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Prevalencia de síndrome metabólico en niños con obesidad y sin ella
Prevalence of metabolic syndrome in children with and without obesity
Iris Paola Guzmán-Guzmána,
Autor para correspondencia
pao_nkiller@yahoo.com.mx

Autor para correspondencia.
, Aralia Berenice Salgado-Bernabéa, José Francisco Muñoz Valleb, Amalia Vences-Velázqueza, Isela Parra-Rojasa
a Unidad Académica de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, México
b Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
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En la poblaci&#243;n infantil mexicana poco se conoce sobre la prevalencia de SM y de la combinaci&#243;n de componentes que lo definen&#44; debido a que de manera independiente cada componente representa un factor de riesgo para ECV&#59; siendo importante identificarlos para implementar medidas de control&#46; El objetivo de este estudio fue determinar la prevalencia de SM&#44; sus principales componentes y combinaciones en una muestra de ni&#241;os mexicanos con y sin obesidad&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Sujetos&#44; material y m&#233;todos</span><p id="par0010" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio de tipo transversal aprobado por el Comit&#233; de &#201;ti ca e Investigaci&#243;n de la Universidad Aut&#243;noma de Guerrero&#44; en el que se incluyeron 225 ni&#241;os seleccionados durante el a&#241;o 2008 de 3 escuelas de educaci&#243;n primaria&#44; ubicadas en la zona urbana de la Ciudad de Chilpancingo&#44; todos nacidos en el estado de Guerrero&#44; M&#233;xico&#46; La muestra incluy&#243; 117 ni&#241;os y 108 ni&#241;as con edades entre 6 y 12 a&#241;os&#44; de los cuales 106 eran obesos y 119 ten&#237;an peso normal&#46; El consentimiento informado por escrito fue obtenido de todos los padres o tutores&#44; y los procedimientos se llevaron a cabo de acuerdo con las gu&#237;as &#233;ticas de 2008 establecidas en la Declaraci&#243;n de Helsinki&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Mediciones antropom&#233;tricas y cl&#237;nicas</span><p id="par0015" class="elsevierStylePara elsevierViewall">Todos los ni&#241;os se sometieron a la valoraci&#243;n antropom&#233;trica determinando el peso corporal&#44; con ropa ligera y sin zapatos&#44; utilizando un monitor de composici&#243;n corporal &#40;Tanita BC-553&#44; Arlington&#44; EE&#46; UU&#46;&#41;&#46; La estatura se midi&#243; con un estadi&#243;metro port&#225;til &#40;Seca&#44; Hamburgo&#44; Alemania&#41;&#46; El &#237;ndice de masa corporal &#40;IMC&#41; fue calculado como peso &#40;kg&#41;&#47;estatura &#40;m<span class="elsevierStyleSup">2</span>&#41;&#46; La circunferencia de la cintura fue medida por duplicado pasando por el ombligo y el borde de la cresta iliaca&#44; usando una cinta antropom&#233;trica con una exactitud de<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;1<span class="elsevierStyleHsp" style=""></span>cm &#40;Seca 201&#44; Hamburgo&#44; Alemania&#41;&#46; La clasificaci&#243;n de obesidad se realiz&#243; empleando las tablas de crecimiento del a&#241;o 2000 de los <span class="elsevierStyleItalic">Centers for Disease Control and Prevention</span><a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#44; determinando peso normal en ni&#241;os con un IMC entre los percentiles 5 y 85&#44; y con obesidad aquellos con un IMC<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>percentil 95&#46; La presi&#243;n arterial fue medida en el brazo derecho del ni&#241;o sentado y en reposo durante al menos 5<span class="elsevierStyleHsp" style=""></span>min&#44; utilizando un esfigmoman&#243;metro &#40;Riester CE 0124&#44; Jungingen&#44; Alemania&#41;&#46; Se tomaron 2 lecturas consecutivas para cada ni&#241;o&#44; con al menos un minuto entre cada lectura&#44; y el promedio de las lecturas fue registrado y usado en el an&#225;lisis subsecuente&#46; La presi&#243;n arterial sist&#243;lica y diast&#243;lica alteradas se determinaron por la presencia de valores<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>percentil 95&#44; de acuerdo con la edad y el sexo&#44; considerando los datos del <span class="elsevierStyleItalic">National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents</span><a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Determinaciones bioqu&#237;micas y definiciones</span><p id="par0020" class="elsevierStylePara elsevierViewall">Las muestras sangu&#237;neas fueron recogidas por punci&#243;n venosa despu&#233;s de una noche de ayuno&#46; A partir de una muestra s&#233;rica se determin&#243; el colesterol total&#44; los triglic&#233;ridos&#44; el colesterol unido a <span class="elsevierStyleItalic">high density lipoproteins</span> &#40;HDL&#44; &#171;lipoprote&#237;nas de alta densidad&#187;&#41;&#44; el colesterol unido a <span class="elsevierStyleItalic">low density lipoproteins</span> &#40;LDL&#44; &#171;lipoprote&#237;nas de baja densidad&#187;&#41;&#44; y los valores de glucosa usando un equipo semiautomatizado &#40;COBAS MIRA&#44; Roche Diagnostics&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">En este estudio la definici&#243;n de SM se realiz&#243; considerando 3 de los criterios establecidos para ni&#241;os y adolescentes de 10 hasta 16 a&#241;os por la <span class="elsevierStyleItalic">International Diabetes Federation</span> &#40;IDF&#41;&#58; glucosa<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; triglic&#233;ridos<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>150<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; colesterol HDL<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; y 2 de los criterios propuestos por la OMS&#58; obesidad&#44; definida por un IMC<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>percentil 95&#44; y presi&#243;n arterial alterada<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>percentil 95<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lisis estad&#237;stico</span><p id="par0030" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico fue realizado con el <span class="elsevierStyleItalic">software</span> STATA v9&#46;2&#46; La estad&#237;stica descriptiva fue generada para todas las variables&#46; Las de tipo cualitativo nominal fueron expresadas como proporciones y las diferencias fueron calculadas usando la prueba de ji al cuadrado&#46; Las variables continuas con distribuci&#243;n normal fueron expresadas como media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#243;n est&#225;ndar&#44; y aquellas sin distribuci&#243;n normal&#44; como medianas y percentiles 5 y 95&#46; Las diferencias entre grupos fueron determinadas mediante las pruebas de t de Student y U de Mann-Whitney&#44; respectivamente&#46; Las frecuencias de SM y de sus componentes fueron definidas como porcentajes&#46; Los valores de <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">0&#44;05</span> fueron considerados estad&#237;sticamente significativos<span class="elsevierStyleItalic">&#46;</span></p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0035" class="elsevierStylePara elsevierViewall">El presente estudio incluy&#243; 225 ni&#241;os &#40;119 con peso normal y 106 con obesidad&#41;&#59; la media de edad en ambos grupos fue de 9 a&#241;os&#44; y la proporci&#243;n participante de ni&#241;os y ni&#241;as fue similar&#46; Los ni&#241;os con obesidad&#44; en comparaci&#243;n con los de peso normal&#44; mostraron un incremento significativo en las medidas antropom&#233;tricas&#44; cl&#237;nicas y metab&#243;licas &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; De acuerdo con los criterios establecidos en este estudio&#44; ambos grupos mostraron par&#225;metros metab&#243;licos alterados &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; En los ni&#241;os con peso normal las principales alteraciones metab&#243;licas observadas fueron en las siguientes mediciones&#58; glucosa en ayunos &#40;26&#44;9&#37;&#41;&#44; colesterol total &#40;19&#44;3&#37;&#41; y colesterol HDL &#40;11&#44;7&#37;&#41;&#46; Por otra parte&#44; los ni&#241;os con obesidad mostraron alteraciones en las siguientes mediciones&#58; colesterol HDL &#40;44&#44;3&#37;&#41;&#44; triglic&#233;ridos &#40;40&#44;6&#37;&#41;&#44; glucosa en ayunas &#40;40&#44;6&#37;&#41; y colesterol total &#40;39&#44;6&#37;&#41;&#46; El incremento en la presi&#243;n sangu&#237;nea se present&#243; &#250;nicamente en el grupo de ni&#241;os con obesidad &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; La prevalencia de SM en ni&#241;os con obesidad fue del 44&#44;3&#37; &#40;47 ni&#241;os&#41;&#44; y en el grupo de peso normal&#44; del 0&#44;84&#37; &#40;un ni&#241;o&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; En este estudio&#44; la prevalencia de SM por sexos no mostr&#243; diferencias significativas &#40;22&#44;2&#37; en ni&#241;as frente a 20&#44;5&#37; en ni&#241;os&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;75&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Considerando el n&#250;mero de componentes metab&#243;licos presentes&#44; un 62&#44;1&#37; de los ni&#241;os con peso normal fue metab&#243;licamente sano&#44; el 31&#44;9&#37; present&#243; un componente metab&#243;lico alterado&#44; y el 5&#44;04&#37;&#44; 2 componentes&#46; En el grupo de ni&#241;os con obesidad&#44; el 31&#44;1&#37; no present&#243; ninguna alteraci&#243;n cl&#237;nico-metab&#243;lica&#44; el 24&#44;5&#37; present&#243;&#44; adem&#225;s de obesidad&#44; un componente metab&#243;lico alterado&#44; el 26&#44;4&#37; 2 componentes&#44; el 15&#44;1&#37; 3 componentes&#44; y el 2&#44;83&#37; 4 componentes metab&#243;licos&#59; ning&#250;n ni&#241;o mostr&#243; alteraci&#243;n en los 5 componentes valorados &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">En este estudio se determinaron las principales combinaciones de componentes cl&#237;nico-metab&#243;licos que definen el SM en la poblaci&#243;n infantil sujeta a estudio&#46; En el grupo de ni&#241;os obesos&#44; la obesidad&#47;triglic&#233;ridos&#47;colesterol HDL fue la principal combinaci&#243;n &#40;34&#44;0&#37;&#41;&#44; seguida por la de obesidad&#47;glucosa&#47;triglic&#233;ridos&#47;colesterol HDL &#40;29&#44;8&#37;&#41; y obesidad&#47;glucosa&#47;colesterol HDL &#40;14&#44;9&#37;&#41;&#46; En ni&#241;os con peso normal&#44; la combinaci&#243;n que defini&#243; el SM fue la presencia de glucosa&#47;colesterol HDL&#47;triglic&#233;ridos &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n y conclusi&#243;n</span><p id="par0050" class="elsevierStylePara elsevierViewall">En estudios previos se ha demostrado que el aumento de la obesidad infantil est&#225; relacionado con un alto riesgo cardiometab&#243;lico durante la infancia y adolescencia<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#44; y el desarrollo de enfermedad coronaria 25 a&#241;os m&#225;s tarde<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#44; mientras que en la poblaci&#243;n adulta&#44; la presencia de componentes del SM independiente de la obesidad se asocia con el desarrollo de ECV<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#44;24</span></a>&#46; Por lo tanto&#44; la presencia de componentes del SM en la infancia predispone al aumento de la morbimortalidad por ECV&#46; Aunque los componentes metab&#243;licos han sido bien establecidos en la poblaci&#243;n adulta&#44; el patr&#243;n que define el SM en poblaci&#243;n infantil sigue siendo contradictorio&#46; En este estudio se observ&#243; la alteraci&#243;n de los par&#225;metros cl&#237;nico-metab&#243;licos asociados a la obesidad&#59; de manera similar&#44; otros estudios han determinado la asociaci&#243;n de la obesidad en la infancia con alteraciones metab&#243;licas&#44; que resultan fuertes determinantes del perfil lip&#237;dico&#44; los valores de insulina&#44; el SM y la DM2<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;26</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Para la poblaci&#243;n adulta mexicana&#44; se han reportado altas cifras de SM&#58; 36&#44;8&#37; de acuerdo con los criterios del <span class="elsevierStyleItalic">National Cholesterol Education Program Adult Treatment Panel III</span> &#40;ATP III&#41;&#44; 41&#44;6&#37; seg&#250;n la <span class="elsevierStyleItalic">American Heart Association&#47;National Heart&#44; Lung and Blood Institute</span>&#44; y 49&#44;8&#37; considerando la IDF<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#46; La alta prevalencia de SM encontrada en este estudio &#40;44&#44;3&#37;&#41;&#44; en los ni&#241;os con obesidad&#44; puede estar indicando que si los ni&#241;os obesos no disminuyen su peso&#44; pueden permanecer con el SM en la adolescencia y la vida adulta&#44; pasando a formar parte de las estad&#237;sticas antes mencionadas&#46; Por ello&#44; es importante realizar intervenciones en su estilo de vida&#44; para reducir su peso y mejorar sus condiciones metab&#243;licas&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En estudios realizados en grandes poblaciones de ni&#241;os y adolescentes se describen prevalencias de SM menores a la encontrada en nuestra poblaci&#243;n&#44; y var&#237;an en funci&#243;n de los criterios empleados en su definici&#243;n&#46; En Norteam&#233;rica&#44; el <span class="elsevierStyleItalic">III National Health and Nutrition Examination Survey</span> describi&#243; en poblaci&#243;n adolescente con obesidad una prevalencia de SM del 32&#44;1&#37;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#46; Considerando los criterios de Cook et al&#46;&#44; la prevalencia de SM fue del 27&#37;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#44; de acuerdo con los criterios del ATP III del 26&#44;1&#37;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&#44; increment&#225;ndose dram&#225;ticamente en ni&#241;os con obesidad de mayor grado&#44; alcanzando prevalencias de hasta el 50&#37; de acuerdo con los criterios de Weiss et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46; Por otra parte&#44; en ni&#241;os latinoamericanos obesos la prevalencia descrita es de alrededor del 36&#37;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#44; en ni&#241;os y adolescentes coreanos&#44; del 37&#44;5&#37;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#44; y en ni&#241;os chinos obesos&#44; del 33&#44;1&#37;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Aunque las prevalencias son altas en la mayor&#237;a de los pa&#237;ses&#44; otros estudios en prep&#250;beres obesos italianos<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a>&#44; ni&#241;os portugueses<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a>&#44; asi&#225;ticos<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> y de Qatar<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> han descrito prevalencias de SM significativamente menores&#46; Si bien la obesidad es un factor potenciador de la ocurrencia de SM en poblaci&#243;n infantil&#44; los ni&#241;os con peso normal tambi&#233;n desarrollan alteraciones metab&#243;licas&#46; En nuestra poblaci&#243;n&#44; el 0&#44;84&#37; de los ni&#241;os con peso normal mostr&#243; SM&#44; una prevalencia menor a la referida en adolescentes coreanos de peso normal &#40;1&#44;61&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> y en poblaci&#243;n infantil china &#40;2&#44;3&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a>&#46; Lo que evidencia que la variabilidad de criterios y valores de corte empleados en la definici&#243;n de SM influye sobre las prevalencias reportadas&#59; el origen &#233;tnico racial<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a>&#44; los factores gen&#233;ticos y los h&#225;bitos diet&#233;ticos y de estilo de vida parecen ser factores determinantes en su desarrollo<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">40&#44;41</span></a>&#46; Existen evidencias que demuestran que los criterios establecidos para la definici&#243;n de SM en poblaci&#243;n infantil estadounidense no son aplicables a todas las poblaciones<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a>&#46; Otros autores han considerado&#44; para el diagn&#243;stico de SM&#44; el &#237;ndice de masa del ventr&#237;culo izquierdo como un par&#225;metro espec&#237;fico y sensible en poblaci&#243;n pedi&#225;trica y adolescentes<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a>&#44; as&#237; como tambi&#233;n la determinaci&#243;n de la funci&#243;n de las c&#233;lulas &#223; pancre&#225;ticas&#44; debido a que la sensibilidad a la insulina disminuye en sujetos en transici&#243;n de tolerante a intolerante a la glucosa y de intolerante a DM2<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a>&#44; as&#237; como el uso de valores de corte para obesidad basados en el z-<span class="elsevierStyleItalic">score</span>&#44; que podr&#237;an ayudar a proveer datos comparables a nivel internacional en ni&#241;os y adolescentes<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">En este estudio se evaluaron las caracter&#237;sticas individuales del SM&#58; los triglic&#233;ridos elevados&#44; el colesterol HDL bajo y la glucosa alterada en ayunos fueron las anormalidades metab&#243;licas m&#225;s frecuentes en la poblaci&#243;n infantil&#46; De manera similar&#44; en otro estudio realizado en ni&#241;os mexicanos&#44; la dislipidemia fue una de las caracter&#237;sticas frecuentemente asociada al SM<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a>&#46; La alta prevalencia de colesterol HDL bajo mostrada en este estudio es una de las alteraciones frecuentemente descrita en la literatura m&#233;dica<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26&#44;37&#44;38&#44;46&#8211;49</span></a>&#46; Se ha encontrado que la hipertrigliceridemia tiene una influencia &#233;tnica racial importante&#44; siendo mayor en blancos no hispanos e hispanos en comparaci&#243;n con la poblaci&#243;n afroamericana&#44; lo que tambi&#233;n se refleja en la tasa de SM referida entre grupos &#233;tnicos<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">48&#44;50</span></a>&#46; La presencia de alteraciones metab&#243;licas en ambos grupos de estudio es importante debido a que su persistencia constituye un factor independiente predictor de diabetes y futura ECV<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">51&#8211;53</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">De acuerdo con nuestro conocimiento&#44; este es el primer estudio que provee evidencia de la heterogeneidad en el desarrollo de SM en la poblaci&#243;n infantil mexicana&#44; mostrando la presencia de patrones variados de componentes que definen el SM en ni&#241;os obesos y con peso normal&#44; predominando las combinaciones de obesidad&#47;triglic&#233;ridos&#47;colesterol HDL &#40;34&#44;0&#37;&#41;&#44; obesidad&#47;glucosa&#47;triglic&#233;ridos&#47;colesterol HDL &#40;29&#44;8&#37;&#41; y obesidad&#47;triglic&#233;ridos&#47;colesterol HDL &#40;14&#44;9&#37;&#41;&#46; Adem&#225;s&#44; en los ni&#241;os con peso normal&#44; el 38&#37; mostraron alteraciones metab&#243;licas&#44; siendo la m&#225;s frecuente la glucosa alterada en ayunos&#44; seguida por un colesterol HDL bajo y un aumento de los triglic&#233;ridos&#46; Algunos autores han determinado la frecuencia de m&#250;ltiples componentes del SM&#44; pero no definen de manera espec&#237;fica qu&#233; componentes lo constituyen&#46; Liu et al&#46;&#44; en ni&#241;os chinos de edad escolar con sobrepeso y obesidad&#44; demostraron que tienen en promedio 1&#44;75 a 2&#44;08 componentes de SM<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Conocer los principales grupos de componentes del SM podr&#237;a ayudar a establecer estrategias de intervenci&#243;n basadas principalmente en la modificaci&#243;n de los estilos de vida y la integraci&#243;n de grupos multidisciplinarios que incluyan pacientes y familias&#44; y no en la utilizaci&#243;n de medidas farmacol&#243;gicas<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">54&#44;55</span></a>&#44; de tal forma que las instituciones responsables de dictar las pol&#237;ticas en salud a nivel del pa&#237;s puedan conocer la magnitud del problema&#44; para dirigir acciones hacia los grupos m&#225;s susceptibles y poder evaluar si las estrategias de prevenci&#243;n o control son efectivas&#44; considerando para su evaluaci&#243;n los componentes del SM que se presentan con mayor frecuencia en la poblaci&#243;n infantil&#46; Adem&#225;s de que la intervenci&#243;n temprana ayudar&#225; a la disminuci&#243;n de las tasas de morbimortalidad en j&#243;venes y adultos&#46; En conclusi&#243;n&#44; el 44&#44;3&#37; de los ni&#241;os escolares con obesidad presentaron SM&#44; siendo las dislipidemias fuertes determinantes de este s&#237;ndrome&#46; Aunque en los ni&#241;os con normopeso la prevalencia es baja&#44; la tercera parte presenta al menos uno de los componentes del s&#237;ndrome&#44; lo que aconseja una intervenci&#243;n inmediata para controlar o revertir estas alteraciones&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicto de intereses</span><p id="par0085" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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              "identificador" => "abst0005"
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            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Pacientes y m&#233;todos"
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            2 => array:2 [
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              "identificador" => "abst0020"
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        1 => array:2 [
          "identificador" => "xpalclavsec841859"
          "titulo" => "Palabras clave"
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          "titulo" => "Abstract"
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            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Background and objective"
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            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Patients and methods"
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              "identificador" => "abst0035"
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              "identificador" => "abst0040"
              "titulo" => "Conclusion"
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        3 => array:2 [
          "identificador" => "xpalclavsec841860"
          "titulo" => "Keywords"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introducci&#243;n"
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        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Sujetos&#44; material y m&#233;todos"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Mediciones antropom&#233;tricas y cl&#237;nicas"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Determinaciones bioqu&#237;micas y definiciones"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "An&#225;lisis estad&#237;stico"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Resultados"
        ]
        7 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Discusi&#243;n y conclusi&#243;n"
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        8 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Conflicto de intereses"
        ]
        9 => array:1 [
          "titulo" => "Bibliograf&#237;a"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2013-06-27"
    "fechaAceptado" => "2013-10-24"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec841859"
          "palabras" => array:4 [
            0 => "S&#237;ndrome metab&#243;lico"
            1 => "Prevalencia"
            2 => "Obesidad"
            3 => "Ni&#241;os"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec841860"
          "palabras" => array:4 [
            0 => "Metabolic syndrome"
            1 => "Prevalence"
            2 => "Obesity"
            3 => "Children"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamento y objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La obesidad infantil es el principal factor de riesgo para el desarrollo de s&#237;ndrome metab&#243;lico &#40;SM&#41; durante la infancia&#44; adolescencia y vida adulta&#46; El objetivo de este estudio fue determinar la prevalencia de los componentes del SM&#44; y de las principales combinaciones que lo definen&#44; en una muestra de ni&#241;os escolares con y sin obesidad&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Un total de 225 ni&#241;os con edades entre 6 y 12 a&#241;os&#44; 106 con obesidad y 119 con peso normal&#44; fueron incluidos&#46; El SM fue definido por la presencia de 3 o m&#225;s de los siguientes componentes&#58; &#237;ndice de masa corporal<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>percentil 95&#44; glucosa en ayunos<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; triglic&#233;ridos<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>150<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; colesterol unido a <span class="elsevierStyleItalic">high density lipoproteins</span> &#40;HDL&#44; &#171;lipoprote&#237;nas de alta densidad&#187;&#41;<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; presi&#243;n arterial sist&#243;lica y diast&#243;lica<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>percentil 95&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En ambos grupos analizados se encontraron componentes del SM&#46; En el grupo con obesidad&#44; el colesterol HDL&#44; los triglic&#233;ridos&#44; la glucosa en ayunos y el colesterol total fueron las alteraciones m&#225;s frecuentes&#59; en los de peso normal predomin&#243; el incremento en los valores de glucosa&#44; colesterol total y disminuci&#243;n de colesterol HDL&#46; La prevalencia de SM en ni&#241;os con obesidad fue del 44&#44;3&#37;&#44; y en ni&#241;os de peso normal&#44; del 0&#44;84&#37;&#46; Las 3 principales combinaciones que definieron el SM en ni&#241;os obesos fueron&#58; obesidad&#47;triglic&#233;ridos&#47;colesterol HDL &#40;34&#44;0&#37;&#41;&#59; obesidad&#47;glucosa&#47;triglic&#233;ridos&#47;colesterol HDL &#40;29&#44;8&#37;&#41; y obesidad&#47;glucosa&#47;colesterol HDL &#40;14&#44;9&#37;&#41;&#59; en el grupo con peso normal&#58; glucosa&#47;colesterol HDL&#47;triglic&#233;ridos&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El 44&#44;3&#37; de los ni&#241;os escolares con obesidad presentaron SM&#59; las dislipidemias mostraron ser fuertes determinantes del SM&#46; Aunque en los ni&#241;os con normopeso la prevalencia es baja&#44; la tercera parte present&#243; al menos uno de los componentes del SM&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Fundamento y objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Pacientes 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">Background and objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Childhood obesity is considered the main risk factor for the development of metabolic syndrome &#40;MetS&#41; during childhood&#44; adolescence and adulthood&#46; This study aimed to determine the prevalence of MetS components and its main defining combinations in a sample of school children with and without obesity&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A total of 225 children aged 6-12 years&#44; 106 obese and 119 with normal weight were included&#46; MetS was defined by the presence of 3 or more of the following&#58; obesity as a body mass index<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>95th percentile&#44; fasting glucose<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; triglycerides<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; high density lipoproteins cholesterol &#40;HDL-c&#41;<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mg&#47;dL and systolic and diastolic blood pressure<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>95th percentile&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We found MetS components in both groups&#46; Most frequent abnormalities in the obese group included increased levels of HDL-c&#44; triglycerides&#44; fasting glucose and total cholesterol&#44; while increased levels of glucose and total cholesterol&#44; and lower HDL-c levels predominated in the normal weight group&#46; The prevalence of MetS in the obese group was 44&#46;3&#37; and&#44; in normal weight children&#44; it was 0&#46;84&#37;&#46; The 3 main components that defined the MetS in the obese group were obesity&#47;triglycerides&#47;HDL-c &#40;34&#46;0&#37;&#41;&#44; obesity&#47;glucose&#47;triglycerides&#47;HDL-c &#40;29&#46;8&#37;&#41; and obesity&#47;glucose&#47;HDL-c &#40;14&#46;9&#37;&#41;&#44; while the only combination observed in the normal weight group was glucose&#47;HDL-c&#47;triglycerides&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A percentage of 44&#46;3 of obese school children had MetS&#44; and dyslipidemia showed to be strong determinants of MetS&#46; Although the prevalence of MetS was low in children with normal weight&#44; one third of them showed one of the components of MetS&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Background and objective"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Patients and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusion"
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        ]
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        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Colesterol HDL&#58; colesterol unido a <span class="elsevierStyleItalic">high density lipoproteins</span> &#40;&#171;lipoprote&#237;nas de alta densidad&#187;&#41;&#59; Colesterol LDL&#58; colesterol unido a <span class="elsevierStyleItalic">low density lipoproteins</span> &#40;&#171;lipoprote&#237;nas de baja densidad&#187;&#41;&#59; IMC&#58; &#237;ndice de masa corporal&#59; PA&#58; presi&#243;n arterial&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Los datos se expresan como media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#243;n est&#225;ndar o como mediana &#40;percentil 5&#8211;percentil 95&#41;&#46; Los valores de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 son considerados estad&#237;sticamente significativos&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Peso normal &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>119&#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">Obesidad &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>106&#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">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Edad &#40;a&#241;os&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;6-12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;6-11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="char" valign="top"><span class="elsevierStyleItalic">Sexo</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ni&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57 &#40;47&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60 &#40;56&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ni&#241;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62 &#40;52&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46 &#40;43&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Peso &#40;kg&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#44;8 &#40;19&#44;2-39&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#44;55 &#40;27&#44;4-63&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>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  " align="left" valign="top"><span class="elsevierStyleItalic">Talla &#40;cm&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130&#44;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">135&#44;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>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  " align="left" valign="top"><span class="elsevierStyleItalic">IMC &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#44;3 &#40;13&#44;9-19&#44;08&#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&#44;1 &#40;18&#44;8-29&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>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  " align="left" valign="top"><span class="elsevierStyleItalic">Circunferencia de cintura &#40;cm&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62 &#40;52-73&#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;64&#44;5-94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>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  " align="left" valign="top"><span class="elsevierStyleItalic">PA sist&#243;lica &#40;mmHg&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90 &#40;80-108&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">101 &#40;90-123&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>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  " align="left" valign="top"><span class="elsevierStyleItalic">PA diast&#243;lica &#40;mmHg&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54 &#40;45-61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60 &#40;50-77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>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  " align="left" valign="top"><span class="elsevierStyleItalic">Glucosa s&#233;rica en ayunos &#40;mg&#47;dl&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95 &#40;72-112&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98 &#40;83-112&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Colesterol total &#40;mg&#47;dl&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">171&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">187&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>29&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>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  " align="left" valign="top"><span class="elsevierStyleItalic">Triglic&#233;ridos &#40;mg&#47;dl&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68 &#40;25-150&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">138 &#40;57-204&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>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  " align="left" valign="top"><span class="elsevierStyleItalic">Colesterol HDL &#40;mg&#47;dl&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64 &#40;34-101&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#44;5 &#40;23-83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>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  " align="left" valign="top"><span class="elsevierStyleItalic">Colesterol LDL &#40;mg&#47;dl&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&#44;3 &#40;53&#44;4-158&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">102&#44;2 &#40;63&#44;5-180&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Prueba U de Mann-Whitney&#46;</p>"
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            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Prueba de ji al cuadrado&#46;</p>"
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            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Prueba t de Student&#46;</p>"
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          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas antropom&#233;tricas&#44; cl&#237;nicas y metab&#243;licas en ni&#241;os mexicanos</p>"
        ]
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        "identificador" => "tbl0010"
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        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Colesterol HDL&#58; colesterol unido a <span class="elsevierStyleItalic">high density lipoproteins</span> &#40;&#171;lipoprote&#237;nas de alta densidad&#187;&#41;&#59; PA&#58; presi&#243;n arterial&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Valores de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 se consideraron estad&#237;sticamente significativos&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>225&#41;&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Peso normal &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>119&#41;&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Obesidad &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>106&#41;&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&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">Glucosa &#40;mg&#47;dl&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">150 &#40;66&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87 &#40;73&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63 &#40;59&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;03<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;26&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;40&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Triglic&#233;ridos &#40;mg&#47;dl&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">176 &#40;78&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">113 &#40;95&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63 &#40;59&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49 &#40;21&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;5&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;40&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Colesterol total &#40;mg&#47;dl&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">160 &#40;71&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96 &#40;80&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64 &#40;60&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65 &#40;28&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;19&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42 &#40;39&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Colesterol HDL &#40;mg&#47;dl&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">164 &#40;72&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">105 &#40;88&#44;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59 &#40;55&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61 &#40;27&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;11&#44;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;44&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">PA sist&#243;lica &#40;mmHg&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>Percentil 95 &#40;&#60;<span class="elsevierStyleHsp" style=""></span>117<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">219 &#40;97&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">119 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100 &#40;94&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;010<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span> Percentil 95 &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>117<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;5&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">PA diast&#243;lica &#40;mmHg&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span> Percentil 95 &#40;&#60;<span class="elsevierStyleHsp" style=""></span>80<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">222 &#40;98&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">119 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">103 &#40;97&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;10<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span> Percentil 95 &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>80<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;1&#44;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;2&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">S&#237;ndrome metab&#243;lico</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">177 &#40;78&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">118 &#40;99&#44;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59 &#40;55&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48 &#40;21&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;44&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Prevalencia de componentes del s&#237;ndrome metab&#243;lico en ni&#241;os mexicanos</p>"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">SM&#58; s&#237;ndrome metab&#243;lico&#46;</p>"
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                  \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">N&#250;mero de componentes de SM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Prevalencia</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>225&#41;&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Peso normal &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>119&#41;&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Obesidad &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>106&#41;&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">107 &#40;47&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74 &#40;62&#44;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33 &#40;31&#44;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64 &#40;28&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;31&#44;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;24&#44;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;15&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;5&#44;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;26&#44;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;15&#44;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;1&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Prevalencia de n&#250;mero de componentes de s&#237;ndrome metab&#243;lico en ni&#241;os mexicanos</p>"
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Colesterol HDL&#58; colesterol unido a <span class="elsevierStyleItalic">high density lipoproteins</span> &#40;&#171;lipoprote&#237;nas de alta densidad&#187;&#41;&#59; PAD&#58; presi&#243;n arterial diast&#243;lica&#59; PAS&#58; presi&#243;n arterial sist&#243;lica&#59; SM&#58; s&#237;ndrome metab&#243;lico&#46;</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Los datos mostrados representan las proporciones de las diferentes combinaciones de componentes que constituyen el s&#237;ndrome metab&#243;lico en ni&#241;os con peso normal y obesidad&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Grupos de componentes&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">Peso normal &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>119&#41;&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Obesidad &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>106&#41;&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SM en el grupo de obesidad &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>47&#41;&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Ninguno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74 &#40;62&#44;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;31&#44;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Glucosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;24&#44;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;13&#44;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Colesterol HDL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;6&#44;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;5&#44;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Triglic&#233;ridos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;4&#44;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">PAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Colesterol HDL&#43;triglic&#233;ridos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;2&#44;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;15&#44;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;34&#44;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Glucosa<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>colesterol HDL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;1&#44;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;6&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;14&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Glucosa<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>triglic&#233;ridos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;3&#44;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;8&#44;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Glucosa<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>PAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#44;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Glucosa<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>colesterol HDL<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>triglic&#233;ridos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;13&#44;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;29&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Glucosa<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>colesterol HDL<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>PAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#44;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Glucosa<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>PAS<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>PAD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#44;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Glucosa<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>colesterol HDL<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>triglic&#233;ridos<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>PAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;1&#44;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;4&#44;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Colesterol HDL<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>triglic&#233;ridos<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>PAS<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>PAD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#44;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1429855.png"
              ]
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        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Grupos de componentes de s&#237;ndrome metab&#243;lico en ni&#241;os con peso normal y con obesidad</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:55 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity in children and young people&#58; A crisis in public health"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "IASO International Obesity Task Force"
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46; Lobstein"
                            1 => "L&#46; Baur"
                            2 => "R&#46; Uauy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1467-789X.2004.00133.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Obes Rev"
                        "fecha" => "2004"
                        "volumen" => "5"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "4"
                        "paginaFinal" => "104"
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