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ARTIGO ORIGINAL
Índices antropométricos em escolares de um município no Sul do Brasil: análise descritiva utilizando o método LMS1
Anthropometric indices among schoolchildren from a municipality in Southern Brazil: a descriptive analysis using the LMS method
Valter Cordeiro Barbosa Filhoa,
Autor para correspondencia
valtercbf@gmail.com

Autor para correspondência.
, Adair da Silva Lopesa, Ricardo Rosa Fagundesb, Wagner de Camposb
a Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brasil
b Universidade Federal do Paraná (UFPR), Curitiba, PR, Brasil
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">O padr&#227;o de crescimento corporal indica o desenvolvimen&#8208;to do corpo &#8220;aceit&#225;vel&#8221; e &#8220;esperado&#8221; durante a inf&#226;ncia&#44; o qual todas as crian&#231;as devem alcan&#231;ar&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> No entanto&#44; a ocorr&#234;ncia de dist&#250;rbios nutricionais relacionados ao cres&#8208;cimento da crian&#231;a&#44; tal como a obesidade geral ou cen&#8208;tralizada &#40;abdominal&#41;&#44; reflete a intera&#231;&#227;o entre fatores ambientais desfavor&#225;veis e&#47;ou predisposi&#231;&#227;o gen&#233;tica&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Como a obesidade geral e abdominal est&#227;o cada vez mais presentes em crian&#231;as<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> e aumentam as chances de compli&#8208;ca&#231;&#245;es metab&#243;licas precoces<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> e futuras&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> o monitoramento do crescimento f&#237;sico &#233; crucial na promo&#231;&#227;o da sa&#250;de das crian&#231;as&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A combina&#231;&#227;o de diferentes medidas antropom&#233;tricas &#40;por exemplo&#44; peso&#44; altura ou circunfer&#234;ncia da cintura &#91;CC&#93;&#41; ou indicadores &#40;por exemplo&#44; &#237;ndice de massa corporal &#91;IMC&#93; e rela&#231;&#227;o cintura&#8208;estatura &#91;RCEst&#93;&#41; tem sido frequentemente utilizada em estudos sobre o crescimento e sa&#250;de da crian&#231;a&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;8</span></a> Desses indicadores antropom&#233;tricos&#44; o IMC &#233; o mais frequentemente utilizado para identificar o padr&#227;o de crescimento f&#237;sico e estado nutricional na pr&#225;tica cl&#237;nica e epidemiol&#243;gica&#44; pois &#233; um indicador simples e de baixo custo&#44; bem como um forte preditor de sa&#250;de da crian&#231;a&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> A CC representa o ac&#250;mulo de gordura abdominal e visceral e prev&#234; fatores de risco cardiovascular&#44; assim como ou at&#233; mesmo melhor do que o IMC&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;6</span></a> Outros estudos enfatizaram que RCEst est&#225; fortemente associada a fatores de risco cardiovascular em idades menores&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;9</span></a> Assim&#44; o uso desses diferentes m&#233;todos antropom&#233;tricos permite uma melhor estimativa do padr&#227;o de crescimento infantil e estado nutricional durante a inf&#226;ncia&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Curvas percent&#237;licas de refer&#234;ncia foram desenvolvidas para mostrar o padr&#227;o de crescimento e estado nutricional das popula&#231;&#245;es pedi&#225;tricas de diferentes pa&#237;ses&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#8211;20</span></a> Estas curvas utilizam o m&#233;todo LMS&#44; um procedimento estat&#237;stico para uma estimativa mais robusta de valores percent&#237;licos&#44; especialmente se as vari&#225;veis de crescimento f&#237;sico n&#227;o t&#234;m uma distribui&#231;&#227;o sim&#233;trica na popula&#231;&#227;o&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Alguns estudos tamb&#233;m utilizaram o m&#233;todo LMS para comparar massa corporal e percentis de altura de crian&#231;as brasileiras com as de outros pa&#237;ses&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#44;24</span></a> No entanto&#44; uma compara&#231;&#227;o dos valores de percentis de IMC&#44; CC e RCEst entre as crian&#231;as brasileiras e crian&#231;as de outros pa&#237;ses &#233; desconhecida&#46; Um estudo com esses diferentes indicadores antropom&#233;tricos pode representar uma melhor estimativa do padr&#227;o de crescimento f&#237;sico entre as crian&#231;as brasileiras&#46; Al&#233;m disso&#44; &#233; necess&#225;rio testar se h&#225; diferen&#231;a antropom&#233;trica entre as crian&#231;as do Brasil e aquelas desses pa&#237;ses&#44; a fim de identificar padr&#245;es distintos de crescimento e testar a necessidade das curvas percent&#237;licas antropom&#233;tricas para as crian&#231;as brasileiras&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Finalmente&#44; essa compara&#231;&#227;o pode identificar se uma popula&#231;&#227;o infantil tem tend&#234;ncias de crescimento f&#237;sico &#40;para condi&#231;&#245;es ambientais e gen&#233;ticas&#41; que favorecem dist&#250;rbios nutricionais&#44; como a obesidade geral e abdominal&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Essas quest&#245;es s&#227;o importantes para o desenvolvimento de pol&#237;ticas p&#250;blicas destinadas a reduzir dist&#250;rbios nutricionais em crian&#231;as brasileiras&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Portanto&#44; o objetivo desse estudo foi determinar o padr&#227;o de crescimento f&#237;sico &#40;IMC&#44; CC e RCEst&#41; em crian&#231;as em idade escolar da cidade de Colombo&#44; estado do Paran&#225;&#44; sul do Brasil&#44; e compar&#225;&#8208;lo com o crescimento f&#237;sico de crian&#231;as de outros pa&#237;ses&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todo</span><p id="par0030" class="elsevierStylePara elsevierViewall">Esse foi um estudo transversal&#44; realizado na cidade de Colombo&#44; estado do Paran&#225;&#44; sul do Brasil&#46; Esse munic&#237;pio est&#225; localizado ao norte da regi&#227;o metropolitana de Curitiba &#40;capital do estado&#41; e seu &#205;ndice de Desenvolvimento Humano &#40;IDH 2000&#41; &#233; 0&#44;764&#44; o 107&#176; entre os 399 munic&#237;pios no estado do Paran&#225;&#46; Colombo tinha 27&#46;000 crian&#231;as matriculadas em aulas regulares da 1<span class="elsevierStyleSup">a</span> a 5<span class="elsevierStyleSup">a</span> s&#233;ries em escolas p&#250;blicas e privadas&#46; 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escolas p&#250;blicas da &#225;rea urbana&#44; escolas p&#250;blicas na &#225;rea rural&#44; e escolas particulares&#46; Em primeiro lugar&#44; foi realizada uma sele&#231;&#227;o aleat&#243;ria de escolas em cada um dos tr&#234;s estratos&#46; O n&#250;mero de escolas por estrato foi calculado considerando&#8208;se a proporcionalidade das crian&#231;as em cada estrato&#46; Todas as escolas selecionadas foram convidadas e aceitaram participar do estudo&#46; Em segundo lugar&#44; todas as crian&#231;as matriculadas em turmas do 1&#176; ao 5&#176; ano do ensino fundamental foram convidadas a participar do estudo&#46; Visitamos 14 escolas&#44; o que incluiu um total de 138 classes e 2&#46;750 crian&#231;as convidadas a participar desse estudo&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">As medidas antropom&#233;tricas &#40;peso&#44; estatura e CC&#41; foram obtidas de mar&#231;o a setembro de 2012&#46; Cada crian&#231;a foi avaliada individualmente&#44; a fim de minimizar ressalvas&#46; Todas as medi&#231;&#245;es foram realizadas por um &#250;nico avaliador experiente com o objetivo de excluir erros interexaminador&#46; Dois professores de Educa&#231;&#227;o F&#237;sica realizaram a anota&#231;&#227;o de dados antropom&#233;tricos&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Os materiais utilizados nesse estudo foram&#58; fita m&#233;trica &#40;Easyread Cateb&#174;&#44; S&#227;o Paulo&#44; Brasil&#41; &#40;0&#44;1<span class="elsevierStyleHsp" style=""></span>cm de largura&#41; fixa em uma parede que n&#227;o tinha rodap&#233; para determinar a altura&#59; balan&#231;a digital &#40;Wiso&#174;&#44; Santa Catarina&#44; Brasil&#41; &#40;resolu&#231;&#227;o de 100<span class="elsevierStyleHsp" style=""></span>g e capacidade de 150<span class="elsevierStyleHsp" style=""></span>kg&#41; para medir o peso corporal&#59; e uma trena de metal &#40;Cescorf&#174;&#44; Rio Grande do Sul&#44; Brasil&#41; &#40;resolu&#231;&#227;o de 0&#44;1<span class="elsevierStyleHsp" style=""></span>cm&#41; para avaliar a CC&#46; A altura e a massa corporal foram medidas de acordo com o protocolo padr&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Para as medi&#231;&#245;es de altura e peso corporal&#44; a crian&#231;a foi avaliada na posi&#231;&#227;o de p&#233;&#44; sem sapatos e vestindo o uniforme de Educa&#231;&#227;o F&#237;sica&#46; Medidas de peso e altura foram utilizadas para calcular o IMC &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#46; O IMC foi classificado por sexo e idade de acordo com os valores propostos pela Organiza&#231;&#227;o Mundial da Sa&#250;de &#40;OMS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">A CC foi medida na posi&#231;&#227;o em p&#233; no ponto m&#233;dio entre a margem costal inferior e a crista il&#237;aca&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Duas medidas foram obtidas de cada crian&#231;a e a m&#233;dia delas foi calculada &#40;coeficiente de correla&#231;&#227;o intraclasse<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;99&#41;&#46; A rela&#231;&#227;o cintura&#8208;estatura &#40;RCEst<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>CC&#47;altura&#41; foi calculada&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">A idade foi calculada considerando&#8208;se a diferen&#231;a entre o anivers&#225;rio e a data de coleta&#46; O seguinte crit&#233;rio foi usado para determinar o intervalo entre as idades&#58; 6&#44;0&#8208;6&#44;9<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#59; 7&#44;0&#8208;7&#44;9<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7 anos&#59; 8&#44;0&#8208;8&#44;9<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#59; 9&#44;0&#8208;9&#44;9<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9 anos&#59; 10&#44;0&#8208;10&#44;9<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10 anos&#44; e 11&#44;0&#8208;11&#44;9<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11 anos&#46; Sexo&#44; tipo de escola&#44; turno&#44; grau e localiza&#231;&#227;o da escola foram determinados de acordo com as informa&#231;&#245;es obtidas a partir de cada conselho escolar&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">As estat&#237;sticas descritivas foram baseadas em m&#233;dia e desvio padr&#227;o para as vari&#225;veis cont&#237;nuas&#44; e em frequ&#234;ncias absolutas e relativas para as vari&#225;veis categ&#243;ricas&#46; Foram constru&#237;das curvas percent&#237;licas espec&#237;ficas de idade e sexo para as vari&#225;veis antropom&#233;tricas &#40;IMC&#44; CC e RCEst&#41;&#44; utili&#8208;zando o m&#233;todo LMS&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> O m&#233;todo LMS presume que&#44; para os dados positivos e independentes&#44; a transforma&#231;&#227;o de Box&#8208;Cox para cada idade pode ser empregada para norma&#8208;lizar a distribui&#231;&#227;o dos valores de cada uma das vari&#225;veis antropom&#233;tricas&#46; Todos os valores percentuais espec&#237;ficos de sexo e idade para IMC&#44; CC e RCEst &#40;3&#44; 10&#44; 25&#44; 50&#44; 75&#44; 90 e 97&#41; foram suavizados com o programa <span class="elsevierStyleItalic">LMSChartmaker Light</span> vers&#227;o 2&#46;3 &#40;The Institute of Child Health&#44; Londres&#58; <a href="http://www/">www</a>&#46; healthforallchildren&#46;co&#46;uk&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Foram constru&#237;dos gr&#225;ficos que inclu&#237;ram os valores percentuais 10&#44; 50 e 90 das crian&#231;as desse estudo e de outros estudos&#46; Valores percentuais de IMC foram comparados com dados da OMS&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> US Center for Disease Control and Prevention&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Paquist&#227;o&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> &#205;ndia13 e Alemanha&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Os valores percentuais da CC foram comparados com dados da Alemanha&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Paquist&#227;o&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> M&#233;xico&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Hong Kong<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> e &#205;ndia&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Finalmente&#44; valores percentuais de RCEst foram comparados com valores da &#205;ndia&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Hong Kong&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Paquist&#227;o<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> e Noruega&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Esses estudos foram escolhidos considerando&#58; &#40;1&#41; crian&#231;as com faixa et&#225;ria semelhante &#224; desse estudo&#59; &#40;2&#41; mesmos procedimentos estat&#237;sticos para a constru&#231;&#227;o das curvas percent&#237;licas &#40;m&#233;todo LMS&#41;&#59; &#40;3&#41; presen&#231;a dos valores percentuais 10&#44; 50 e 90&#44; e &#40;4&#41; mesmos protocolos para medidas antropom&#233;tricas&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">O Comit&#234; de &#201;tica em Pesquisa da Universidade Federal do Paran&#225; aprovou o estudo &#40;CAAE&#58; 5371&#46;0&#46;000&#46;091&#8208;10&#41;&#46; Cada escola deu sua permiss&#227;o formal para coletar os dados&#46; Cada um dos pais&#47;respons&#225;veis de cada crian&#231;a assinou um termo de consentimento para a participa&#231;&#227;o no estudo&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0085" class="elsevierStylePara elsevierViewall">Entre as 2&#46;750 crian&#231;as convidadas a participar do estudo&#44; 26&#37; n&#227;o retornaram o formul&#225;rio de consentimento assinado pelos pais&#47;respons&#225;veis ou se recusaram a participar&#46; Essas crian&#231;as n&#227;o foram avaliadas&#46; Al&#233;m disso&#44; uma crian&#231;a com 15 anos de idade foi exclu&#237;da&#46; N&#227;o houve perdas devido ao preenchimento incompleto de dados&#46; Assim&#44; a amostra final foi composta por 2&#46;035 crian&#231;as &#40;1&#46;016 meninos e 1&#46;019 meninas&#41; que tinham uma idade m&#233;dia de 8&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;4 anos de idade&#46; A maior parte da amostra foi composta por alunos que estudavam no per&#237;odo da manh&#227; &#40;55&#44;4&#37;&#41;&#44; em escolas p&#250;blicas &#40;63&#44;3&#37;&#41; e em escolas localizadas na &#225;rea urbana&#46; De acordo com os crit&#233;rios da OMS&#44; 0&#44;8&#37; das crian&#231;as apresentavam baixo peso&#44; 19&#44;4&#37; apresentavam sobrepeso e 6&#44;0&#37; eram obesos&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Considerando&#8208;se os valores percentuais suavizados e espec&#237;ficos para sexo e idade&#44; o IMC aumentou com a idade&#44; tanto em meninos quanto em meninas&#46; O IMC mostrou tend&#234;ncia a ser semelhante em meninos e meninas at&#233; os 10 anos de idade&#46; Aos 11 anos&#44; as meninas apresentavam valores de IMC mais elevados do que os meninos&#46; A CC teve um ligeiro aumento at&#233; os 8 anos de idade&#46; Ap&#243;s essa idade&#44; houve um aumento mais r&#225;pido da CC tanto para os meninos quanto para as meninas&#46; A CC foi semelhante em meninos e meninas at&#233; os 8 anos de idade&#46; As meninas apresentaram uma CC mais elevada do que os meninos em idades posteriores&#46; A RCEst manteve&#8208;se est&#225;vel at&#233; os 9 anos de idade&#46; Foram observadas redu&#231;&#245;es m&#237;nimas nos valores de RCEst em idades posteriores&#46; Essa tend&#234;ncia foi semelhante em meninos e meninas &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Os percentis 10 e 50 de IMC foram semelhantes entre as crian&#231;as de diferentes estudos&#44; tanto em meninos quanto em meninas&#46; As maiores diferen&#231;as entre os pa&#237;ses ocorre&#8208;ram nos valores do percentil 90&#46; As crian&#231;as de Colombo &#40;Brasil&#41; apresentaram percentis de IMC semelhantes aos de crian&#231;as alem&#227;s e maiores do que de crian&#231;as de outros pa&#237;ses&#44; incluindo as crian&#231;as do estudo da OMS e dos Estados Unidos&#44; &#205;ndia e Paquist&#227;o&#46; Este padr&#227;o foi semelhante em meninos e meninas &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Para a CC&#44; as diferen&#231;as entre os pa&#237;ses tamb&#233;m foram mais evidentes nos valores de percentil 90&#46; Os meninos e meninas de Colombo &#40;Brasil&#41; apresentaram valores de percentil 90 mais baixos espec&#237;ficos para idade do que as crian&#231;as de outros pa&#237;ses&#46; Al&#233;m disso&#44; os meninos e meninas mexicanas apresentaram os maiores valores de percentil 90 para CC&#46; Meninos da Alemanha e meninas do Paquist&#227;o tamb&#233;m apresentaram valores de percentil 90 mais ele&#8208;vados do que as crian&#231;as de Colombo &#40;Brasil&#41; e de outros pa&#237;ses &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">As diferen&#231;as para valores percentuais da RCEst entre crian&#231;as de Colombo &#40;Brasil&#41; e de outros pa&#237;ses foram mais evidentes&#44; considerando os valores de percentil 90&#46; No entanto&#44; em alguns casos&#44; os valores de percentil 50 entre as crian&#231;as de um pa&#237;s foram similares aos valores de percentil 10 de outros pa&#237;ses &#40;por exemplo&#44; as crian&#231;as de Colombo Brasil e Hong Kong tiveram valores de percentil 50 muito pr&#243;ximos dos valores de percentil 10 de crian&#231;as da &#205;ndia&#41;&#46; Meninos e meninas de Colombo &#40;Brasil&#41; apresentaram valores de percentil intermedi&#225;rios ou mais baixos em compara&#231;&#227;o com as crian&#231;as dos outros pa&#237;ses&#46; Os maiores valores de percentil 90 para RCEst foram observados em meninos e meninas paquistanesas &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discuss&#227;o</span><p id="par0115" class="elsevierStylePara elsevierViewall">Em nosso conhecimento&#44; esse foi o primeiro estudo que mostra os valores percentuais do IMC&#44; CC e RCEst em uma amostra de crian&#231;as brasileiras e os compara com dados internacionais&#46; A compara&#231;&#227;o dos indicadores antropo&#8208;m&#233;tricos de obesidade geral e abdominal &#233; &#250;til e vi&#225;vel para identificar padr&#245;es de crescimento entre as crian&#231;as de diferentes regi&#245;es&#47;pa&#237;ses<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Tr&#234;s implica&#231;&#245;es pr&#225;ticas podem ser destacadas com o presente estudo&#58; &#40;1&#41; ele permite uma melhor estimativa do padr&#227;o de crescimento porque o m&#233;todo LMS foi utilizado&#44; &#40;2&#41; pode demonstrar popula&#231;&#245;es infantis com tend&#234;ncias de crescimento f&#237;sico que s&#227;o favor&#225;veis a dist&#250;rbios nutricionais &#40;ou seja&#44; uma popula&#231;&#227;o de crian&#231;as com &#237;ndices antropom&#233;tricos elevados em compara&#231;&#227;o com as outras&#41;&#44; e &#40;3&#41; ele testa a neces&#8208;sidade das curvas percent&#237;licas dos &#237;ndices antropom&#233;tricos para crian&#231;as brasileiras&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">A principal evid&#234;ncia do estudo foi que as crian&#231;as de Colombo apresentaram maiores valores percentis de IMC quando comparadas a crian&#231;as de v&#225;rios pa&#237;ses&#46; Por exemplo&#44; meninos e meninas de Colombo tinham um valor de percentil 90 para o IMC maior do que os propostos pelo CDC<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> e pela OMS&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> que s&#227;o frequentemente usados como curvas de refer&#234;ncia&#46; Uma combina&#231;&#227;o multifatorial &#40;fatores gen&#233;ti&#8208;cos&#44; sociais&#44; comportamentais e econ&#244;micos&#41; pode explicar as diferen&#231;as entre as popula&#231;&#245;es em rela&#231;&#227;o ao padr&#227;o de crescimento f&#237;sico&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;27</span></a> No entanto&#44; observamos que as crian&#231;as brasileiras apresentaram valores percentuais mais elevados de IMC do que as crian&#231;as dos pa&#237;ses em que a obe&#8208;sidade infantil tem grandes taxas de preval&#234;ncia&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a> Essas evid&#234;ncias refor&#231;am a import&#226;ncia de pol&#237;ticas p&#250;blicas para combater e prevenir o IMC elevado entre as crian&#231;as brasileiras&#46; Interven&#231;&#245;es em diferentes n&#237;veis &#40;por exemplo&#44; a melhoria da condi&#231;&#227;o econ&#244;mica&#44; educa&#231;&#227;o nutri&#8208;cional e promo&#231;&#227;o da atividade f&#237;sica&#41; podem contribuir para o crescimento f&#237;sico saud&#225;vel em crian&#231;as brasileiras e evitar um prov&#225;vel aumento de dist&#250;rbios nutricionais &#40;por exemplo&#44; obesidade geral&#41; nos pr&#243;ximos anos&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Considerando a CC&#44; as crian&#231;as de Colombo tinham os menores valores percentuais para CC do que aquelas pro&#8208;venientes de v&#225;rios pa&#237;ses&#44; especialmente se os valores percentis 50 e 90 forem observados&#46; Esses resultados posi&#8208;tivos indicam um padr&#227;o de CC &#40;especialmente o valor do percentil 90&#41; que ainda &#233; menor nessa amostra de crian&#231;as brasileiras do que os encontrados em crian&#231;as de pa&#237;ses com taxas alarmantes de obesidade abdominal&#46;3</p><p id="par0130" class="elsevierStylePara elsevierViewall">Com frequ&#234;ncia os estudos utilizaram curvas de refer&#234;ncia para CC que n&#227;o foram baseadas em dados espec&#237;ficos de suas crian&#231;as &#40;ou seja&#44; os estudos com crian&#231;as brasileiras usaram valores de refer&#234;ncia de CC de crian&#231;as n&#227;o brasileiras&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;28</span></a> Por conta da diferen&#231;a entre os valores percentuais&#44; o uso de curvas de refer&#234;ncia de outros pa&#237;ses &#40;principalmente Alemanha<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> e M&#233;xico<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#41; pode subestimar a propor&#231;&#227;o real da obesidade abdominal em crian&#231;as de Colombo &#40;Brasil&#41;&#46; Portanto&#44; a constru&#231;&#227;o da curva de refer&#234;ncia da CC com uma amostra representativa de crian&#231;as brasileiras &#233; relevante para o monitoramento do crescimento f&#237;sico da popula&#231;&#227;o infantil no pa&#237;s&#46; A curva de refer&#234;ncia que &#233; baseada em amostras multinacionais&#44; como as existentes para o IMC&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> ter&#225; vantagens adicio&#8208;nais gra&#231;as &#224; possibilidade de compara&#231;&#227;o entre pa&#237;ses&#46; Considerando que a obesidade abdominal tem um forte impacto na sa&#250;de das crian&#231;as&#44;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;6&#44;9</span></a> o desenvolvimento de curvas de refer&#234;ncia nacionais e internacionais s&#227;o cruciais para elaborar pol&#237;ticas p&#250;blicas voltadas para a preven&#231;&#227;o e combate &#224; obesidade abdominal na inf&#226;ncia&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">A RCEst foi o &#250;nico indicador de crescimento f&#237;sico que ficou est&#225;vel ou diminuiu ligeiramente com a idade entre as crian&#231;as de Colombo&#46; Essa tend&#234;ncia tamb&#233;m foi obser&#8208;vada em outros estudos&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;12&#44;14&#44;19</span></a> Os meninos de Colombo apresentaram valores percentuais mais baixos do que os observados na maioria dos estudos<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;14&#44;19</span></a> Entre as meninas&#44; os valores percentuais para RCEst foram intermedi&#225;rios&#58; menor que os valores percentuais obtidos em alguns pa&#237;ses<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;14</span></a> e maior do que em outros&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;19</span></a> Em geral&#44; as crian&#231;as de Colombo tinham um padr&#227;o mais saud&#225;vel de RCEst em compara&#231;&#227;o com as crian&#231;as dos outros pa&#237;ses&#46; Na pr&#225;tica cl&#237;nica e epidemiol&#243;gica&#44; o ponto de corte de 0&#44;50 tem sido frequentemente usado para identificar as crian&#231;as com RCEst alta&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;9&#44;12&#44;14</span></a> No entanto&#44; os nossos resultados e os valores percentuais observados em outros pa&#237;ses &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41; indicam que esse ponto de corte pode n&#227;o ser apropriado para identificar obesidade abdominal em crian&#231;as&#44; espe&#8208;cialmente em idades mais jovens&#46; Portanto&#44; a identifica&#231;&#227;o dos pontos de corte da RCEst que podem discriminar risco cardiovascular deve ser estimulada&#46; Isso &#233; fundamental para monitorar tend&#234;ncias seculares e o impacto na sa&#250;de p&#250;blica da obesidade abdominal em crian&#231;as no Brasil e em outros pa&#237;ses&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Alguns pontos fortes do presente estudo devem ser destacados&#46; Mais uma vez&#44; destacamos que esse foi o primeiro estudo a incluir valores de percentil para IMC&#44; CC e RCEst em uma amostra de crian&#231;as brasileiras&#46; Outro ponto forte foi a utiliza&#231;&#227;o do m&#233;todo LMS para suavizar os valores percentuais&#46; Ele permitiu descrever as dimens&#245;es dos indicadores antropom&#233;tricos e suas altera&#231;&#245;es com a idade&#44; consideran&#8208;do os par&#226;metros estat&#237;sticos que melhoram a interpreta&#231;&#227;o do crescimento f&#237;sico&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Em terceiro lugar&#44; todos os estudos foram selecionados porque eles usaram o mesmo indicador de crescimento f&#237;sico&#44; usaram o mesmo ponto anat&#244;mico&#44; e adotaram o mesmo procedimento estat&#237;stico &#40;m&#233;todo LMS&#41; para a constru&#231;&#227;o de valores percentuais&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#8211;20</span></a> Essas seme&#8208;lhan&#231;as foram importantes para permitir a compara&#231;&#227;o interestudo&#46; Finalmente&#44; esse estudo selecionou crian&#231;as de diferentes regi&#245;es &#40;urbanas e rurais&#41; e os sistemas de ensino &#40;p&#250;blico e privado&#41; de Colombo&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Esse estudo tamb&#233;m teve limita&#231;&#245;es&#46; A amostra do estudo incluiu crian&#231;as de um pequeno munic&#237;pio brasileiro e nossos resultados n&#227;o devem ser extrapolados para outras ou todas as regi&#245;es do Brasil&#46; Al&#233;m disso&#44; estes valores percentuais n&#227;o devem ser utilizados para classificar o estado nutricional em amostras de crian&#231;as brasileiras&#46; Outra limita&#231;&#227;o foi a pequena amostra de crian&#231;as em algumas idades &#40;6 e 11 anos de idade&#41;&#44; o que pode distorcer os valores percentuais reais&#46; No entanto&#44; outros estudos utilizaram um n&#250;mero similar de crian&#231;as em algumas idades&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11&#44;14&#44;18&#44;20</span></a> Al&#233;m disso&#44; as ten&#8208;d&#234;ncias foram consistentes entre as idades&#44; o que sugere que o tamanho reduzido da amostra em algumas idades n&#227;o distorce substancialmente o padr&#227;o de crescimento f&#237;sico e a interpreta&#231;&#227;o dos resultados&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Em conclus&#227;o&#44; diferen&#231;as claras no IMC&#44; CC e RCEst foram encontradas entre as crian&#231;as de Colombo &#40;Brasil&#41; e outros pa&#237;ses&#46; Meninos e meninas de Colombo tiveram valo&#8208;res de IMC mais elevados do que as crian&#231;as de outros pa&#237;&#8208;ses&#44; incluindo crian&#231;as norte&#8208;americanas e os valores apre&#8208;sentados pela OMS&#46; Inversamente&#44; as crian&#231;as de Colombo &#40;Brasil&#41; apresentaram valores percentuais intermedi&#225;rios ou mais baixos para CC e RCEst em compara&#231;&#227;o com as crian&#231;as dos outros pa&#237;ses&#46; Esse foi um resultado positivo que indica um padr&#227;o de crescimento com menor risco de obesidade abdominal&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Financiamento</span><p id="par0155" class="elsevierStylePara elsevierViewall">VCBF recebeu suporte financeiro da Coordena&#231;&#227;o de Aperfei&#231;oamento de Pessoal de N&#237;vel Superior &#40;CAPES&#41;&#44; por meio da bolsa de Doutorado&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflitos de interesse</span><p id="par0160" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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            0 => "Desenvolvimento infantil"
            1 => "Antropometria"
            2 => "Estado nutricional"
            3 => "Estudo transversal"
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            0 => "Child development"
            1 => "Anthropometry"
            2 => "nutritional status"
            3 => "Cross&#8208;sectional study"
            4 => "Children"
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    "resumen" => array:2 [
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Descrever os valores percent&#237;licos do &#237;ndice de massa corporal &#40;IMC&#41;&#44; circun&#8208;fer&#234;ncia da cintura &#40;CC&#41; e rela&#231;&#227;o cintura&#8208;estatura &#40;RCEst&#41; em crian&#231;as de Colombo&#44; Brasil&#44; e compar&#225;&#8208;los com os de crian&#231;as de outros pa&#237;ses&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo transversal com amostra probabil&#237;stica de 2&#46;035 crian&#231;as de 6 a 11 anos de idade&#46; Valores percent&#237;licos do IMC&#44; CC e RCEst&#44; suavizados e espec&#237;ficos para sexo e idade&#44; foram calculados utilizando o m&#233;todo LMS&#46; Os percentis 10&#44; 50 e 90 foram comparados com dados de diferentes pa&#237;ses&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Houve uma clara tend&#234;ncia de aumento do IMC e da CC com a idade&#44; em ambos os sexos&#46; Os valores da RCEst permaneceram est&#225;veis com o avan&#231;o da idade&#44; em meninos e meninas&#46; A compara&#231;&#227;o do padr&#227;o de crescimento mostrou claras diferen&#231;as entre os pa&#237;ses&#46; Meninos e meninas deste estudo tiveram elevados valores de percentil 90 para o IMC&#44; semelhantes aos de crian&#231;as alem&#227;s e superiores aos de crian&#231;as ameri&#8208;canas e do padr&#227;o da Organiza&#231;&#227;o Mundial de Sa&#250;de&#46; Contudo&#44; as crian&#231;as deste estudo tiveram valores intermedi&#225;rios para a CC e RCEst&#44; em compara&#231;&#227;o com crian&#231;as de outros pa&#237;ses&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclus&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Valores elevados para IMC e intermedi&#225;rios para CC e RCEst foram obser&#8208;vados&#44; em compara&#231;&#227;o &#224;s crian&#231;as de outros pa&#237;ses&#46; Interven&#231;&#245;es em diferentes n&#237;veis sociais podem evitar uma prov&#225;vel eleva&#231;&#227;o de disfun&#231;&#245;es nutricionais &#40;principalmente obesidade geral&#41; nos pr&#243;ximos anos&#46;</p></span>"
        "secciones" => array:4 [
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          1 => array:2 [
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            "titulo" => "M&#233;todos"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To describe the percentile values for body mass index &#40;BMI&#41;&#44; waist circumference &#40;WC&#41; and waist&#8208;to&#8208;height &#40;WHtR&#41; of children from Colombo&#44; Brazil&#44; and compare them with data of children from other countries&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">This was a cross&#8208;sectional study with a random sample of 2&#44;035 children aged 6&#8208;11 years&#46; Age&#8208;and sex&#8208;specific smoothed percentiles curves for BMI&#44; WC and WHtR were created using the LMS method&#46; Values of 10<span class="elsevierStyleSup">th</span>&#44; 50<span class="elsevierStyleSup">th</span> and 90<span class="elsevierStyleSup">th</span> percentiles from Brazilian children were compared with data from other countries&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">There was a trend of increasing BMI and WC with age in both sexes&#46; WHtR remained constant with advancing age in boys and girls&#46; Comparison of the growth pattern among countries showed clear differences&#46; Southern Brazil boys and girls had elevated 90<span class="elsevierStyleSup">th</span> percentile values for BMI&#44; which was similar to German children and higher than the North American and World Health Organization percentile values&#46; However&#44; children from this study had intermediate values for WC and WHtR in comparison to children from other countries&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Elevated BMI values were observed among southern Brazilian children&#44; but WC and WHtR percentile values were lower in southern Brazilian children than in children from other countries&#46; Interventions at different levels should be made to avoid a probable increase of nutritional disorders &#40;especially general obesity&#41; in the next years&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Estudo conduzido no Centro de Desportos&#44; Departamento de Educa&#231;&#227;o F&#237;sica&#44; Universidade Federal de Santa Catarina&#44; Florian&#243;polis&#44; SC&#44; Brasil&#46;</p>"
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          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Compara&#231;&#227;o dos valores de percentis 10&#44; 50&#44; e 90 para circunfer&#234;ncia da cintura entre crian&#231;as de Colombo e crian&#231;as de outros pa&#237;ses&#46;</p>"
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          "pt" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Compara&#231;&#227;o dos valores de percentis 10&#44; 50&#44; e 90 para raz&#227;o cintura&#8208;altura entre crian&#231;as de Colombo e crian&#231;as de outros pa&#237;ses&#46;</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">A idade indica grupo et&#225;rio inteiro&#44; por exemplo&#44; 6&#44;0&#8208;6&#44;99 anos etc&#59; L&#44; valor enviesado&#59; M&#44; m&#233;dia&#59; P&#44; percentil&#59; S&#44; coeficiente de varia&#231;&#227;o&#46;</p>"
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                  \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="" valign="top">&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="" valign="top">&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="" valign="top">&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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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">RCEst&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="" valign="top">&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="" valign="top">&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="" valign="top">&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="" valign="top">&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="" 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">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;2&#44;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;52&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">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">228&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;1&#44;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;51&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">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">241&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;1&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;50&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">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">221&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;0&#44;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;49&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">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">184&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;0&#44;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;49&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">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;0&#44;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;50&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">Meninas&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="" valign="top">&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="" valign="top">&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="" valign="top">&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="" valign="top">&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="" 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">IMC &#40;kg&#47;m2&#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><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="" valign="top">&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="" valign="top">&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="" valign="top">&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="" valign="top">&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">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;3&#44;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#44;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#44;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#44;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#44;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#44;77&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">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">214&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;2&#44;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#44;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#44;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#44;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#44;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#44;90&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">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">228&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;2&#44;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#44;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#44;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#44;99&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">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">232&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;2&#44;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#44;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#44;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#44;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#44;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#44;58&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">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">187&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;1&#44;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#44;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#44;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#44;10&nbsp;\t\t\t\t\t\t\n
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          "pt" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Valores percentuais suavizados espec&#237;ficos de sexo e idade para o &#237;ndice de massa corporal&#44; circunfer&#234;ncia da cintura e rela&#231;&#227;o cintura&#8208;estatura</p>"
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ISSN: 01030582
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