Influence of overweight on the health-related quality of life in adolescents

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Martín-Ancel, A. Balaguer, A. García-Alix" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Martín-Ancel" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Balaguer" ] 2 => array:2 [ "nombre" => "A." 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Herranz Barbero, Mª.R. López de Mesa, C. Azcona San Julián" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Herranz Barbero" "email" => array:1 [ 0 => "anaherranzbarbero@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Mª.R." "apellidos" => "López de Mesa" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Azcona San Julián" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Pediatría, Clínica Universidad de Navarra, Pamplona, Navarra, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Influencia del exceso de peso en la calidad de vida relacionada con la salud de los adolescentes" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1271 "Ancho" => 1371 "Tamanyo" => 173689 ] ] "descripcion" => array:1 [ "en" => "Box plots for the domain and subdomain scores of the CHIP-AE questionnaires for which the multivariate analysis found significant differences according to age." ] ] ] "textoCompleto" => "IntroductionOverweight–obesity is an endemic disease in developed countries. They are the most frequent metabolic disorders in the western world. The World Health Organization believes that it constitutes a serious public health problem and has labelled it as the pandemic of the XXI century.<a class="elsevierStyleCrossRef" href="#bib0170">1</a> According to the last national survey conducted in Spain, the Encuesta Nacional de Salud de España 2011–2012, the prevalence of overweight in the 2–17 year old population is of 18.26%, and the prevalence of obesity of 9.56%. The figures specific to the Autonomous Community of Navarra for this age group show a prevalence of overweight and obesity of 15.79% and 7.81%, respectively.<a class="elsevierStyleCrossRef" href="#bib0175">2</a>The aetiology of obesity has been subject to numerous studies. Nowadays, it would be more accurate to speak of “obesities” than of “obesity”, as there is evidence that it can be due to endogenous or exogenous causes; be a primary disease or develop secondary to another condition; or be a monogenic or polygenic trait.<a class="elsevierStyleCrossRef" href="#bib0180">3</a> The literature has described numerous clinical and metabolic complications associated with excess body fat, both in the short and the long term: insulin resistance, hypercholesterolaemia, type 2 diabetes mellitus, metabolic syndrome, polycystic ovary syndrome, or cardiovascular disease.<a class="elsevierStyleCrossRefs" href="#bib0185">4,5</a> Excess body fat is also associated with behavioural and psychosocial complications: eating disorders, anxiety, depression, dependence, passivity, poor academic performance, social isolation, real or perceived discrimination, and low self-esteem.<a class="elsevierStyleCrossRefs" href="#bib0195">6–8</a>The concept of health encompasses more than the absence of disease. In children and adolescents, the concept of health has certain characteristics, as stated by Starfield: “The measurement of health in children should consider their capacity to fully participate in physical, social, and psychosocial activities and functions adequate to their age.”<a class="elsevierStyleCrossRef" href="#bib0210">9</a> The concept of health-related quality of life (HRQoL) entered the healthcare field in the 1970s, and stemmed from the belief that patient wellbeing and how patients experience their disease and the medical care they receive are important factors to consider during treatment and followup.<a class="elsevierStyleCrossRefs" href="#bib0215">10,11</a> Adolescence is a key stage in the development of an individual's personality and traits, and it is a very vulnerable period during which individuals are particularly susceptible to beneficial and deleterious environmental factors. As noted above, overweight and obesity have a significant impact on overall HRQoL and on self-esteem, physical wellbeing, and emotional wellbeing in particular.There are studies about the impact of overweight–obesity on the HRQoL of adolescents, but so far none have been conducted in Spain. Our hypothesis was that overweight and obesity may have physical and psychosocial consequences that are detrimental to the HRQoL of adolescents. The aim of this study was to analyse the scores obtained by adolescents 12–16 years of age for different aspects of HRQoL and assess whether there are differences associated with sociodemographic characteristics or weight status.Patients and methodsStudy designWe performed a descriptive, observational, cross-sectional study.Ethical considerationsThe study was approved by the research ethics committee of our hospital in March 2010.Study sample and participantsWe included adolescents of both sexes (45 male and 44 female) 12–16 years of age with normal weight, overweight or obesity that received care in our general paediatrics department or care for overweight or obesity in the paediatric endocrinology department of our hospital between April 1, 2010 and December 15, 2011, and who agreed to their voluntary participation in the study.We provided information about the study and obtained the informed consent of the parents of the participants and the written consent of the adolescents, who were considered minors capable of consenting, at the hospital. We reviewed the medical and anthropometric data and provided the questionnaire used to assess HRQoL, the Child Health and Illness Profile-Adolescent Edition (CHIP-AE).Inclusion criteria: age 12–16 years, voluntary agreement to participate in the study, as well as written informed consent from legal guardians and participants.Exclusion criteria: presence of acute or chronic disease other than overweight–obesity that affected the HRQoL of the patient, or not giving consent or revoking it at any time during the study.Withdrawal criteria: inability to fill out the questionnaires properly or insufficient number of answered questions.The sample size was calculated in relation to the 32 patients 12–16 years of age with overweight–obesity that were being followed up in the paediatric endocrinology department. Taking into account potential losses and new diagnoses, we estimated a minimum sample size of 35 cases and at least one control per case.We established the 12–16 years of age interval to avoid mixing preadolescents and adolescents. When we included the control group the purpose was to ensure that the two groups that we were to compare would have a similar social background.The participants (n=89) were classified according to the body mass index (BMI) calculated in the hospital using the standards established by Ferrández-Longás et al. (1980–2002)<a class="elsevierStyleCrossRef" href="#bib0225">12</a> as a reference. We used the BMI because it is a good correlate for the amount of body fat assessed by means of computer tomography or magnetic resonance imaging, which are the gold standards in body fat measurement. Participants with a BMI below the 85th percentile for their age and sex were classified as having a normal weight, participants with a BMI equal or greater than the 85th and below the 95th as overweight, and participants with a BMI above the 95th percentile as obese.<a class="elsevierStyleCrossRef" href="#bib0230">13</a>Measurement of health-related quality of lifeWe used the adolescent edition of the CHIP self-administered questionnaire, developed by the Johns Hopkins Bloomberg School of Public Health.<a class="elsevierStyleCrossRef" href="#bib0235">14</a> This is the first self-reported health assessment tool based on a multidimensional concept of health specifically designed for adolescents that has been published in the medical literature.<a class="elsevierStyleCrossRef" href="#bib0240">15</a> The reliability and validity of the Spanish version have been demonstrated.<a class="elsevierStyleCrossRef" href="#bib0245">16</a> The CHIP-AE is addressed to adolescents 12–16 years of age. The questionnaire is organised into 5 domains, each of which comprises information on the aspects listed in parentheses: satisfaction (self-esteem, self-perception, satisfaction with oneself and one's own health), discomfort (physical comfort, emotional comfort, and limitations of daily activity), resilience (family involvement, problem solving abilities for issues characteristic of this age, resilience in physical activity, and health and safety in the home environment), risk avoidance (engagement in risk activities, attitudes that threaten achievement, and peer influences) and achievement (academic achievement and achievement in age-appropriate responsibilities). The questionnaire also has 14 subdomains that provide detailed information of each of the domains (see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<a class="elsevierStyleCrossRef" href="#bib0250">17</a><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The score correlates positively with health: a higher score is indicative of greater satisfaction and wellbeing, fewer risks, etcetera. Participants had to answer at least 70% of the questions in each domain or subdomain.<a class="elsevierStyleCrossRef" href="#bib0255">18</a>Data collectionThe independent variables under consideration were (1) sex; (2) age; (3) anthropometric variables measured at the hospital with participants in underwear: weight measured in kilograms with TANITA® scales accurate to 0.05kg; height measured in centimetres with a Harpender stadiometer accurate to 0.1cm and with the participant standing barefoot with the heels, buttocks, shoulder blades and occiput touching the stadiometer; BMI, defined as the weight in kilograms divided by the squared height in metres; (4) personal history (diseases, allergies, treatments, surgeries); (5) nutrition-specific followup: we requested a 7-day food count and checked whether it adhered to the recommendations given at the hospital according to their normal or overweight–obesity status; we considered that the patient did not comply with the recommendations if they did not follow them 2 or more times a day and 3 or more days a week; and (6) socioeconomic status measured with The Family Affluence Scale II, which asks about the presence and number of family cars, individual bedrooms, holidays, and computers in the participant's household; the scale is considered appropriate to assess a family's expenditure and consumption; the sum of the values obtained in each section is used to categorise socioeconomic status as low (score, 0–3), middle (4–6) or high (7 or greater).<a class="elsevierStyleCrossRef" href="#bib0260">19</a>The dependent variables were the domains and subdomains into which the information obtained through the questionnaire is organised (see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).Statistical analysisWe assigned consecutive code numbers to the questionnaires to ensure the confidentiality and anonymity of the participants.We performed a descriptive analysis of the sociodemographic characteristics of the groups to compare, normal weight versus overweight–obesity. Categorical variables were compared by means of the chi square test. Quantitative variables with a normal distribution were compared using Student's t test, and continuous variables that did not have a normal distribution using the Mann–Whitney U test.We performed a multivariate multiple regression analysis of the scores obtained in the different domains and subdomains relative to weight status and adjusted for sex, age and socioeconomic status.We have used error plots for the graphical representation of quantitative variables with a normal distribution, and box plots for quantitative variables that did not follow a normal distribution.The statistical analysis was performed with IBM SPSS Statistics version 20.0 (Chicago) for Windows.ResultsOf the 99 adolescents that were asked to participate in the study, 7 declined. Of the 92 adolescents that agreed to participate, 3 were withdrawn because they did not answer the required minimum number of questions. The final sample included 89 adolescents of both sexes, 12–16 years of age. Of all participants, 54 were classified as having normal weight, and 35 as having overweight–obesity. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the sociodemographic characteristics of the participants.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>We found significant differences between the weight status groups in the compliance with the dietary recommendations. Of all participants with overweight–obesity, 45.7% were in compliance, compared to 1.9% of participants with normal weight (P<.001).The multivariate analysis of the scores of the domains and subdomains by weight status and adjusted for sex, age and socioeconomic status revealed that adolescents with overweight–obesity had less resilience (P=.003), less family involvement (P=.017), less capacity for physical activity (P=.04) and more peer influences (P=.024) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Furthermore, the multivariate analysis showed that the scores obtained by girls were significantly lower than those of boys in the satisfaction (P=.001) and resilience (P=.001) domains, and in the self-esteem (P<.001) and physical activity (P<.001) subdomains (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>The multiple linear regression analysis showed that as the age of participants increased, they obtained lower scores in the risks domain (P<.001) and in the home health and safety (P=.037), individual risk (P=.001) and peer influences (P<.001) subdomains (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>DiscussionSeveral authors have assessed the psychosocial consequences of overweight and obesity in adolescents, but there are few studies on the impact of excess weight in their HRQoL. We must nevertheless take into account that psychosocial aspects are, in fact, part of HRQoL.The works of Mirza et al. and Sjoberg et al. show that excess weight in adolescence leads to body dissatisfaction, low self-esteem and a higher incidence of depression, which are more pronounced in female adolescents.<a class="elsevierStyleCrossRefs" href="#bib0265">20,21</a> The study by Al-Akour et al. conducted in Jordan as well as the study by Beer et al. conducted in the Netherlands showed an association between the presence of overweight–obesity and lower scores in every aspect of HRQoL.<a class="elsevierStyleCrossRefs" href="#bib0275">22,23</a> Keating et al. specifically analysed the consequences of excess weigh on physical aspects and observed that overweight and obese patients obtained significantly lower scores compared to patients with normal weight.<a class="elsevierStyleCrossRef" href="#bib0285">24</a> According to the review by Griffiths et al., as BMI increases, self-esteem and HRQoL decrease.<a class="elsevierStyleCrossRefs" href="#bib0290">25,26</a> The results that we present here are consistent with all of the above.Still, weight status in not the sole determinant of HRQoL. The differences in perception between the sexes have a considerable impact on its consequences on HRQoL. Several studies have reported that the influence of body image, social acceptance and mood impairment is stronger in female than in male adolescents, which makes girls more vulnerable to psychosocial disorders.<a class="elsevierStyleCrossRefs" href="#bib0265">20,24,27,28</a> These differences were also observed in our study, as girls reported lower satisfaction, self-esteem, resiliency and physical capacity than boys.Excess weight often elicits teasing from peers. The increased influence of the environment combined with perceived teasing and bullying lead to greater insecurity, lower self-esteem and emotional wellbeing, and more difficult interpersonal relationships.<a class="elsevierStyleCrossRefs" href="#bib0310">29,30</a> As children grow they become more aware of their environment and of interpersonal differences; self-criticism increases and negative self-perceptions and self-dissatisfaction develop, negatively affecting HRQoL. The decrease in self-esteem leads to increased peer influence and a reduced perceived social acceptance. These aspects may lead to a more introverted character that, as our results demonstrate, may reduce family involvement. The reduced interaction with the family may delay finding the help that the adolescent needs.<a class="elsevierStyleCrossRefs" href="#bib0310">29,31,32</a>To date, there are no other published studies of this nature conducted on the adolescent population in Spain. A European multicentre study on the impact of overweight on the HRQoL of participants 8–18 years of age included a representative sample of 714 individuals from Spain; the study concluded that overweight and obesity have deleterious effects on HRQoL, especially on physical comfort and self-perception.<a class="elsevierStyleCrossRef" href="#bib0330">33</a>The anthropometric measurements were taken at the hospital by trained staff, as opposed to self-reported. None of the participants had IBM values at the border between normal weight and overweight–obesity, which guarantees that the groups were separated correctly.The main limitation of this study is its cross-sectional design, which can establish correlation but not causality. Furthermore, we used a convenience sample because those participants could then be considered for health-promoting interventions, but this means that the sample may not be representative of the adolescent population of Navarra. There may also be a selection bias, as the adolescents with overweight–obesity that seek care in the endocrinology department may have a greater awareness of the repercussions of their disease. One of the main biases to consider is the observer bias: since participants are aware of being questioned, they give more favourable responses in regards to their health status. However, this potential confounding factor would not invalidate the results of this study, since were it not at play, the differences found in the study would be even greater.ConclusionOverweight–obesity has a detrimental effect on the HRQoL of adolescents, but it must be taken into account that sex and age have a significant impact on the decrease of HRQoL.The stronger influence of body image and social acceptance in women makes them more vulnerable to psychosocial disorders. These negative perceptions already occur in female adolescents and have an influence on the development of their personality and behaviour.We believe that in order to offer patients personalised and multidisciplinary care it is crucial that we know the subjective perception and impact of their health status, and to assess the emotional and psychosocial features related to health from the perspective of the paediatric patient.Conflicts of interestThe authors have no conflicts of interest to declare." 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This disorder can lead to significant physical and psychosocial effects that affect the health related quality of life (HRQOL). Adolescence is a time of great vulnerability and very decisive in personality development. The objective of this study was to assess the influence of weight status on HRQoL in adolescents. Population and methodsA cross-sectional study conducted on adolescents of 12–16 years old and an assessment of HRQOL using the CHIP-Adolescents Edition questionnaires. ResultsOut of a total of 89 adolescents included, 60.7% had a normal weight and 39.3% were overweight–obese. The normal weight participants had a higher mean age than overweight–obesity participants, 14.2 vs. 13.6 years old, respectively. There were no other differences in sociodemographic characteristics between groups. Overweight–obese adolescents had a worse HRQoL, specifically as regards less resilience, lower capacity for physical activity, less family involvement, and greater peer influence. Moreover, the girls showed a lower self-esteem, satisfaction, resilience and physical activity than boys. Furthermore, less home safety and health, higher individual risk and greater peer influence was reported with increasing age of participants. ConclusionOverweight–obesity negatively affects the HRQoL of adolescents. It is important to evaluate the psychosocial aspects from the perspective of the adolescents, in order to offer them a complete, personalised and multidisciplinary care." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Population and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLos cambios en el estilo de vida y la alimentación han conllevado un aumento progresivo de la prevalencia del sobrepeso-obesidad. Esta enfermedad puede conllevar importantes repercusiones físicas y psicosociales que deterioran la calidad de vida relacionada con la salud (CVRS). La adolescencia es una etapa de gran vulnerabilidad por el entorno y muy determinante en el desarrollo de la personalidad del individuo. El objetivo fue evaluar la influencia del estado ponderal en la CVRS de los adolescentes. Población y métodosEstudio transversal de adolescentes de 12 a 16 años. Evaluación de la CVRS mediante los cuestionarios CHIP-Adolescent Edition. ResultadosOchenta y nueve adolescentes, 60,7%, eran normoponderales y el 39,3% tenía sobrepeso-obesidad. Los participantes normoponderales tenían una edad media superior a los participantes con sobrepeso-obesidad, 14,2 frente a 13,6 años, respectivamente. No había otras diferencias entre las características sociodemográficas de ambos grupos. Los adolescentes con sobrepeso-obesidad reflejaron peor CVRS, concretamente refirieron menor resistencia, menor capacidad de actividad física, menor participación familiar y mayor influencia de sus iguales. Asimismo, las chicas reflejaron menor autoestima, satisfacción, resistencia y capacidad de actividad física que los chicos. Por otro lado, a medida que aumentaba la edad de los participantes, referían menor salud y seguridad en el hogar, mayor riesgo individual y mayor influencia de sus iguales. ConclusiónEl sobrepeso-obesidad repercute negativamente en la CVRS de los adolescentes. Consideramos importante evaluar los aspectos psicosociales desde la perspectiva del paciente para poder ofrecerle una atención personalizada y multidisciplinar." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Población y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Herranz Barbero A, López de Mesa MR, Azcona San Julián C. Influencia del exceso de peso en la calidad de vida relacionada con la salud de los adolescentes. An Pediatr (Barc). 2015;82:131–138." ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "Previous presentation: the results of this study were presented in part as an oral communication under the title “Repercusión del sobrepeso y la obesidad en la calidad de vida relacionada con la salud de los adolescentes” at the 61 Congreso de la Asociación Española de Pediatría; May 31–June 2, 2012; Granada, Spain." ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1637 "Ancho" => 996 "Tamanyo" => 151320 ] ] "descripcion" => array:1 [ "en" => "Box plots and error plots for the domain and subdomain scores of the CHIP-AE questionnaire for which the multivariate analysis found significant differences according to weight status." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1634 "Ancho" => 991 "Tamanyo" => 146434 ] ] "descripcion" => array:1 [ "en" => "Box plots for the domain and subdomain scores of the CHIP-AE questionnaire for which the multivariate analysis found significant differences according to sex." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1271 "Ancho" => 1371 "Tamanyo" => 173689 ] ] "descripcion" => array:1 [ "en" => "Box plots for the domain and subdomain scores of the CHIP-AE questionnaires for which the multivariate analysis found significant differences according to age." ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "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"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Normal weightn=54 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Overweight–obesityn=35 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Conventional analysis \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Adjusted analysis<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a></th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P value<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \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 value \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">Significant model for \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">Satisfaction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.41 (51.39–60.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.5 (51.1–60.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.537 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.263 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sex (female)<a class="elsevierStyleCrossRef" href="#tblfn0015">#</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Satisfaction with health \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54.55 (7.62) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54.01 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.738 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.257 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Self-esteem \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.02 (52.81–59.76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56.28 (49.34–59.76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.503 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sex (female) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Discomfort \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.69 (52.45–61.91) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.9 (57.41–63.54) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.134 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.251 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Physical comfort \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.55 (51.83–61.47) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.41 (55.58–62.67) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.151 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.145 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Emotional comfort \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.9 (50.87–63.76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.9 (55.56–64.35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.306 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Limitation of activity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54.71 (51.24–58.17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.17 (54.71–58.17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.386 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.357 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Resilience \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.82 (55.56–63.09) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54.75 (53.57–61.41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.022 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.003 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sex (female) \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">Family involvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.25 (53.77–62.48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.11 (49.42–58.99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.092 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.017 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Problem solving \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52.11 (47.19–54.56) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49.65 (44.74–57.02) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.591 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.607 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Physical activity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53.53 (8.54) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.73 (8.58) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.135 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sex (female) \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">Home safety and health \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.52 (5.33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.13 (5.17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.329 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Age (older) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Risk avoidance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.11 (56.62–64.07) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.92 (59.28–64.86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.467 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.704 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Age (older) \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">Individual risks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.48 (57.54–63.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.09 (58.75–63.45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.384 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.774 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Age (older) \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">Threats to achievement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.6 (51.02–60.18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.89 (55.03–61.33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.047 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.229 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Peer influences \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.63 (56.69–65.59) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.66 (56.69–65.59) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.479 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.024 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Age (older) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Achievement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.53 (5.9–16.72) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.98 (2.02–12.08) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.179 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.417 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Academic achievement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.48 (10.51) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.48 (11.25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.204 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.106 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Work achievement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−16.0 (−16.0 to −16.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−16.0 (−16.0 to −16.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.529 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.923 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab752219.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "P-values for Student's t test for normally distributed continuous variables (expressed as mean and standard deviation) and Mann–Whitney U test for non-normally distributed variables (expressed as median and IQR)." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "**" "nota" => "Multiple linear regression adjusted for sex, age and socioeconomic status." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "#" "nota" => "The category with the lower score is noted in parenthesis. Range of possible scores: −16 to 70." ] ] ] "descripcion" => array:1 [ "en" => "Scores of the CHIP-AE questionnaire domains and subdomains by weight status." ] ] 4 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Normal weightn=54 (60.7%) \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">Overweight–obesityn=35 (39.3%) \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 value<a class="elsevierStyleCrossRef" href="#tblfn0020">*</a> \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="4" align="left" valign="top">Sex</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (55.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (40%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.152 \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">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (44.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (60%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.2 (1.32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.6 (1.18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.022 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Socioeconomic status</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Low-middle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 (64.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (54.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.321 \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">High \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (35.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (45.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">BMI SDs<a class="elsevierStyleCrossRef" href="#tblfn0025">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.36 (−0.78 to 0.33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.07 (1.78 to 3.25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab752220.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "*" "nota" => "P-values for chi square test for categorical variables (expressed as absolute frequency and percentage), Student's t test for normally distributed continuous variables (expressed as mean and standard deviation) and Mann–Whitney U test for non-normally distributed variables (expressed as median and IQR)." ] 1 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "**" "nota" => "BMI SDs: number of standard deviations from the BMI mean." ] ] ] "descripcion" => array:1 [ "en" => "Sociodemographic characteristics of the sample." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" 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Influence of overweight on the health-related quality of life in adolescents

Influencia del exceso de peso en la calidad de vida relacionada con la salud de los adolescentes

A. Herranz Barbero

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anaherranzbarbero@gmail.com

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, Mª.R. López de Mesa, C. Azcona San Julián

Departamento de Pediatría, Clínica Universidad de Navarra, Pamplona, Navarra, Spain

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    "titulo" => "Influence of overweight on the health-related quality of life in adolescents"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Box plots for the domain and subdomain scores of the CHIP-AE questionnaires for which the multivariate analysis found significant differences according to age&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Overweight&#8211;obesity is an endemic disease in developed countries&#46; They are the most frequent metabolic disorders in the western world&#46; The World Health Organization believes that it constitutes a serious public health problem and has labelled it as the pandemic of the XXI century&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a> According to the last national survey conducted in Spain&#44; the Encuesta Nacional de Salud de Espa&#241;a 2011&#8211;2012&#44; the prevalence of overweight in the 2&#8211;17 year old population is of 18&#46;26&#37;&#44; and the prevalence of obesity of 9&#46;56&#37;&#46; The figures specific to the Autonomous Community of Navarra for this age group show a prevalence of overweight and obesity of 15&#46;79&#37; and 7&#46;81&#37;&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The aetiology of obesity has been subject to numerous studies&#46; Nowadays&#44; it would be more accurate to speak of &#8220;obesities&#8221; than of &#8220;obesity&#8221;&#44; as there is evidence that it can be due to endogenous or exogenous causes&#59; be a primary disease or develop secondary to another condition&#59; or be a monogenic or polygenic trait&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">3</span></a> The literature has described numerous clinical and metabolic complications associated with excess body fat&#44; both in the short and the long term&#58; insulin resistance&#44; hypercholesterolaemia&#44; type 2 diabetes mellitus&#44; metabolic syndrome&#44; polycystic ovary syndrome&#44; or cardiovascular disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">4&#44;5</span></a> Excess body fat is also associated with behavioural and psychosocial complications&#58; eating disorders&#44; anxiety&#44; depression&#44; dependence&#44; passivity&#44; poor academic performance&#44; social isolation&#44; real or perceived discrimination&#44; and low self-esteem&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">6&#8211;8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The concept of health encompasses more than the absence of disease&#46; In children and adolescents&#44; the concept of health has certain characteristics&#44; as stated by Starfield&#58; &#8220;The measurement of health in children should consider their capacity to fully participate in physical&#44; social&#44; and psychosocial activities and functions adequate to their age&#46;&#8221;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">9</span></a> The concept of health-related quality of life &#40;HRQoL&#41; entered the healthcare field in the 1970s&#44; and stemmed from the belief that patient wellbeing and how patients experience their disease and the medical care they receive are important factors to consider during treatment and followup&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">10&#44;11</span></a> Adolescence is a key stage in the development of an individual&#39;s personality and traits&#44; and it is a very vulnerable period during which individuals are particularly susceptible to beneficial and deleterious environmental factors&#46; As noted above&#44; overweight and obesity have a significant impact on overall HRQoL and on self-esteem&#44; physical wellbeing&#44; and emotional wellbeing in particular&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">There are studies about the impact of overweight&#8211;obesity on the HRQoL of adolescents&#44; but so far none have been conducted in Spain&#46; Our hypothesis was that overweight and obesity may have physical and psychosocial consequences that are detrimental to the HRQoL of adolescents&#46; The aim of this study was to analyse the scores obtained by adolescents 12&#8211;16 years of age for different aspects of HRQoL and assess whether there are differences associated with sociodemographic characteristics or weight status&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design</span><p id="par0025" class="elsevierStylePara elsevierViewall">We performed a descriptive&#44; observational&#44; cross-sectional study&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Ethical considerations</span><p id="par0030" class="elsevierStylePara elsevierViewall">The study was approved by the research ethics committee of our hospital in March 2010&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Study sample and participants</span><p id="par0035" class="elsevierStylePara elsevierViewall">We included adolescents of both sexes &#40;45 male and 44 female&#41; 12&#8211;16 years of age with normal weight&#44; overweight or obesity that received care in our general paediatrics department or care for overweight or obesity in the paediatric endocrinology department of our hospital between April 1&#44; 2010 and December 15&#44; 2011&#44; and who agreed to their voluntary participation in the study&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We provided information about the study and obtained the informed consent of the parents of the participants and the written consent of the adolescents&#44; who were considered minors capable of consenting&#44; at the hospital&#46; We reviewed the medical and anthropometric data and provided the questionnaire used to assess HRQoL&#44; the Child Health and Illness Profile-Adolescent Edition &#40;CHIP-AE&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Inclusion criteria</span>&#58; age 12&#8211;16 years&#44; voluntary agreement to participate in the study&#44; as well as written informed consent from legal guardians and participants&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Exclusion criteria</span>&#58; presence of acute or chronic disease other than overweight&#8211;obesity that affected the HRQoL of the patient&#44; or not giving consent or revoking it at any time during the study&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Withdrawal criteria</span>&#58; inability to fill out the questionnaires properly or insufficient number of answered questions&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The sample size was calculated in relation to the 32 patients 12&#8211;16 years of age with overweight&#8211;obesity that were being followed up in the paediatric endocrinology department&#46; Taking into account potential losses and new diagnoses&#44; we estimated a minimum sample size of 35 cases and at least one control per case&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">We established the 12&#8211;16 years of age interval to avoid mixing preadolescents and adolescents&#46; When we included the control group the purpose was to ensure that the two groups that we were to compare would have a similar social background&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The participants &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>89&#41; were classified according to the body mass index &#40;BMI&#41; calculated in the hospital using the standards established by Ferr&#225;ndez-Long&#225;s et al&#46; &#40;1980&#8211;2002&#41;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">12</span></a> as a reference&#46; We used the BMI because it is a good correlate for the amount of body fat assessed by means of computer tomography or magnetic resonance imaging&#44; which are the gold standards in body fat measurement&#46; Participants with a BMI below the 85th percentile for their age and sex were classified as having a normal weight&#44; participants with a BMI equal or greater than the 85th and below the 95th as overweight&#44; and participants with a BMI above the 95th percentile as obese&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">13</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Measurement of health-related quality of life</span><p id="par0075" class="elsevierStylePara elsevierViewall">We used the adolescent edition of the CHIP self-administered questionnaire&#44; developed by the Johns Hopkins Bloomberg School of Public Health&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">14</span></a> This is the first self-reported health assessment tool based on a multidimensional concept of health specifically designed for adolescents that has been published in the medical literature&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">15</span></a> The reliability and validity of the Spanish version have been demonstrated&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">16</span></a> The CHIP-AE is addressed to adolescents 12&#8211;16 years of age&#46; The questionnaire is organised into 5 domains&#44; each of which comprises information on the aspects listed in parentheses&#58; satisfaction &#40;self-esteem&#44; self-perception&#44; satisfaction with oneself and one&#39;s own health&#41;&#44; discomfort &#40;physical comfort&#44; emotional comfort&#44; and limitations of daily activity&#41;&#44; resilience &#40;family involvement&#44; problem solving abilities for issues characteristic of this age&#44; resilience in physical activity&#44; and health and safety in the home environment&#41;&#44; risk avoidance &#40;engagement in risk activities&#44; attitudes that threaten achievement&#44; and peer influences&#41; and achievement &#40;academic achievement and achievement in age-appropriate responsibilities&#41;&#46; The questionnaire also has 14 subdomains that provide detailed information of each of the domains &#40;see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">17</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The score correlates positively with health&#58; a higher score is indicative of greater satisfaction and wellbeing&#44; fewer risks&#44; etcetera&#46; Participants had to answer at least 70&#37; of the questions in each domain or subdomain&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Data collection</span><p id="par0085" class="elsevierStylePara elsevierViewall">The independent variables under consideration were &#40;1&#41; sex&#59; &#40;2&#41; age&#59; &#40;3&#41; anthropometric variables measured at the hospital with participants in underwear&#58; weight measured in kilograms with TANITA<span class="elsevierStyleSup">&#174;</span> scales accurate to 0&#46;05<span class="elsevierStyleHsp" style=""></span>kg&#59; height measured in centimetres with a Harpender stadiometer accurate to 0&#46;1<span class="elsevierStyleHsp" style=""></span>cm and with the participant standing barefoot with the heels&#44; buttocks&#44; shoulder blades and occiput touching the stadiometer&#59; BMI&#44; defined as the weight in kilograms divided by the squared height in metres&#59; &#40;4&#41; personal history &#40;diseases&#44; allergies&#44; treatments&#44; surgeries&#41;&#59; &#40;5&#41; nutrition-specific followup&#58; we requested a 7-day food count and checked whether it adhered to the recommendations given at the hospital according to their normal or overweight&#8211;obesity status&#59; we considered that the patient did not comply with the recommendations if they did not follow them 2 or more times a day and 3 or more days a week&#59; and &#40;6&#41; socioeconomic status measured with The Family Affluence Scale II&#44; which asks about the presence and number of family cars&#44; individual bedrooms&#44; holidays&#44; and computers in the participant&#39;s household&#59; the scale is considered appropriate to assess a family&#39;s expenditure and consumption&#59; the sum of the values obtained in each section is used to categorise socioeconomic status as low &#40;score&#44; 0&#8211;3&#41;&#44; middle &#40;4&#8211;6&#41; or high &#40;7 or greater&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">19</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The dependent variables were the domains and subdomains into which the information obtained through the questionnaire is organised &#40;see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0095" class="elsevierStylePara elsevierViewall">We assigned consecutive code numbers to the questionnaires to ensure the confidentiality and anonymity of the participants&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">We performed a descriptive analysis of the sociodemographic characteristics of the groups to compare&#44; normal weight versus overweight&#8211;obesity&#46; Categorical variables were compared by means of the chi square test&#46; Quantitative variables with a normal distribution were compared using Student&#39;s <span class="elsevierStyleItalic">t</span> test&#44; and continuous variables that did not have a normal distribution using the Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">We performed a multivariate multiple regression analysis of the scores obtained in the different domains and subdomains relative to weight status and adjusted for sex&#44; age and socioeconomic status&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">We have used error plots for the graphical representation of quantitative variables with a normal distribution&#44; and box plots for quantitative variables that did not follow a normal distribution&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The statistical analysis was performed with IBM SPSS Statistics version 20&#46;0 &#40;Chicago&#41; for Windows&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0120" class="elsevierStylePara elsevierViewall">Of the 99 adolescents that were asked to participate in the study&#44; 7 declined&#46; Of the 92 adolescents that agreed to participate&#44; 3 were withdrawn because they did not answer the required minimum number of questions&#46; The final sample included 89 adolescents of both sexes&#44; 12&#8211;16 years of age&#46; Of all participants&#44; 54 were classified as having normal weight&#44; and 35 as having overweight&#8211;obesity&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the sociodemographic characteristics of the participants&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">We found significant differences between the weight status groups in the compliance with the dietary recommendations&#46; Of all participants with overweight&#8211;obesity&#44; 45&#46;7&#37; were in compliance&#44; compared to 1&#46;9&#37; of participants with normal weight &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The multivariate analysis of the scores of the domains and subdomains by weight status and adjusted for sex&#44; age and socioeconomic status revealed that adolescents with overweight&#8211;obesity had less resilience &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;003&#41;&#44; less family involvement &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;017&#41;&#44; less capacity for physical activity &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;04&#41; and more peer influences &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;024&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Furthermore&#44; the multivariate analysis showed that the scores obtained by girls were significantly lower than those of boys in the satisfaction &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and resilience &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; domains&#44; and in the self-esteem &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and physical activity &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; subdomains &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">The multiple linear regression analysis showed that as the age of participants increased&#44; they obtained lower scores in the risks domain &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and in the home health and safety &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;037&#41;&#44; individual risk &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and peer influences &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; subdomains &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0145" class="elsevierStylePara elsevierViewall">Several authors have assessed the psychosocial consequences of overweight and obesity in adolescents&#44; but there are few studies on the impact of excess weight in their HRQoL&#46; We must nevertheless take into account that psychosocial aspects are&#44; in fact&#44; part of HRQoL&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The works of Mirza et al&#46; and Sjoberg et al&#46; show that excess weight in adolescence leads to body dissatisfaction&#44; low self-esteem and a higher incidence of depression&#44; which are more pronounced in female adolescents&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">20&#44;21</span></a> The study by Al-Akour et al&#46; conducted in Jordan as well as the study by Beer et al&#46; conducted in the Netherlands showed an association between the presence of overweight&#8211;obesity and lower scores in every aspect of HRQoL&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">22&#44;23</span></a> Keating et al&#46; specifically analysed the consequences of excess weigh on physical aspects and observed that overweight and obese patients obtained significantly lower scores compared to patients with normal weight&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">24</span></a> According to the review by Griffiths et al&#46;&#44; as BMI increases&#44; self-esteem and HRQoL decrease&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">25&#44;26</span></a> The results that we present here are consistent with all of the above&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Still&#44; weight status in not the sole determinant of HRQoL&#46; The differences in perception between the sexes have a considerable impact on its consequences on HRQoL&#46; Several studies have reported that the influence of body image&#44; social acceptance and mood impairment is stronger in female than in male adolescents&#44; which makes girls more vulnerable to psychosocial disorders&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">20&#44;24&#44;27&#44;28</span></a> These differences were also observed in our study&#44; as girls reported lower satisfaction&#44; self-esteem&#44; resiliency and physical capacity than boys&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Excess weight often elicits teasing from peers&#46; The increased influence of the environment combined with perceived teasing and bullying lead to greater insecurity&#44; lower self-esteem and emotional wellbeing&#44; and more difficult interpersonal relationships&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">29&#44;30</span></a> As children grow they become more aware of their environment and of interpersonal differences&#59; self-criticism increases and negative self-perceptions and self-dissatisfaction develop&#44; negatively affecting HRQoL&#46; The decrease in self-esteem leads to increased peer influence and a reduced perceived social acceptance&#46; These aspects may lead to a more introverted character that&#44; as our results demonstrate&#44; may reduce family involvement&#46; The reduced interaction with the family may delay finding the help that the adolescent needs&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">29&#44;31&#44;32</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">To date&#44; there are no other published studies of this nature <span class="elsevierStyleItalic">conducted</span> on the adolescent population in Spain&#46; A European multicentre study on the impact of overweight on the HRQoL of participants 8&#8211;18 years of age included a representative sample of 714 individuals from Spain&#59; the study concluded that overweight and obesity have deleterious effects on HRQoL&#44; especially on physical comfort and self-perception&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">33</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">The anthropometric measurements were taken at the hospital by trained staff&#44; as opposed to self-reported&#46; None of the participants had IBM values at the border between normal weight and overweight&#8211;obesity&#44; which guarantees that the groups were separated correctly&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">The main limitation of this study is its cross-sectional design&#44; which can establish correlation but not causality&#46; Furthermore&#44; we used a convenience sample because those participants could then be considered for health-promoting interventions&#44; but this means that the sample may not be representative of the adolescent population of Navarra&#46; There may also be a selection bias&#44; as the adolescents with overweight&#8211;obesity that seek care in the endocrinology department may have a greater awareness of the repercussions of their disease&#46; One of the main biases to consider is the observer bias&#58; since participants are aware of being questioned&#44; they give more favourable responses in regards to their health status&#46; However&#44; this potential confounding factor would not invalidate the results of this study&#44; since were it not at play&#44; the differences found in the study would be even greater&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusion</span><p id="par0180" class="elsevierStylePara elsevierViewall">Overweight&#8211;obesity has a detrimental effect on the HRQoL of adolescents&#44; but it must be taken into account that sex and age have a significant impact on the decrease of HRQoL&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">The stronger influence of body image and social acceptance in women makes them more vulnerable to psychosocial disorders&#46; These negative perceptions already occur in female adolescents and have an influence on the development of their personality and behaviour&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">We believe that in order to offer patients personalised and multidisciplinary care it is crucial that we know the subjective perception and impact of their health status&#44; and to assess the emotional and psychosocial features related to health from the perspective of the paediatric patient&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "titulo" => "Palabras clave"
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          "titulo" => "Patients and methods"
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              "titulo" => "Ethical considerations"
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              "identificador" => "sec0025"
              "titulo" => "Study sample and participants"
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              "identificador" => "sec0030"
              "titulo" => "Measurement of health-related quality of life"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2014-04-27"
    "fechaAceptado" => "2014-06-20"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec498181"
          "palabras" => array:4 [
            0 => "Health related quality of life"
            1 => "Adolescents"
            2 => "Overweight"
            3 => "Obesity"
          ]
        ]
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        0 => array:4 [
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          "palabras" => array:4 [
            0 => "Calidad de vida relacionada con la salud"
            1 => "Adolescentes"
            2 => "Sobrepeso"
            3 => "Obesidad"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Changes in lifestyle and diet have led to a progressive increase in the prevalence of overweight and obesity&#46; This disorder can lead to significant physical and psychosocial effects that affect the health related quality of life &#40;HRQOL&#41;&#46; Adolescence is a time of great vulnerability and very decisive in personality development&#46; The objective of this study was to assess the influence of weight status on HRQoL in adolescents&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Population and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional study conducted on adolescents of 12&#8211;16 years old and an assessment of HRQOL using the CHIP-Adolescents Edition questionnaires&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Out of a total of 89 adolescents included&#44; 60&#46;7&#37; had a normal weight and 39&#46;3&#37; were overweight&#8211;obese&#46; The normal weight participants had a higher mean age than overweight&#8211;obesity participants&#44; 14&#46;2 vs&#46; 13&#46;6 years old&#44; respectively&#46; There were no other differences in sociodemographic characteristics between groups&#46; Overweight&#8211;obese adolescents had a worse HRQoL&#44; specifically as regards less resilience&#44; lower capacity for physical activity&#44; less family involvement&#44; and greater peer influence&#46; Moreover&#44; the girls showed a lower self-esteem&#44; satisfaction&#44; resilience and physical activity than boys&#46; Furthermore&#44; less home safety and health&#44; higher individual risk and greater peer influence was reported with increasing age of participants&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Overweight&#8211;obesity negatively affects the HRQoL of adolescents&#46; It is important to evaluate the psychosocial aspects from the perspective of the adolescents&#44; in order to offer them a complete&#44; personalised and multidisciplinary care&#46;</p></span>"
        "secciones" => array:4 [
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            "titulo" => "Introduction"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Population and methods"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los cambios en el estilo de vida y la alimentaci&#243;n han conllevado un aumento progresivo de la prevalencia del sobrepeso-obesidad&#46; Esta enfermedad puede conllevar importantes repercusiones f&#237;sicas y psicosociales que deterioran la calidad de vida relacionada con la salud &#40;CVRS&#41;&#46; La adolescencia es una etapa de gran vulnerabilidad por el entorno y muy determinante en el desarrollo de la personalidad del individuo&#46; El objetivo fue evaluar la influencia del estado ponderal en la CVRS de los adolescentes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Poblaci&#243;n y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal de adolescentes de 12 a 16 a&#241;os&#46; Evaluaci&#243;n de la CVRS mediante los cuestionarios CHIP-Adolescent Edition&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Ochenta y nueve adolescentes&#44; 60&#44;7&#37;&#44; eran normoponderales y el 39&#44;3&#37; ten&#237;a sobrepeso-obesidad&#46; Los participantes normoponderales ten&#237;an una edad media superior a los participantes con sobrepeso-obesidad&#44; 14&#44;2 frente a 13&#44;6 a&#241;os&#44; respectivamente&#46; No hab&#237;a otras diferencias entre las caracter&#237;sticas sociodemogr&#225;ficas de ambos grupos&#46; Los adolescentes con sobrepeso-obesidad reflejaron peor CVRS&#44; concretamente refirieron menor resistencia&#44; menor capacidad de actividad f&#237;sica&#44; menor participaci&#243;n familiar y mayor influencia de sus iguales&#46; Asimismo&#44; las chicas reflejaron menor autoestima&#44; satisfacci&#243;n&#44; resistencia y capacidad de actividad f&#237;sica que los chicos&#46; Por otro lado&#44; a medida que aumentaba la edad de los participantes&#44; refer&#237;an menor salud y seguridad en el hogar&#44; mayor riesgo individual y mayor influencia de sus iguales&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El sobrepeso-obesidad repercute negativamente en la CVRS de los adolescentes&#46; Consideramos importante evaluar los aspectos psicosociales desde la perspectiva del paciente para poder ofrecerle una atenci&#243;n personalizada y multidisciplinar&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Please cite this article as&#58; Herranz Barbero A&#44; L&#243;pez de Mesa MR&#44; Azcona San Juli&#225;n C&#46; Influencia del exceso de peso en la calidad de vida relacionada con la salud de los adolescentes&#46; An Pediatr &#40;Barc&#41;&#46; 2015&#59;82&#58;131&#8211;138&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0035"><span class="elsevierStyleBold">Previous presentation</span>&#58; the results of this study were presented in part as an oral communication under the title &#8220;Repercusi&#243;n del sobrepeso y la obesidad en la calidad de vida relacionada con la salud de los adolescentes&#8221; at the 61 Congreso de la Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a&#59; May 31&#8211;June 2&#44; 2012&#59; Granada&#44; Spain&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Box plots and error plots for the domain and subdomain scores of the CHIP-AE questionnaire for which the multivariate analysis found significant differences according to weight status&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Normal weight<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>54&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">Overweight&#8211;obesity<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>35&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">Conventional analysis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><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="" 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"><span class="elsevierStyleItalic">P</span> value<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> value&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">Significant model for&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">Satisfaction</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;41 &#40;51&#46;39&#8211;60&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;5 &#40;51&#46;1&#8211;60&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;537&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;263&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sex &#40;female&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#35;</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>Satisfaction with health&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#46;01 &#40;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">&#46;738&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;257&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="elsevierStyleHsp" style=""></span>Self-esteem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#46;02 &#40;52&#46;81&#8211;59&#46;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;28 &#40;49&#46;34&#8211;59&#46;76&#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;503&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sex &#40;female&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Discomfort</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;69 &#40;52&#46;45&#8211;61&#46;91&#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&#46;9 &#40;57&#46;41&#8211;63&#46;54&#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;134&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;251&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="elsevierStyleHsp" style=""></span>Physical comfort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;55 &#40;51&#46;83&#8211;61&#46;47&#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&#46;41 &#40;55&#46;58&#8211;62&#46;67&#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;151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;145&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="elsevierStyleHsp" style=""></span>Emotional comfort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;9 &#40;50&#46;87&#8211;63&#46;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;9 &#40;55&#46;56&#8211;64&#46;35&#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;306&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;51&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="elsevierStyleHsp" style=""></span>Limitation of activity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#46;71 &#40;51&#46;24&#8211;58&#46;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#46;17 &#40;54&#46;71&#8211;58&#46;17&#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;386&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;357&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="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Resilience</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#46;82 &#40;55&#46;56&#8211;63&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#46;75 &#40;53&#46;57&#8211;61&#46;41&#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;022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sex &#40;female&#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"><span class="elsevierStyleHsp" style=""></span>Family involvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;25 &#40;53&#46;77&#8211;62&#46;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;11 &#40;49&#46;42&#8211;58&#46;99&#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;092&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;017&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="elsevierStyleHsp" style=""></span>Problem solving&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#46;11 &#40;47&#46;19&#8211;54&#46;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&#46;65 &#40;44&#46;74&#8211;57&#46;02&#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;591&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;607&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="elsevierStyleHsp" style=""></span>Physical activity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&#46;53 &#40;8&#46;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#46;73 &#40;8&#46;58&#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;135&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sex &#40;female&#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"><span class="elsevierStyleHsp" style=""></span>Home safety and health&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#46;52 &#40;5&#46;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#46;13 &#40;5&#46;17&#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;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;329&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Age &#40;older&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Risk avoidance</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;11 &#40;56&#46;62&#8211;64&#46;07&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;92 &#40;59&#46;28&#8211;64&#46;86&#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;467&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;704&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Age &#40;older&#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"><span class="elsevierStyleHsp" style=""></span>Individual risks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;48 &#40;57&#46;54&#8211;63&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;09 &#40;58&#46;75&#8211;63&#46;45&#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;384&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;774&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Age &#40;older&#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"><span class="elsevierStyleHsp" style=""></span>Threats to achievement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;6 &#40;51&#46;02&#8211;60&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;89 &#40;55&#46;03&#8211;61&#46;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;047&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;229&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="elsevierStyleHsp" style=""></span>Peer influences&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;63 &#40;56&#46;69&#8211;65&#46;59&#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&#46;66 &#40;56&#46;69&#8211;65&#46;59&#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;479&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;024&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Age &#40;older&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Achievement</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;53 &#40;5&#46;9&#8211;16&#46;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;98 &#40;2&#46;02&#8211;12&#46;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">&#46;179&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;417&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="elsevierStyleHsp" style=""></span>Academic achievement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;48 &#40;10&#46;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#46;48 &#40;11&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;204&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;106&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="elsevierStyleHsp" style=""></span>Work achievement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;16&#46;0 &#40;&#8722;16&#46;0 to &#8722;16&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;16&#46;0 &#40;&#8722;16&#46;0 to &#8722;16&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;529&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;923&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \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
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;40&#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">&#46;152&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>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;44&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;60&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 23412879
Original language: English

DOI:10.1016/j.anpede.2014.06.004

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	9	11	20
2024 October	45	32	77
2024 September	42	25	67
2024 August	59	56	115
2024 July	43	38	81
2024 June	45	26	71
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2024 April	35	32	67
2024 March	38	25	63
2024 February	28	30	58
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2023 December	28	16	44
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2023 October	29	32	61
2023 September	18	20	38
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2022 October	38	51	89
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2022 May	43	46	89
2022 April	35	45	80
2022 March	41	49	90
2022 February	41	25	66
2022 January	58	34	92
2021 December	48	42	90
2021 November	45	39	84
2021 October	51	54	105
2021 September	26	59	85
2021 August	39	43	82
2021 July	21	27	48
2021 June	32	37	69
2021 May	23	32	55
2021 April	94	33	127
2021 March	41	21	62
2021 February	45	12	57
2021 January	35	23	58
2020 December	38	23	61
2020 November	27	16	43
2020 October	37	24	61
2020 September	31	20	51
2020 August	19	30	49
2020 July	26	36	62
2020 June	27	19	46
2020 May	37	13	50
2020 April	32	16	48
2020 March	35	26	61
2020 February	36	16	52
2020 January	26	20	46
2019 December	58	18	76
2019 November	36	14	50
2019 October	35	9	44
2019 September	20	9	29
2019 August	52	22	74
2019 July	24	38	62
2019 June	27	26	53
2019 May	36	29	65
2019 April	63	38	101
2019 March	35	13	48
2019 February	35	16	51
2019 January	21	13	34
2018 December	28	26	54
2018 November	40	27	67
2018 October	41	16	57
2018 September	23	20	43
2018 July	1	0	1
2018 June	2	0	2
2018 May	4	0	4
2018 April	20	0	20
2018 March	23	0	23
2018 February	8	0	8
2018 January	16	0	16
2017 December	8	0	8
2017 November	11	0	11
2017 October	21	0	21
2017 September	11	0	11
2017 August	14	0	14
2017 July	25	3	28
2017 June	20	3	23
2017 May	17	8	25
2017 April	17	3	20
2017 March	2	1	3
2017 February	5	2	7
2017 January	4	2	6
2016 December	22	4	26
2016 November	36	4	40
2016 October	23	3	26
2016 September	29	2	31
2016 August	15	2	17
2016 July	9	0	9

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