyleHsp" style=""></span>UI diarias durante el primer a&#241;o de vida<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">32&#44;33</span></a>&#8212;&#44; tales como fomentar una adecuada exposici&#243;n solar&#46; La exposici&#243;n al sol de mediod&#237;a &#40;entre las 10 de la ma&#241;ana y las 3 de la tarde&#41; entre 10 y 15<span class="elsevierStyleHsp" style=""></span>min en al menos un 20&#37; de la superficie corporal &#40;cabeza y extremidades descubiertas&#41; durante los meses de primavera&#44; verano y oto&#241;o se considera suficiente para conseguir una adecuada s&#237;ntesis de vitamina<span class="elsevierStyleHsp" style=""></span>D<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">7</span></a>&#46; Asimismo&#44; si existieran alguno de los factores asociados a la hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D&#44; especialmente en pacientes con riesgo de escasa exposici&#243;n solar &#40;discapacitados y&#47;o sometidos a ingresos hospitalarios prolongados&#44; etc&#46;&#41;&#44; habr&#237;a que considerar la necesidad de administrar suplementos farmacol&#243;gicos de vitamina<span class="elsevierStyleHsp" style=""></span>D &#40;600<span class="elsevierStyleHsp" style=""></span>UI&#47;d&#237;a&#41; y&#47;o ingerir mayores cantidades de sus fuentes diet&#233;ticas naturales &#40;arenque&#44; salm&#243;n&#44; sardinas&#44; at&#250;n&#44; etc&#46;&#41;&#44; o bien habituarse a ingerir alimentos enriquecidos en vitamina<span class="elsevierStyleHsp" style=""></span>D &#40;l&#225;cteos&#44; cereales&#44; margarina&#44; etc&#46;&#41; desde el oto&#241;o hasta la primavera&#44; tal y como han sugerido distintas sociedades cient&#237;ficas<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">2&#44;3&#44;6&#44;9&#44;12&#44;17&#44;19&#44;20&#44;26</span></a>&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Financiaci&#243;n</span><p id="par0165" class="elsevierStylePara elsevierViewall">Los autores declaran que para la realizaci&#243;n de este trabajo no se ha obtenido ning&#250;n tipo de financiaci&#243;n&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflicto de intereses</span><p id="par0170" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizar la prevalencia de hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D y factores asociados en escolares y adolescentes residentes en una regi&#243;n del norte peninsular&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Dise&#241;o</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo transversal &#40;muestreo de conveniencia&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Emplazamiento</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Atenci&#243;n primaria&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Participantes</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Fueron incluidos 602 sujetos sanos de raza cauc&#225;sica con edades comprendidas entre 3&#44;1 y 15&#44;4<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Mediciones principales</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Se ha calculado la prevalencia de hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D &#40;variable dependiente&#41; seg&#250;n los criterios de la <span class="elsevierStyleItalic">US Endocrine Society</span>&#58; deficiencia &#40;calcidiol &#60;<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#41;&#44; insuficiencia &#40;calcidiol&#58; 20-29<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#41; y suficiencia &#40;calcidiol &#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#41;&#46; Se han registrado como variables independientes&#58; sexo&#44; edad&#44; &#237;ndice de masa corporal&#44; lugar de residencia y estaci&#243;n del a&#241;o&#44; analiz&#225;ndose su asociaci&#243;n con la hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D mediante regresi&#243;n log&#237;stica m&#250;ltiple&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Resultados</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D era del 60&#44;4&#37; &#40;insuficiencia&#58; 44&#44;6&#37;&#59; deficiencia&#58; 15&#44;8&#37;&#41;&#46; Las variables asociadas con la hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D eran el sexo femenino &#40;OR&#58; 1&#44;6&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;1-2&#44;3&#41;&#44; la edad puberal &#40;OR&#58; 1&#44;8&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;2-2&#44;6&#41;&#44; las estaciones de oto&#241;o &#40;OR&#58; 9&#44;5&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 4&#44;8-18&#44;7&#41;&#44; invierno &#40;OR&#58; 8&#44;8&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 4&#44;5-17&#44;5&#41; y primavera &#40;OR&#58; 13&#44;2&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 6&#44;4-27&#44;5&#41;&#44; el entorno urbano &#40;OR&#58;1&#44;6&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;1-2&#44;2&#41; y la obesidad severa &#40;OR&#58; 4&#44;4&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;9-10&#44;3&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusiones</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En la poblaci&#243;n infantojuvenil existe una alta prevalencia de hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D&#44; y los factores asociados son el sexo femenino&#44; la edad puberal&#44; el oto&#241;o&#44; el invierno y la primavera&#44; la obesidad severa y el entorno urbano&#46; Habr&#237;a que considerar la necesidad de administrar suplementos vitam&#237;nicos o ingerir mayores cantidades de sus fuentes diet&#233;ticas naturales y&#47;o alimentos enriquecidos durante los meses de oto&#241;o&#44; invierno y primavera&#46;</p></span>"
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        "resumen" => "<span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Objective</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">To analyse the prevalence of hypovitaminosis<span class="elsevierStyleHsp" style=""></span>D and associated factors in school children and adolescents living in a region of northern Spain&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Design</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional study &#40;convenience sampling&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Setting</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Primary Health Care&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Participants</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">A total of 602 Caucasian individuals &#40;aged 3&#46;1 to 15&#46;4<span class="elsevierStyleHsp" style=""></span>years&#41; were included in the study&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Main measurements</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Prevalence of hypovitaminosis<span class="elsevierStyleHsp" style=""></span>D were calculated &#40;dependent variable&#41;&#46; Hypovitaminosis<span class="elsevierStyleHsp" style=""></span>D is defined according to the US Endocrine Society criteria&#58; deficiency &#40;calcidiol &#60;<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#41;&#44; insufficiency &#40;calcidiol&#58; 20-29<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#41;&#44; and sufficiency &#40;calcidiol &#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#41;&#46; Gender&#44; age&#44; body mass index&#44; residence&#44; and season of the year were recorded &#40;independent variables&#41;&#44; and their association with hypovitaminosis<span class="elsevierStyleHsp" style=""></span>D was analysed by multiple regression&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The prevalence of hypovitaminosis<span class="elsevierStyleHsp" style=""></span>D was 60&#46;4&#37; &#40;insufficiency&#58; 44&#46;6&#37;&#59; deficiency&#58; 15&#46;8&#37;&#41;&#46; Multivariate analysis showed that factors associated to hypovitaminosis<span class="elsevierStyleHsp" style=""></span>D were being female &#40;OR&#58; 1&#46;6&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;1-2&#46;3&#41;&#44; pubertal age &#40;OR&#58; 1&#46;8&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;2-2&#46;6&#41;&#44; autumn &#40;OR&#58; 9&#46;5&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 4&#46;8-18&#46;7&#41;&#44; winter &#40;OR&#58; 8&#46;8&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 4&#46;5-17&#46;5&#41; and spring time &#40;OR&#58; 13&#46;2&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 6&#46;4-27&#46;5&#41;&#44; living in urban areas &#40;OR&#58;1&#46;6&#59; CI<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#46;1-2&#46;2&#41;&#44; and severe obesity &#40;OR&#58; 4&#46;4&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;9-10&#46;3&#41;&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusions</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">There is a high prevalence of hypovitaminosis<span class="elsevierStyleHsp" style=""></span>D in juvenile populations&#46; being female&#44; pubertal age&#44; autumn&#44; winter and spring seasons&#44; severe obesity&#44; and living in urban areas are factors associated to hypovitaminosis<span class="elsevierStyleHsp" style=""></span>D&#46; Consideration should be given to the administration of vitamin supplements and&#47;or the increase in the ingestion of natural vitamin<span class="elsevierStyleHsp" style=""></span>D dietary sources&#46;</p></span>"
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" 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="2" align="left" valign="top"><span class="elsevierStyleItalic">Grupo de edad</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Escolar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">299 &#40;49&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Adolescente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">303 &#40;50&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" 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="2" align="left" valign="top"><span class="elsevierStyleItalic">Residencia</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Urbana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">394 &#40;65&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Rural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">207 &#40;34&#44;4&#37;&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="2" 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="2" align="left" valign="top"><span class="elsevierStyleItalic">Estaci&#243;n del a&#241;o</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Invierno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">180 &#40;29&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Primavera&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">131 &#40;21&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Verano&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Oto&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">185 &#40;30&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" 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="2" align="left" valign="top"><span class="elsevierStyleItalic">Status nutricional</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">393 &#40;67&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sobrepeso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69 &#40;11&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Obesidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68 &#40;11&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Obesidad severa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54 &#40;9&#44;2&#37;&#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">4&#44;71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;57&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">29&#44;90<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;27&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">28&#44;50<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#44;87<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Adolescente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#44;97<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#44;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#44;58<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#44;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Significaci&#243;n &#40;p&#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">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;157&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;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  " colspan="7" 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="7" align="left" valign="top"><span class="elsevierStyleItalic">Residencia</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Urbana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;44<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#44;97<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;60<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#44;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&#44;49<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Rural&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">10&#44;05<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;61<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&#44;02<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#44;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Significaci&#243;n &#40;p&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;171&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;885&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;807&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;019&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="7" 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="7" align="left" valign="top"><span class="elsevierStyleItalic">Estaci&#243;n del a&#241;o</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Invierno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#44;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;49<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;04<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#44; 54<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&#44;02<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Primavera&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;24<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;02<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;61<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#44;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&#44;28<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Verano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;44<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#44;97<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;66<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&#44;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#44;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Oto&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#44;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#44;93<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;60<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#44;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&#44;88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Significaci&#243;n &#40;p&#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">0&#44;806&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;119&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  " colspan="7" 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="7" align="left" valign="top"><span class="elsevierStyleItalic">Status nutricional</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Normal&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">&#8722;0&#44;64<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;94&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">4&#44;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#44;18<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&#44;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;58&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">10&#44;02<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#44;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#44;12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;25&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">Suficiencia<br>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">&#967;<span class="elsevierStyleSup">2</span> &#40;p&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Sexo</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mujeres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56 &#40;16&#44;7&#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">161 &#40;47&#44;9&#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">119 &#40;35&#44;4&#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">5&#44;65 &#40;0&#44;059&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Varones&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;14&#44;6&#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">105 &#40;40&#44;4&#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">117 &#40;45&#37;&#41;&#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">Grupo de edad</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Escolar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;11&#44;1&#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">131 &#40;44&#44;3&#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">132 &#40;44&#44;6&#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">11&#44;696 &#40;0&#44;003&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Adolescente&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;20&#44;3&#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">135 &#40;45&#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">104 &#40;34&#44;7&#37;&#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">Residencia</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Urbana&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;19&#44;3&#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">175 &#40;45&#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">139 &#40;35&#44;7&#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">12&#44;671 &#40;0&#44;002&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Rural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;9&#44;2&#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">91 &#40;44&#44;2&#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">96 &#40;46&#44;6&#37;&#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">Estaci&#243;n del a&#241;o</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Invierno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;21&#44;1&#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">79 &#40;41&#44;6&#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">71 &#40;37&#44;4&#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">69&#44;12 &#40;&#60; 0&#44;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Primavera&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;13&#44;3&#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">76 &#40;59&#44;4&#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">35 &#40;27&#44;3&#37;&#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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Verano&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;5&#44;3&#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">11 &#40;14&#44;7&#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">60 &#40;80&#37;&#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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Oto&#241;o&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;16&#44;3&#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">100 &#40;49&#44;3&#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">70 &#40;34&#44;5&#37;&#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">Status nutricional</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46 &#40;11&#44;8&#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">176 &#40;45&#44;1&#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">168 &#40;43&#44;1&#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">30&#44;135 &#40;&#60; 0&#44;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sobrepeso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;15&#44;9&#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">27 &#40;39&#44;1&#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">31 &#40;44&#44;9&#37;&#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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Obesidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;18&#44;2&#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">33 &#40;50&#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">21 &#40;31&#44;8&#37;&#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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Obesidad severa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;37&#44;7&#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">23 &#40;43&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;18&#44;9&#37;&#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" style="border-bottom: 2px solid black">&#205;tems&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">Deficiencia OR &#40;IC 95&#37;&#41; &#40;p&#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">Insuficiencia OR &#40;IC 95&#37;&#41; &#40;p&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Sexo</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Varones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;referencia&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;referencia&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mujeres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;1 &#40;0&#44;9-1&#44;8&#41; &#40;0&#44;676&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;6 &#40;1&#44;1-2&#44;3&#41; &#40;0&#44;011&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" 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="3" align="left" valign="top"><span class="elsevierStyleItalic">Grupo de edad</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Escolar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;referencia&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;referencia&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Adolescente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;0 &#40;1&#44;2-3&#44;4&#41; &#40;0&#44;005&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;8 &#40;1&#44;2-2&#44;6&#41; &#40;0&#44;003&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" 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="3" align="left" valign="top"><span class="elsevierStyleItalic">Estaci&#243;n del a&#241;o</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Verano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;referencia&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;referencia&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Oto&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;8 &#40;1&#44;3-11&#44;5&#41; &#40;0&#44;018&#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&#44;5 &#40;4&#44;8-18&#44;7&#41; &#40;&#60; 0&#44;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Invierno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;8 &#40;1&#44;9-17&#44;4&#41; &#40;0&#44;002&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;8 &#40;4&#44;5-17&#44;5&#41; &#40;&#60; 0&#44;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Primavera&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;1 &#40;0&#44;9-9&#44;9&#41; &#40;0&#44;058&#41;&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis de regresi&#243;n m&#250;ltiple de los factores asociados a hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D &#40;deficiencia e insuficiencia&#41;</p>"
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Esquema del estudio&#58;</span> estudio descriptivo transversal para determinar la prevalencia de hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D y los factores asociados en la edad infantojuvenil&#46;</p>"
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          "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Lo conocido sobre el tema</span><p id="par0130" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0135" class="elsevierStylePara elsevierViewall">La vitamina D&#44; adem&#225;s de intervenir en el metabolismo &#243;seo&#44; tiene un amplio espectro de funciones biol&#243;gicas relacionadas con la proliferaci&#243;n&#44; la diferenciaci&#243;n y el metabolismo celulares&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0140" class="elsevierStylePara elsevierViewall">Se considera importante alcanzar unos niveles s&#233;ricos suficientes de vitamina<span class="elsevierStyleHsp" style=""></span>D&#44; lo que podr&#237;a justificar el inter&#233;s de la monitorizaci&#243;n de su contenido org&#225;nico&#46;</p></li></ul></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Qu&#233; aporta este estudio</span><p id="par0145" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0150" class="elsevierStylePara elsevierViewall">En nuestro medio se detecta una alta prevalencia de hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D en la poblaci&#243;n infantojuvenil&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0155" class="elsevierStylePara elsevierViewall">El sexo femenino&#44; la edad puberal&#44; las estaciones de oto&#241;o&#44; invierno y primavera&#44; el entorno urbano y la obesidad severa son factores asociados con la hipovitaminosis<span class="elsevierStyleHsp" style=""></span>D&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0160" class="elsevierStylePara elsevierViewall">Se podr&#237;a considerar la necesidad de ingerir mayores cantidades de fuentes diet&#233;ticas naturales de vitamina<span class="elsevierStyleHsp" style=""></span>D y&#47;o alimentos enriquecidos entre los meses de oto&#241;o y primavera&#44; o de administrar suplementos de vitamina<span class="elsevierStyleHsp" style=""></span>D&#46;</p></li></ul></p></span></span>"
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                      "titulo" => "Vitamin<span class="elsevierStyleHsp" style=""></span>D&#58; The underappreciated D-light-ful hormone that is important for skeletal and cellular health"
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                      "doi" => "10.3233/PRM-140287"
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                            3 => "C&#46;M&#46; Gordon"
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                      "titulo" => "Vitamin<span class="elsevierStyleHsp" style=""></span>D status and parathyroid hormone in obese children before and after weight loss"
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                          "etal" => false
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                            0 => "T&#46; Reinehr"
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                      "doi" => "10.1530/EJE-07-0188"
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                        "tituloSerie" => "Eur J Endocrinol&#46;"
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                          "autores" => array:4 [
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                            2 => "G&#46; Babar"
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                          "etal" => true
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                            1 => "C&#46; Anania"
                            2 => "J&#46;F&#46; Osborn"
                            3 => "F&#46; Ferraro"
                            4 => "E&#46; Bonci"
                            5 => "E&#46; Olivero"
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                      "doi" => "10.1530/EJE-11-0545"
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Información del artículo
ISSN: 02126567
Idioma original: Español
DOI:10.1016/j.aprim.2017.06.003
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