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Prevalencia y factores de riesgo asociados a distintas comorbilidades en niños y adolescentes obesos
Prevalence and risk factors associated with different comorbidities in obese children and adolescents
Juan Pablo López-Galisteoa, Teresa Gavela-Pérezb, Francisco Javier Mejorado-Molanob, Pilar Pérez-Segurab, Isabel Aragón-Gómezb, Carmen Garcésc, Leandro Soriano-Guillénb,
Autor para correspondencia
leandro.soriano@uam.es

Autor para correspondencia.
a Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
b Unidad de Endocrinología Infantil, Servicio de Pediatría, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
c Laboratorio de Lípidos, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
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Lamentablemente&#44; en nuestro pa&#237;s no hemos sido ajenos a este problema sociosanitario de primer orden&#46; As&#237;&#44; Espa&#241;a se sit&#250;a entre los pa&#237;ses europeos con mayor prevalencia de obesidad infantil entre 6 y 9 a&#241;os&#44; con una cifra de 17&#44;7&#37;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a>&#46; Todav&#237;a resulta m&#225;s alarmante constatar que la prevalencia de obesidad severa en este rango de edad se sit&#250;a en un 4&#37;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">En los &#250;ltimos a&#241;os se ha podido comprobar que el ni&#241;o preescolar y escolar obeso tiene muchas probabilidades de continuar obeso en la adolescencia y en la etapa adulta<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; Desde hace ya una d&#233;cada se ha relacionado la perpetuaci&#243;n del exceso de peso en la infancia con un estado de inflamaci&#243;n de bajo grado<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a>&#46; M&#225;s recientemente&#44; se ha constatado que cambios en los dep&#243;sitos y en la funcionalidad del tejido adiposo contribuyen a modificar la s&#237;ntesis y liberaci&#243;n de diferentes adipoquinas&#44; generando un estado de inflamaci&#243;n cr&#243;nica&#44; lo que favorece la aparici&#243;n de distintas comorbilidades<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Desafortunadamente&#44; la aparici&#243;n de comorbilidades en pacientes obesos no es exclusiva de la edad adulta&#46; De hecho&#44; el incremento de casos de obesidad infantil en edades cada vez m&#225;s tempranas junto con la detecci&#243;n cada vez mayor de ni&#241;os con obesidad severa ha supuesto un cambio en el paradigma de la atenci&#243;n de ni&#241;os y adolescentes obesos&#46; As&#237;&#44; las gu&#237;as m&#225;s recientes recomiendan el cribado de distintas comorbilidades como alteraciones del metabolismo hidrocarbonado&#44; perfil lip&#237;dico&#44; deficiencia de vitamina D&#44; hipertensi&#243;n arterial y esteatohepatitis no alcoh&#243;lica&#44; entre otras<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Con el fin de optimizar la gesti&#243;n de los recursos sanitarios&#44; resultar&#237;a de suma importancia conocer los factores predictores de la aparici&#243;n de estas comorbilidades asociadas a la obesidad&#46; En particular&#44; pensamos que el an&#225;lisis de esos factores en la edad pedi&#225;trica ser&#237;a relevante por la posibilidad de reversibilidad&#46; Por todo ello nos planteamos los siguientes objetivos&#58; a&#41; analizar la prevalencia de comorbilidades relacionadas con la obesidad en una muestra de ni&#241;os y adolescentes obesos&#59; b&#41; estudiar distintos factores relacionados con la presencia de comorbilidades&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Estudio descriptivo de pacientes diagnosticados de obesidad infantil entre enero 2018 y diciembre 2020 en una Unidad de Obesidad Infantil de un hospital de tercer nivel&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">C&#225;lculo del tama&#241;o muestral</span><p id="par0030" class="elsevierStylePara elsevierViewall">Para una prevalencia estimada del 25&#37; de comorbilidades asociadas a la obesidad en la adolescencia<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a>&#44; se necesitar&#237;a incluir un m&#237;nimo de 113 sujetos con una precisi&#243;n &#40;&#969;&#41; del 8&#37; y un nivel de significaci&#243;n &#40;&#947;&#41; del 95&#37; &#40;programa Ene 2&#46;0&#174;&#41;&#44; pareados por sexo y con un n&#250;mero similar de sujetos en estadios prepuberales&#44; estadios de inicio y mitad de la pubertad y en estadios finales de la pubertad&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Criterios de inclusi&#243;n</span><p id="par0035" class="elsevierStylePara elsevierViewall">Ni&#241;os entre 6 y 18 a&#241;os con &#237;ndice de masa corporal &#40;IMC&#41; por encima de &#43;2 SDS seg&#250;n tablas de referencia espa&#241;olas<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a>&#44; sin enfermedad cr&#243;nica previa al diagn&#243;stico de obesidad&#44; ni terapia cr&#243;nica con corticoides&#44; antidepresivos&#44; antipsic&#243;ticos y&#47;o antiepil&#233;pticos&#46; Tambi&#233;n se descartaron sujetos con sospecha de cuadro sindr&#243;mico&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Variables a estudiar</span><p id="par0040" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Datos antropom&#233;tricos&#58;</span> peso &#40;kg&#41;&#44; talla &#40;cm&#41;&#44; IMC &#40;valor absoluto y SDS para edad y sexo seg&#250;n tablas de referencia<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a>&#41; y cintura &#40;cm y SDS seg&#250;n tablas de referencia<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a>&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Composici&#243;n corporal&#58;</span> masa grasa &#40;&#37; y kg&#41; medida mediante impedanciometr&#237;a &#40;Tanita 3000&#174;&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Estadio puberal de Tanner</span><a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">12&#44;13</span></a><span class="elsevierStyleItalic">&#44; edad de la menarquia y calendario de ciclos menstruales&#46;</span></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Tensi&#243;n arterial sist&#243;lica &#40;TAS&#41; y tensi&#243;n arterial diast&#243;lica &#40;TAD&#41;&#58;</span> mm de Hg&#44; obteniendo la media de 3 mediciones&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Datos bioqu&#237;micos tras 12<span class="elsevierStyleHsp" style=""></span>h de ayuno&#58; glucosa &#40;mg&#47;dl&#41;&#44; HbA1c &#40;&#37;&#41;&#44; insulina &#40;&#956;UI&#47;ml&#41;&#44; colesterol total &#40;mg&#47;dl&#41;&#44; triglic&#233;ridos &#40;TG&#41; &#40;mg&#47;dl&#41;&#44; c-HDL &#40;mg&#47;dl&#41;&#44; c-LDL &#40;mg&#47;dl&#41;&#44; GOT &#40;UI&#47;l&#41;&#44; GPT &#40;UI&#47;l&#41;&#44; 25-OH-vitamina D &#40;ng&#47;ml&#41;&#44; TSH &#40;&#956;UI&#47;ml&#41;&#44; T4 libre &#40;ng&#47;dl&#41;&#44; PCR &#40;mg&#47;dl&#41;&#44; creatinina &#40;mg&#47;dl&#41;&#44; &#225;cido &#250;rico &#40;mg&#47;dl&#41;&#46;</p></li></ul></p><p id="par0070" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8728;</span><p id="par0075" class="elsevierStylePara elsevierViewall">C&#225;lculo del HOMA&#58; insulina basal &#40;&#956;UI&#47;ml&#41;<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>glucosa basal &#40;mmol&#47;l&#41;&#47;22&#44;5&#46;</p></li></ul></p><p id="par0080" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">Presencia de s&#237;ndrome de apnea&#47;hipopnea del sue&#241;o&#44; hipertensi&#243;n intracraneal idiop&#225;tica&#44; s&#237;ndrome de ovario poliqu&#237;stico&#46;</p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Definiciones</span><p id="par0090" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Hipertensi&#243;n arterial&#58;</span> media de 3 determinaciones de TAS y&#47;o TAD por encima de percentil 95 para edad&#44; sexo y altura<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Alteraci&#243;n del metabolismo hidrocarbonado&#58;</span></p></li></ul></p><p id="par0105" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8728;</span><p id="par0110" class="elsevierStylePara elsevierViewall">Insulinorresistencia<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a>&#58;</p></li></ul></p><p id="par0115" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0120" class="elsevierStylePara elsevierViewall">Prepuberales&#58; insulina basal<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>&#956;UI&#47;ml y&#47;u HOMA<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>3&#44;5&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#8226;</span><p id="par0125" class="elsevierStylePara elsevierViewall">Puberales&#58; insulina basal<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25<span class="elsevierStyleHsp" style=""></span>&#956;UI&#47;ml y&#47;u HOMA<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>4&#44;5&#46;</p></li></ul></p><p id="par0130" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">&#8728;</span><p id="par0135" class="elsevierStylePara elsevierViewall">Prediabetes<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a>&#58;</p></li></ul></p><p id="par0140" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">&#8226;</span><p id="par0145" class="elsevierStylePara elsevierViewall">HbA1c entre 5&#44;7 y 6&#44;4&#37;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">&#8226;</span><p id="par0150" class="elsevierStylePara elsevierViewall">Alteraci&#243;n de la glucemia en ayunas&#58; glucemia 100-125<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">&#8226;</span><p id="par0155" class="elsevierStylePara elsevierViewall">Intolerancia a hidratos de carbono&#58; a los 120<span class="elsevierStyleHsp" style=""></span>min de sobrecarga oral&#44; glucemia 140-199<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46;</p></li></ul></p><p id="par0160" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0045"><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">&#8728;</span><p id="par0165" class="elsevierStylePara elsevierViewall">Diabetes mellitus tipo 2&#58; obesidad m&#225;s alguno de los siguientes criterios&#44; tras haber descartado diabetes mellitus tipo 1<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a>&#58;</p></li></ul></p><p id="par0170" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0050"><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">&#8226;</span><p id="par0175" class="elsevierStylePara elsevierViewall">HbA1c<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>6&#44;5&#37;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">&#8226;</span><p id="par0180" class="elsevierStylePara elsevierViewall">Glucemia venosa en ayunas<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>126<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46;</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">&#8226;</span><p id="par0185" class="elsevierStylePara elsevierViewall">Glucemia<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl a los 120<span class="elsevierStyleHsp" style=""></span>min de sobrecarga oral&#46;</p></li></ul></p><p id="par0190" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0055"><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel"><span class="elsevierStyleBold">-</span></span><p id="par0195" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Dislipidemia&#58;</span> TG<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>percentil 95 y&#47;o c-HDL<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>percentil 5 para edad y sexo<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">-</span><p id="par0200" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Hiperuricemia&#58;</span> &#225;cido &#250;rico<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>mg&#47;dl<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">-</span><p id="par0205" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">D&#233;ficit de vitamina D&#58;</span> 25-OH-vitamina D<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>ng&#47;ml<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">-</span><p id="par0210" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Enfermedad de h&#237;gado graso no alcoh&#243;lico&#58;</span> valores de GPT &#40;ALAT&#41;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>UI&#47;l<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> junto con ecograf&#237;a sugerente de esteatosis hep&#225;tica &#40;tras excluir otras causas de hipertransaminasemia&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">-</span><p id="par0215" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Hipotiroidismos subcl&#237;nico no autoinmune&#58;</span> TSH<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>l&#237;mite superior para la edad&#44; T4 libre normal e inmunidad tiroidea negativa<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">-</span><p id="par0220" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">S&#237;ndrome de apnea&#47;hipopnea del sue&#241;o</span>&#58; &#237;ndice de apnea-hipopnea<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>5&#44; junto a ronquido y&#47;o apneas presenciadas<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0135"><span class="elsevierStyleLabel">-</span><p id="par0225" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Hipertensi&#243;n intracraneal idiop&#225;tica&#58;</span> cefalea&#44; papiledema&#44; presi&#243;n de l&#237;quido cefalorraqu&#237;deo<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O tras punci&#243;n lumbar y neuroimagen sin lesi&#243;n ocupante de espacio<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0140"><span class="elsevierStyleLabel">-</span><p id="par0230" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">S&#237;ndrome de ovario poliqu&#237;stico&#58;</span> a&#41; hiperandrogenismo cl&#237;nico y&#47;o bioqu&#237;mico&#59; b&#41; alteraci&#243;n del ciclo menstrual teniendo en cuenta el tiempo transcurrido tras la primera menstruaci&#243;n&#59; c&#41; descartar otras causas de hiperandrogenismo<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0145"><span class="elsevierStyleLabel">-</span><p id="par0235" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Obeso metab&#243;licamente sano&#58;</span> sin alteraci&#243;n del metabolismo hidrocarbonado&#44; dislipidemia&#44; hiperuricemia ni hipertensi&#243;n arterial&#46;</p></li></ul></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">An&#225;lisis estad&#237;stico</span><p id="par0240" class="elsevierStylePara elsevierViewall">En el an&#225;lisis descriptivo&#44; las variables cualitativas se muestran en tablas de frecuencias y las variables cuantitativas como media e intervalo de confianza al 95&#37;&#46; Se aplic&#243; la prueba de Kolmogorov<span class="elsevierStyleItalic">-</span>Smirnov para comprobar la distribuci&#243;n normal de los datos&#46; Aquellas variables que no segu&#237;an una distribuci&#243;n normal fueron transformadas logar&#237;tmicamente&#46; Se analiz&#243; la prevalencia de comorbilidades de forma global&#46; Asimismo&#44; se estudi&#243; el porcentaje de comorbilidades en funci&#243;n de la edad&#44; estadio puberal&#44; sexo&#44; IMC y composici&#243;n corporal utilizando las siguientes pruebas estad&#237;sticas&#58; &#967;<span class="elsevierStyleSup">2</span>&#44; t de Student y ANOVA&#46; Se consider&#243; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 como valores significativos&#46; Para el an&#225;lisis estad&#237;stico se utiliz&#243; programa SPSS versi&#243;n 25&#46;0&#174;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Aspectos &#233;tico-legales</span><p id="par0245" class="elsevierStylePara elsevierViewall">El desarrollo del estudio fue aprobado por el Comit&#233; de &#201;tica de la Investigaci&#243;n de nuestro hospital &#40;n&#46;<span class="elsevierStyleSup">o</span> TFG012-21&#44; 8 de febrero de 2021&#41; y se llev&#243; a cabo de acuerdo con la &#250;ltima versi&#243;n de la Declaraci&#243;n de Helsinki y cumpliendo la legislaci&#243;n espa&#241;ola vigente&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Resultados</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Descripci&#243;n de la muestra</span><p id="par0250" class="elsevierStylePara elsevierViewall">Se han incluido un total de 158 ni&#241;os obesos con una edad media al diagn&#243;stico de 12&#44;48 a&#241;os &#40;12&#44;05-12&#44;91&#41; y un IMC &#40;Z-Score&#41; de &#43;3&#44;24 SDS &#40;3&#44;04-3&#44;44&#41;&#46; De los 158 pacientes&#44; 76 eran ni&#241;os &#40;48&#44;1&#37;&#41; y 82 eran ni&#241;as &#40;51&#44;9&#37;&#41;&#46; La distribuci&#243;n por estadio puberal fue&#58; 44 en Tanner I &#40;30 ni&#241;os&#44; 14 ni&#241;as&#41;&#44; 16 en Tanner II &#40;12 ni&#241;os y 4 ni&#241;as&#41;&#44; 23 en Tanner III &#40;13 ni&#241;os y 10 ni&#241;as&#41;&#44; 19 en Tanner IV &#40;9 ni&#241;os y 10 ni&#241;as&#41; y 56 en Tanner V &#40;12 hombres y 44 mujeres&#41;&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Los datos antropom&#233;tricos&#44; de composici&#243;n corporal&#44; de tensi&#243;n arterial y bioqu&#237;micos aparecen reflejados en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0260" class="elsevierStylePara elsevierViewall">La edad media de la menarquia de las adolescentes fue de 11&#44;37 a&#241;os &#40;11&#44;04-11&#44;70&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Prevalencia comorbilidades</span><p id="par0265" class="elsevierStylePara elsevierViewall">Se presenta en orden decreciente la prevalencia de las distintas comorbilidades encontradas en nuestra muestra&#58; d&#233;ficit de 25-OH-vitamina D &#40;64&#44;2&#37;&#41;&#44; insulinorresistencia &#40;45&#44;1&#37;&#41;&#44; dislipidemia &#40;32&#44;2&#37;&#41;&#44; hiperuricemia &#40;18&#44;5&#37;&#41;&#44; HTA &#40;15&#37;&#41;&#44; s&#237;ndrome de ovario poliqu&#237;stico &#40;9&#44;3&#37; entre mujeres en estadio puberal Tanner V&#41;&#44; enfermedad de h&#237;gado graso no alcoh&#243;lico &#40;8&#44;2&#37;&#41;&#44; hipotiroidismo subcl&#237;nico &#40;6&#44;9&#37;&#41;&#44; prediabetes &#40;6&#44;8&#37;&#41;&#44; SHAS &#40;6&#44;2&#37;&#41;&#44; hipertensi&#243;n intracraneal idiop&#225;tica &#40;1&#44;2&#37;&#41; y diabetes tipo 2 &#40;0&#44;6&#37;&#41;&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Un 13&#44;4&#37; de los sujetos del estudio podr&#237;a considerarse como obesos metab&#243;licamente sanos&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Factores predictores de presencia de comorbilidad</span><p id="par0275" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se describe la relaci&#243;n de la edad&#44; el sexo&#44; el IMC Z-Score y el porcentaje de masa grasa con el porcentaje de comorbilidades en nuestra muestra&#46; As&#237;&#44; aquellos pacientes obesos por encima de la mediana de edad presentaban de forma significativa mayor prevalencia de hipertensi&#243;n arterial y de hiperuricemia&#46; Por otra parte&#44; se encontr&#243; mayor prevalencia de enfermedad de h&#237;gado graso no alcoh&#243;lico entre los varones&#46; Tambi&#233;n&#44; aquellos pacientes con IMC Z-Score por encima de la mediana ten&#237;an mayor porcentaje de insulinorresistencia&#44; HTA y enfermedad de h&#237;gado graso no alcoh&#243;lico que los situados por debajo de la mediana&#46; Por &#250;ltimo&#44; aquellos con porcentaje de masa grasa por encima de la mediana ten&#237;an mayor prevalencia de HTA&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0280" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> comparamos par&#225;metros bioqu&#237;micos seg&#250;n terciles de edad&#44; IMC Z-Score y porcentaje de masa grasa&#46; La edad influ&#237;a de forma decreciente sobre 25-OH-vitamina D y c-HDL y de forma creciente sobre HOMA y &#225;cido &#250;rico&#46; El IMC Z-Score se correlacion&#243; positivamente con HOMA&#46; Por &#250;ltimo&#44; el porcentaje de masa grasa influ&#237;a sobre el HOMA de forma creciente y&#44; sobre c-HDL&#44; de forma decreciente&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0285" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> comparamos los mismos par&#225;metros bioqu&#237;micos seg&#250;n sexo y estadio puberal de Tanner&#46; De esta forma&#44; observamos que el sexo masculino asocia mayores valores de GOT y GPT que el femenino&#46; Por otro lado&#44; a mayor estadio puberal&#44; valores significativamente menores de 25-OH-vitamina D y de HDL-C y mayores de HOMA y &#225;cido &#250;rico&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discusi&#243;n</span><p id="par0290" class="elsevierStylePara elsevierViewall">Presentamos un estudio descriptivo de la frecuencia de distintas comorbilidades asociadas a la obesidad infantojuvenil&#46; Adicionalmente&#44; hemos evaluado la influencia de posibles factores de riesgo en la aparici&#243;n de estos trastornos tales como edad&#44; IMC&#44; composici&#243;n corporal y estadio puberal&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">En nuestra muestra&#44; la comorbilidad m&#225;s prevalente es el d&#233;ficit de vitamina D que alcanza al 64&#37; de nuestros pacientes&#46; Previamente nuestro grupo demostr&#243; una elevada prevalencia de d&#233;ficit de vitamina D entre ni&#241;os y adolescentes obesos frente al grupo compuesto por individuos con normopeso<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">19&#44;25</span></a>&#46; Se han postulado diferentes hip&#243;tesis para tratar de explicar la mayor prevalencia de d&#233;ficit de vitamina D entre la poblaci&#243;n de ni&#241;os y adolescentes obesos&#46; Por un lado&#44; cambios en los estilos de vida que ocasionan una disminuci&#243;n de la actividad f&#237;sica al aire libre&#44; lo que produce una menor exposici&#243;n solar&#46; Adicionalmente&#44; la biodisponibilidad de vitamina D en individuos obesos es menor que en individuos con normopeso debido a un mayor dep&#243;sito en el tejido grado de estos individuos<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a>&#46; En nuestro trabajo hemos encontrado a la edad y al estadio puberal m&#225;s avanzado como posibles factores de riesgo relacionados con mayor porcentaje de d&#233;ficit de vitamina D&#46; Estos hallazgos pueden relacionarse con menor actividad f&#237;sica y exposici&#243;n solar que en edades m&#225;s tempranas<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a>&#46; En suma&#44; pensamos que estos datos apuntan a la necesidad de implementar cribados peri&#243;dicos de d&#233;ficit de vitamina D en pacientes obesos&#44; particularmente en adolescentes&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">La segunda comorbilidad m&#225;s frecuente entre los individuos obesos es la presencia de insulinorresistencia&#44; situ&#225;ndose en un 45&#44;1&#37; de los pacientes&#46; Estos datos son similares a los reportados por un estudio espa&#241;ol que incluye a 1300 pacientes<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a>&#46; Los factores relacionados con esta comorbilidad son edad&#44; IMC&#44; porcentaje de masa grasa y estadio puberal&#46; Por ello&#44; ser&#237;a recomendable evaluar la presencia de insulinorresistencia a partir de estadio puberal Tanner II y&#47;o adolescentes mayores de 11&#44;5 a&#241;os&#46; Independientemente de la edad y del estadio puberal&#44; en sujetos con IMC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>3&#44;5 SDS y&#47;o &#37; de masa grasa<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>41&#44;7&#37; tambi&#233;n ser&#237;a aconsejable valorar la presencia de insulinorresistencia&#46; A diferencia del estudio espa&#241;ol anteriormente comentado donde se evidencia un 46&#37; de sujetos con prediabetes<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a>&#44; en nuestro estudio se document&#243; un 6&#44;8&#37; de pacientes con criterios de prediabetes&#46; S&#237; coinciden ambos estudios en la prevalencia de diabetes tipo 2&#44; que se sit&#250;a por debajo del 1&#37;&#46; Este &#250;ltimo hallazgo nos deber&#237;a hacer reflexionar sobre la metodolog&#237;a empleada para realizar el cribado de alteraciones del metabolismo hidrocarbonado entre los adolescentes obesos de nuestro entorno&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">En nuestro estudio encontramos un porcentaje de sujetos con dislipidemia de un 32&#44;2&#37;&#44; ligeramente menor que en otros estudios&#44; como el realizado en casi 2000 ni&#241;os polacos<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a>&#44; en los que el porcentaje de dislipidemia fue del 38&#44;2&#37; en ni&#241;as y del 40&#44;5&#37; en ni&#241;os&#46; Estas diferencias probablemente sean debidas a distintos criterios en la definici&#243;n de dislipidemia&#44; en la selecci&#243;n de la muestra&#44; el tiempo de ayunas y en el n&#250;mero de pacientes incluidos&#46; Al igual que en nuestro estudio&#44; el grupo polaco observa que los valores sangu&#237;neos de HDL correlacionan negativamente con edad&#44; IMC y porcentaje de masa grasa<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a>&#46; Aunque el porcentaje de dislipidemias sea mayor entre los adolescentes&#44; no es desde&#241;able en la etapa escolar&#44; hecho que&#44; sumado a la bien conocida relaci&#243;n existente entre los niveles de l&#237;pidos y el riesgo cardiovascular&#44; nos indica que es necesario realizar una determinaci&#243;n del perfil lip&#237;dico en todo ni&#241;o obeso al diagn&#243;stico&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">Los valores de &#225;cido &#250;rico aumentan ligeramente con la edad y presentan cierto dimorfismo sexual en la adolescencia<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a>&#46; No obstante&#44; si tenemos en cuenta el valor medio y la desviaci&#243;n est&#225;ndar para el c&#225;lculo de &#43;2 DE en funci&#243;n de la edad y el sexo&#44; ya desde los 10 a&#241;os el punto de corte para definir hiperuricemia se situar&#237;a entre 6 y 7<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; Por esta raz&#243;n&#44; hemos decidido utilizar 7<span class="elsevierStyleHsp" style=""></span>mg&#47;dl como punto de corte&#44; que es el empleado habitualmente en poblaci&#243;n adulta&#46; De esta forma&#44; el 18&#44;5&#37; de los pacientes incluidos en nuestro estudio presenta hiperuricemia&#46; Si nos centramos en estudios cuyo punto de corte ha sido similar al nuestro&#44; se aprecia que la prevalencia de hiperuricemia oscila entre 0&#44;45 y 26&#44;5&#37; en poblaci&#243;n general pedi&#225;trica&#46; En individuos obesos la prevalencia se sit&#250;a en 24&#44;4&#37;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a>&#46; Por otra parte&#44; en nuestro estudio aparecen diferencias en los niveles de &#225;cido &#250;rico en funci&#243;n de la edad&#44; IMC Z-Score y el estadio puberal&#46; Con nuestros resultados no podemos discernir si existe una relaci&#243;n directa entre hiperuricemia e IMC y&#47;o relaci&#243;n con malos h&#225;bitos alimentarios&#46; Sospechamos que a mayor edad&#44; peores h&#225;bitos nutricionales&#46; Por ello&#44; ser&#237;a recomendable la realizaci&#243;n de estudios prospectivos que recogieran encuestas nutricionales para tratar de relacionar ingesta con valores sangu&#237;neos de &#225;cido &#250;rico&#46; Mientras tanto&#44; podr&#237;a recomendarse su determinaci&#243;n a partir de la adolescencia&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">La prevalencia de HTA en la poblaci&#243;n general pedi&#225;trica&#44; utilizando los criterios cl&#225;sicos publicados en 2004 por la Task Force<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a>&#44; se sit&#250;a entre 1&#44;5 y 8&#37;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a>&#46; Este porcentaje asciende a un 25&#37; entre los adolescentes obesos<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a>&#46; De forma global&#44; un 15&#37; de nuestros pacientes presentan HTA&#46; Si tenemos en consideraci&#243;n la mediana de edad de nuestra muestra&#44; la prevalencia es mayor en los ni&#241;os que se sit&#250;an por encima de la misma &#40;20&#44;8 frente a 9&#44;2&#37;&#41;&#46; Por tanto&#44; pensamos que la edad y posiblemente el tiempo de evoluci&#243;n de la obesidad se relacionar&#237;an con una mayor prevalencia de HTA&#46; Adicionalmente&#44; se objetiva mayor porcentaje de HTA en ni&#241;os con mayores valores de IMC y de masa grasa&#46; Lo anteriormente citado apunta a una estrecha relaci&#243;n entre el estado de inflamaci&#243;n cr&#243;nica que presentan los adolescentes obesos y la aparici&#243;n de HTA&#46; Al tratarse de una medida no invasiva&#44; es absolutamente aconsejable la determinaci&#243;n de tensi&#243;n arterial en el seguimiento de los pacientes obesos a cualquier edad&#46; La HTA debe confirmarse con la media de al menos 3 determinaciones en un entorno propicio para tal fin&#46;</p><p id="par0320" class="elsevierStylePara elsevierViewall">Otra complicaci&#243;n relacionada con la obesidad es la enfermedad de h&#237;gado graso no alcoh&#243;lico&#46; La prevalencia entre ni&#241;os y adolescentes obesos oscila en funci&#243;n de los criterios de selecci&#243;n utilizados&#44; ya sean bioqu&#237;micos y&#47;o de prueba de imagen&#46; Aunque la prueba m&#225;s precisa para el diagn&#243;stico sigue siendo la biopsia hep&#225;tica&#44; no es una prueba rutinaria en la pr&#225;ctica cl&#237;nica habitual en pediatr&#237;a&#46; En nuestra muestra se ha objetivado una prevalencia inferior a lo reportado por un grupo espa&#241;ol en 2015 en el que hasta el 19&#44;66&#37; de individuos con sobrepeso y obesidad presentaban hipertransaminasemia &#40;GPT<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>UI&#47;l&#41;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a>&#46; Un metaan&#225;lisis reciente recoge una prevalencia de h&#237;gado graso no alcoh&#243;lico del 34&#44;2&#37; en ni&#241;os y adolescentes obesos frente a un 7&#44;6&#37; entre la poblaci&#243;n general pedi&#225;trica<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a>&#46; Hemos observado una prevalencia mayor de este trastorno en el sexo masculino &#40;13&#44;7 vs&#46; 2&#44;7&#41;&#44; sin haber encontrado relaci&#243;n con edad ni con estadio puberal&#46; As&#237;&#44; se especula sobre la existencia de otros factores condicionantes&#44; aparte de los esteroides sexuales&#44; para explicar este dimorfismo sexual ya desde la etapa prepuberal<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a>&#46; Tambi&#233;n hemos constatado que la prevalencia de enfermedad de h&#237;gado graso no alcoh&#243;lico es superior en aquellos individuos con IMC por encima de la mediana &#40;1&#44;4 vs&#46; 15&#44;1&#41;&#46; En suma&#44; parece recomendable la determinaci&#243;n de transaminasas en el estudio inicial de todo paciente obeso&#46; El seguimiento posterior&#44; en el que se valorar&#225; la realizaci&#243;n de prueba de imagen hep&#225;tica&#44; vendr&#225; determinado por los valores de transaminasas iniciales&#44; el grado de obesidad y el sexo del paciente&#46;</p><p id="par0325" class="elsevierStylePara elsevierViewall">Un 13&#44;4&#37; de nuestros pacientes fueron clasificados como metab&#243;licamente sanos&#44; siendo los factores predictores encontrados en ellos la edad y el IMC&#46; Resulta dif&#237;cil hacer comparaciones con otros estudios puesto que los criterios para considerar a un paciente obeso metab&#243;licamente sano no son un&#225;nimes en ning&#250;n grupo de edad&#44; a pesar de diversos intentos realizados en reuniones de expertos<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a>&#46; As&#237;&#44; a d&#237;a de hoy&#44; no hay unanimidad para establecer par&#225;metros bioqu&#237;micos&#44; antropom&#233;tricos ni de h&#225;bitos de vida para considerar a los individuos obesos como metab&#243;licamente sanos&#46; En este sentido&#44; pensamos que en poblaci&#243;n pedi&#225;trica se necesitar&#237;an criterios diferentes seg&#250;n la edad y el estadio puberal&#46; Adem&#225;s&#44; se requieren nuevos estudios para analizar el riesgo cardiovascular real de estos pacientes a largo plazo&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Limitaciones</span><p id="par0330" class="elsevierStylePara elsevierViewall">Este trabajo no est&#225; exento de limitaciones&#46; Entre ellas&#44; la naturaleza transversal del estudio y la ausencia de grupo control&#46; Otra limitaci&#243;n ha sido la imposibilidad de recoger la variable raza ya que pudiera considerarse como factor de riesgo en la obesidad&#46; Asimismo&#44; al no disponerse de prueba de imagen hep&#225;tica en todos los pacientes para evaluar la presencia de esteatosis hep&#225;tica&#44; no se ha incluido esta informaci&#243;n en este trabajo&#46; Finalmente&#44; la determinaci&#243;n de los valores de 25-OH-vitamina D no se realiz&#243; a todos los pacientes en la misma estaci&#243;n del a&#241;o&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conclusiones</span><p id="par0335" class="elsevierStylePara elsevierViewall">Los ni&#241;os obesos de nuestro entorno presentan una elevada frecuencia de comorbilidades&#46; Estos hallazgos nos plantean el reto de diagnosticar de forma m&#225;s temprana estas alteraciones teniendo en cuenta la relevancia de distintos factores de riesgo como la edad y el tiempo de evoluci&#243;n de la obesidad&#44; el sexo&#44; el grado de obesidad evaluado mediante IMC Z-score y porcentaje de masa grasa&#44; as&#237; como el estadio puberal&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflicto de intereses</span><p id="par0340" class="elsevierStylePara elsevierViewall">La presente investigaci&#243;n no ha recibido ayudas espec&#237;ficas provenientes de agencias del sector p&#250;blico&#44; sector comercial o entidades sin &#225;nimo de lucro&#46; Los autores de este trabajo declaran no tener conflicto de intereses&#46;</p></span></span>"
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          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1556279"
          "palabras" => array:7 [
            0 => "Obesidad infantil"
            1 => "Comorbilidades"
            2 => "D&#233;ficit de vitamina D"
            3 => "Insulinorresistencia"
            4 => "Dislipidemia"
            5 => "Hiperuricemia"
            6 => "Hipertensi&#243;n arterial"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1556280"
          "palabras" => array:7 [
            0 => "Childhood obesity"
            1 => "Comorbidities"
            2 => "Vitamin D deficiency"
            3 => "Insulin resistance"
            4 => "Dyslipidaemia"
            5 => "Hyperuricaemia"
            6 => "Arterial hypertension"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">En la etapa infantil ya se presentan diferentes comorbilidades relacionas con la obesidad&#44; como por ejemplo&#58; d&#233;ficit de vitamina D&#44; alteraci&#243;n del metabolismo hidrocarbonado&#44; dislipidemia&#44; hipertensi&#243;n arterial y esteatohepatitis no alcoh&#243;lica&#46; En el presente estudio queremos analizar la prevalencia de estas comorbilidades en ni&#241;os y adolescentes obesos y estudiar los factores predictores relacionados con su aparici&#243;n&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se recogieron variables antropom&#233;tricas&#44; datos demogr&#225;ficos y bioqu&#237;micos de pacientes obesos entre 6 y 18 a&#241;os&#46; Posteriormente&#44; se realiz&#243; un an&#225;lisis estad&#237;stico para describir las caracter&#237;sticas de los pacientes&#44; la prevalencia de comorbilidades&#44; as&#237; como los factores predictores de las mismas&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron un total de 158 ni&#241;os obesos &#40;76 ni&#241;os y 82 ni&#241;as&#41; con una edad media al diagn&#243;stico de 12&#44;48 a&#241;os y un IMC Z-Score de &#43;3&#44;24 SDS&#46; Las comorbilidades m&#225;s prevalentes fueron d&#233;ficit de vitamina D &#40;64&#44;2&#37;&#41;&#44; insulinorresistencia &#40;45&#44;1&#37;&#41;&#44; dislipidemia &#40;32&#44;2&#37;&#41;&#44; hiperuricemia &#40;18&#44;5&#37;&#41; e hipertensi&#243;n arterial &#40;15&#37;&#41;&#46; Como factores predictores de estas comorbilidades se han encontrado la edad&#44; el IMC Z-Score&#44; el porcentaje de masa grasa&#44; el sexo masculino y el mayor estadio puberal&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los ni&#241;os y adolescentes de nuestro entorno presentan una elevada prevalencia de comorbilidades&#46; Establecido el diagn&#243;stico de obesidad&#44; ser&#237;a de gran utilidad reconocer precozmente a aquellos pacientes con mayor riesgo de comorbilidades&#44; conocida su relaci&#243;n con el sexo&#44; la edad&#44; IMC Z-Score&#44; porcentaje de masa grasa y estadio puberal&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Different obesity-related comorbidities are already present in childhood&#44; such as&#58; vitamin D deficiency&#44; impaired carbohydrate metabolism&#44; dyslipidaemia&#44; arterial hypertension and non-alcoholic steatohepatitis&#46; In this study&#44; we aim to analyse the prevalence of comorbidities and to determine the predictive factors that affect these comorbidities&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Anthropometric&#44; demographic and biochemical variables were collected from obese patients between 6 and 18 years of age&#46; Subsequently&#44; a statistical analysis was performed to describe the characteristics of the patients and the prevalence of comorbidities&#44; as well as their predictive factors&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 158 obese children &#40;76 boys and 82 girls&#41; with a mean age at diagnosis of 12&#46;48 years and a BMI Z-score of &#43;3&#46;24 SDS were included&#46; The most prevalent comorbidities were vitamin D deficiency &#40;64&#46;2&#37;&#41;&#44; insulin resistance &#40;45&#46;1&#37;&#41;&#44; dyslipidaemia &#40;32&#46;2&#37;&#41;&#44; hyperuricaemia &#40;18&#46;5&#37;&#41; and arterial hypertension &#40;15&#37;&#41;&#46; Age&#44; BMI Z-score&#44; percentage of fat mass&#44; male sex and higher pubertal stage have been found to be predictors of these comorbidities&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Obese children and adolescents have a high prevalence of comorbidities&#46; Once the diagnosis of obesity has been established&#44; it would be very useful to identify early those patients with a higher risk of comorbidities&#44; knowing their relationship with sex&#44; age&#44; BMI Z-score&#44; percentage of fat mass and pubertal stage&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusion"
          ]
        ]
      ]
    ]
    "multimedia" => array:4 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intervalo de confianza al 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edad decimal &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;90-12&#44;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IMC &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;82-31&#44;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IMC &#40;Z-Score&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;08-3&#44;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Talla &#40;Z-Score&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;83-1&#44;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cintura &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#44;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96&#44;30-100&#44;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cintura &#40;Z-Score&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;38-2&#44;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Masa grasa &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#44;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#44;62-40&#44;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TAS &#40;mm de Hg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">111&#44;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">109&#44;74-113&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TAS &#40;Z-Score&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;30-0&#44;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TAD &#40;mm de Hg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#44;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#44;26-72&#44;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TAD &#40;Z-Score&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;72-0&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Glucosa &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#44;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#44;01-87&#44;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HbA1C &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;11-5&#44;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Insulina &#40;&#956;UI&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;77-28&#44;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HOMA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">c-HDL &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18&#44;86&#40;16&#44;99-20&#44;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;55&#40;16&#44;09-19&#44;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;26&#40;15&#44;54-18&#44;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ANOVANS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HOMA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;42&#40;3&#44;55-5&#44;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;08&#40;4&#44;99-7&#44;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;54&#40;4&#44;67-6&#44;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ANOVA<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a>Post-hoc&#58;1-2<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;04&#40;4&#44;08-6&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;72&#40;3&#44;96-5&#44;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;66&#40;5&#44;48-7&#44;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ANOVA&#42;Post-hoc&#58;2-3&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;47&#40;4&#44;37-6&#44;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;55&#40;3&#44;73-5&#44;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;53&#40;5&#44;32-7&#44;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ANOVA<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a>Post-hoc&#58;2-3<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TG&#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">105&#44;57&#40;86&#44;62-124&#44;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">112&#44;33&#40;89&#44;30-135&#44;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&#44;10&#40;83&#44;26-106&#44;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ANOVANS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">114&#44;66&#40;91&#44;10-138&#44;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">102&#44;76&#40;85&#44;78-119&#44;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&#44;94&#40;85&#44;25-106&#44;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ANOVANS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">116&#44;05&#40;91&#44;15-140&#44;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">105&#44;70&#40;84&#44;22-127&#44;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#44;07&#40;86&#44;96-113&#44;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ANOVANS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">c-HDL&#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#44;96&#40;43&#44;42-48&#44;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#44;50&#40;42&#44;67-48&#44;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#44;38&#40;39&#44;34-43&#44;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ANOVA<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a>Post-hoc&#58;1-3<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#44;98&#40;42&#44;57-47&#44;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#44;32&#40;42&#44;67-47&#44;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#44;88&#40;40&#44;45-45&#44;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ANOVANS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#44;86&#40;43&#44;66-50&#44;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#44;79&#40;41&#44;44-46&#44;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#44;86&#40;39&#44;40-44&#44;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ANOVA<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a>Post-hoc&#58;1-3<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GOT&#40;UI&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;73&#40;23&#44;50-31&#44;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#44;28&#40;20&#44;49-26&#44;07&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;13&#40;17&#44;34-26&#44;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ANOVANS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#44;22&#40;20&#44;29-25&#44;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#44;63&#40;20&#44;28-28&#44;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#44;98&#40;20&#44;31-29&#44;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ANOVANS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#44;59&#40;20&#44;81-26&#44;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;38&#40;21&#44;13-31&#44;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#44;45&#40;18&#44;49-28&#44;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ANOVANS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GPT&#40;UI&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;89&#40;19&#44;31-38&#44;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;10&#40;19&#44;89-30&#44;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;85&#40;18&#44;26-37&#44;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ANOVANS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#44;29&#40;18&#44;97-23&#44;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;64&#40;18&#44;93-38&#44;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;64&#40;22&#44;30-40&#44;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ANOVANS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#44;17&#40;20&#44;55-25&#44;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#193;cido &#250;rico&#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ANOVA<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>Post-hoc&#58;1-2<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>1-3<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;49&#40;4&#44;95-6&#44;03&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ANOVANS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25-OH-vitamina D&#40;ng&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18&#44;29&#40;17&#44;01-19&#44;56&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18&#44;15&#40;16&#44;79-19&#44;51&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">t de StudentNS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17&#44;38&#40;15&#44;74-19&#44;02&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17&#44;71&#40;16&#44;19-19&#44;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ANOVA<a class="elsevierStyleCrossRef" href="#tblfn0025">&#42;</a>Post-hoc&#58;1-2<a class="elsevierStyleCrossRef" href="#tblfn0025">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HOMA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">5&#44;43&#40;4&#44;70-6&#44;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">5&#44;52&#40;4&#44;62-6&#44;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">t de StudentNS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#44;23&#40;3&#44;48-4&#44;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">6&#44;18&#40;5&#44;15-7&#44;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;66&#40;4&#44;58-6&#44;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ANOVA<a class="elsevierStyleCrossRef" href="#tblfn0025">&#42;</a>Post-hoc&#58;1-2<a class="elsevierStyleCrossRef" href="#tblfn0025">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Triglic&#233;ridos&#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">103&#44;14&#40;91&#44;07-115&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">106&#44;22&#40;89&#44;23-123&#44;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">t de StudentNS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#44;30&#40;82&#44;31-114&#44;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">120&#44;27&#40;98&#44;39-142&#44;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">94&#44;65&#40;80&#44;44-108&#44;87&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ANOVANS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">c-HDL&#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#44;82&#40;42&#44;82-46&#44;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#44;36&#40;42&#44;29-46&#44;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">t de StudentNS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#44;07&#40;44&#44;43-49&#44;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#44;75&#40;42&#44;23-47&#44;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#44;15&#40;39&#44;85-44&#44;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ANOVA<a class="elsevierStyleCrossRef" href="#tblfn0025">&#42;</a>Post-hoc&#58;1-3<a class="elsevierStyleCrossRef" href="#tblfn0025">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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Información del artículo
ISSN: 25300164
Idioma original: Español
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es en pt

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Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos