Treatment of obesity in a hospital endocrinology clinic: Influence of parental body mass index

array:24 ["pii" => "S2341287915001751" "issn" => "23412879" "doi" => "10.1016/j.anpede.2015.09.012" "estado" => "S300" "fechaPublicacion" => "2015-11-01" "aid" => "1794" "copyright" => "Asociación Española de Pediatría" "copyrightAnyo" => "2014" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2015;83:297-303" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1764 "formatos" => array:3 [ "EPUB" => 140 "HTML" => 1227 "PDF" => 397 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1695403314005621" "issn" => "16954033" "doi" => "10.1016/j.anpedi.2014.11.019" "estado" => "S300" "fechaPublicacion" => "2015-11-01" "aid" => "1794" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2015;83:297-303" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4893 "formatos" => array:3 [ "EPUB" => 146 "HTML" => 4080 "PDF" => 667 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "ORIGINAL" "titulo" => "Tratamiento de la obesidad en la consulta de endocrinología de un hospital. Influencia del índice de masa corporal de los padres" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "297" "paginaFinal" => "303" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Treatment of obesity in a hospital endocrinology clinic. Influence of parental body mass index" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1300 "Ancho" => 1613 "Tamanyo" => 55677 ] ] "descripcion" => array:1 [ "es" => "Adherencia a las recomendaciones terapéuticas según si ambos padres eran o no obesos. Cuando los 2 padres son obesos, los niños tienen menor adherencia al tratamiento de la obesidad (p=0,01)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Regueras Santos, A. Díaz Moro, C. Iglesias Blázquez, C. Rodríguez Fernández, R. Quiroga González, J.A. de Paz Fernández, L.M. Rodríguez Fernández" "autores" => array:7 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Regueras Santos" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Díaz Moro" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Iglesias Blázquez" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Rodríguez Fernández" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Quiroga González" ] 5 => array:2 [ "nombre" => "J.A." "apellidos" => "de Paz Fernández" ] 6 => array:2 [ "nombre" => "L.M." "apellidos" => "Rodríguez Fernández" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341287915001751" "doi" => "10.1016/j.anpede.2015.09.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001751?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403314005621?idApp=UINPBA00005H" "url" => "/16954033/0000008300000005/v1_201510300037/S1695403314005621/v1_201510300037/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341287915001994" "issn" => "23412879" "doi" => "10.1016/j.anpede.2014.12.004" "estado" => "S300" "fechaPublicacion" => "2015-11-01" "aid" => "1789" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2015;83:304-10" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1967 "formatos" => array:3 [ "EPUB" => 130 "HTML" => 1415 "PDF" => 422 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Physical activity, screen time and sleep patterns in Chilean girls" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "304" "paginaFinal" => "310" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Actividad física, tiempo de pantalla y patrones de sueño en niñas chilenas" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.M. Aguilar, F.A. Vergara, E.J.A. Velásquez, A. García-Hermoso" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.M." "apellidos" => "Aguilar" ] 1 => array:2 [ "nombre" => "F.A." "apellidos" => "Vergara" ] 2 => array:2 [ "nombre" => "E.J.A." "apellidos" => "Velásquez" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "García-Hermoso" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403314005578" "doi" => "10.1016/j.anpedi.2014.12.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403314005578?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001994?idApp=UINPBA00005H" "url" => "/23412879/0000008300000005/v1_201512040119/S2341287915001994/v1_201512040119/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341287915001982" "issn" => "23412879" "doi" => "10.1016/j.anpede.2015.07.019" "estado" => "S300" "fechaPublicacion" => "2015-11-01" "aid" => "1930" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "An Pediatr (Barc). 2015;83:295-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1723 "formatos" => array:3 [ "EPUB" => 142 "HTML" => 1182 "PDF" => 399 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Editorial" "titulo" => "The development of Spanish paediatric cardiology and its impact on congenital heart disease management" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "295" "paginaFinal" => "296" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El desarrollo de la cardiología pediátrica española y su impacto en el manejo de las cardiopatías congénitas" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D.C. Albert Brotons" "autores" => array:1 [ 0 => array:2 [ "nombre" => "D.C." "apellidos" => "Albert Brotons" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403315003033" "doi" => "10.1016/j.anpedi.2015.07.022" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403315003033?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001982?idApp=UINPBA00005H" "url" => "/23412879/0000008300000005/v1_201512040119/S2341287915001982/v1_201512040119/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Treatment of obesity in a hospital endocrinology clinic: Influence of parental body mass index" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "297" "paginaFinal" => "303" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L. Regueras Santos, A. Díaz Moro, C. Iglesias Blázquez, C. Rodríguez Fernández, R. Quiroga González, J.A. de Paz Fernández, L.M. Rodríguez Fernández" "autores" => array:7 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Regueras Santos" "email" => array:1 [ 0 => "lregsan@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Díaz Moro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Iglesias Blázquez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "C." "apellidos" => "Rodríguez Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "R." "apellidos" => "Quiroga González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "J.A." "apellidos" => "de Paz Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 6 => array:3 [ "nombre" => "L.M." "apellidos" => "Rodríguez Fernández" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Complejo Asistencial Universitario de León (CAULE), León, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto de Biomedicina (IBIOMED), Universidad de León, León, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento de la obesidad en la consulta de endocrinología de un hospital. Influencia del índice de masa corporal de los padres" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2596 "Ancho" => 1527 "Tamanyo" => 166319 ] ] "descripcion" => array:1 [ "en" => "Degree of obesity of the sample based on the BMI z-score at the time of the initial measurement (M1) and the measurement at six-month checkup (M2), applying the 2010 cross-sectional study charts. Source: Carrascosa et al.<a class="elsevierStyleCrossRef" href="#bib0190">12</a>" ] ] ] "textoCompleto" => "IntroductionChildhood obesity is a public health problem in developed countries. The World Health Organisation (WHO) has called obesity the XXI century epidemic due to the proportions it has acquired and its impact on morbidity, mortality, quality of life and health care costs.<a class="elsevierStyleCrossRefs" href="#bib0135">1,2</a> Europe has a surveillance system that has alerted us to the high prevalence of childhood obesity in countries in southern Europe.<a class="elsevierStyleCrossRef" href="#bib0145">3</a> Spain ranks third in Europe, with a 19.1% prevalence of childhood obesity and a 26.1% prevalence of childhood overweight, according to the Estudio de Alimentación, Actividad física, Desarrollo Infantil y Obesidad (Study on Nutrition, Physical Activity, Childhood Development and Obesity [ALADINO]) conducted in 2011.<a class="elsevierStyleCrossRef" href="#bib0150">4</a>Childhood obesity is a multifactorial condition. The literature has described many risk factors involved, including parental obesity and sociocultural level. A study conducted in Sweden by Moraeus et al.<a class="elsevierStyleCrossRef" href="#bib0155">5</a> addressed the importance of the association between parental obesity and future obesity in their children. The study conducted in Spain by Santiago et al.<a class="elsevierStyleCrossRef" href="#bib0160">6</a> also referred to the importance of parental obesity, which was the best predictor of childhood overweight in both sexes. Rodriguez et al.<a class="elsevierStyleCrossRef" href="#bib0165">7</a> reported that a high percentage of parents in Spain do not correctly assess the weight status of their overweight children, especially at earlier ages. This inadequate perception by overweight parents may also be a risk factor for childhood obesity. Several studies have concluded that parents influence the dietary behaviours of their children concerning food preferences and the type, amount, and quality of consumed foods.<a class="elsevierStyleCrossRef" href="#bib0170">8</a>It seems evident that there is a significant relationship between obesity in parents and obesity in their children. However, few studies have assessed whether obesity in the parents once children are already obese can influence the children's response and adherence to obesity treatment. It is known that mothers are mainly responsible for passing on healthy dietary habits to their children,<a class="elsevierStyleCrossRefs" href="#bib0175">9,10</a> but it is not known whether the response to obesity treatment varies depending on which of the parents is obese. There is also some degree of controversy as to whether parents influence the nutritional status of their children throughout their entire development, or whether their influence reaches only as far as 10 years of age or the beginning of puberty.<a class="elsevierStyleCrossRef" href="#bib0185">11</a> Knowing this would help us implement more effective therapeutic strategies.The aim of this study was to learn whether having obese parents influenced the response and adherence to treatment of obese children, and to analyse the response to lifestyle and dietary recommendations given to the population under study at the paediatric endocrinology clinic.Materials and methodsWe conducted a prospective, longitudinal analytical study. We recruited children and adolescents aged 4–14 years referred by their paediatrician to the paediatric endocrinology clinic of a tertiary hospital between November 2010 and November 2012 for obesity treatment. The children's weight (kg), height (cm) and waist circumference (cm) were measured at the clinic, followed by calculation of their body mass index (BMI, kg/m2) and z-scores for weight, height, BMI and waist circumference for their sex and age (charts of the 2010 Spanish study by Carrascosa for weight, height and BMI; charts of the cross-sectional 2011 Fundación Orbegozo study for waist circumference).<a class="elsevierStyleCrossRefs" href="#bib0190">12,13</a> The degree of pubertal development was assessed during the physical examination (prepubertal: Tanner stage 1, and pubertal: Tanner stage>1).Patients were included in the study as they were referred to the clinic by their paediatricians, and the sole inclusion criterion was that they have a BMI z-score above 2 for their age and sex. We excluded patients with neuropsychological disorders, such as neurodevelopmental delay or autism, as these disorders would influence response to lifestyle and dietary interventions, and patients that received a diagnosis of clinical hypothyroidism or hypercortisolism based on the initial laboratory tests.During the first visit, lifestyle and dietary recommendations were given to both the parents and the child (<a class="elsevierStyleCrossRef" href="#sec0055">Appendix 1</a>), recommending daily physical activity and a diet based on on-demand and light-calorie foods according to the classification of foods presented in <a class="elsevierStyleCrossRef" href="#sec0060">Appendix 2</a>.Thereafter, patients came for medical checkups at the paediatric endocrinology clinic of the hospital. The first checkup was scheduled at one month, and subsequent checkups every one to two months, during which the lifestyle and dietary recommendations and the advice to perform physical activity for 1h a day were reinforced. At six months after the first visit, patients were assessed once more, measuring their weight, height, BMI and waist circumference and recalculating their z-scores for all parameters. We defined success as a decrease of 0.5 or more in the BMI z-score, and adherence to treatment as showing up to the six-month checkup.During the first checkup, the weight and height of both parents were measured, and their BMI calculated (kg/m2). Based on their BMI, parents were classified into: underweight (<18.5kg/m2), normal weight (18.5–24.9kg/m2), class I overweight (25.0–26.9kg/m2) or class II overweight (27.0–29.9kg/m2), moderate obesity (30.0–34.9kg/m2), severe obesity (35.0–39.9kg/m2), morbid obesity (40.0–49.9kg/m2) and extreme obesity (>50kg/m2), following the 2000 classification scheme of the Sociedad Española para el Estudio de la Obesidad (SEEDO).<a class="elsevierStyleCrossRef" href="#bib0200">14</a> In order to determine the association between the children's response to treatment and parental weight, we divided parents into obese and not obese.We performed the statistical analysis of the results with the statistical package SPSS V.19. We have expressed qualitative variables as mean±standard deviation (SD) and compared them with the Student t test verifying that they followed a normal distribution by means of the Kolmogorov–Smirnov test. We compared categorical variables with the χ2 test. We set a confidence interval of 95% (significance, P≤.05). We assessed risk by calculating the odds ratio (OR).The parents of the patients were informed and asked to agree to take part in the study when it was observed that the patients met the inclusion criteria.ResultsWe studied a total of 100 obese children, 47 girls and 53 boys, with a mean age of 9.91±2.73 years. In terms of pubertal development, there were 25 prepubertal and 28 pubertal girls, and 31 prepubertal and 16 pubertal boys.Anthropometric characteristics of the sample<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> presents the degree of obesity of the sample on the 2 occassions it was assessed (M1 and M2), which was determined on the basis of the BMI z-score. A high percentage of children (82%) had high-degree obesity at the beginning of the study (BMI z-score≥3).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0015">Table 1</a> summarises the anthropometric characteristics (height, weight and BMI z-score) of the patients at the time of the first measurement (M1) and the second measurement (M2). For each group, we compared the data obtained at M1 and M2 by means of the Student t test for paired samples, and found statistically significant differences, with the group of pubertal boys being the only one in which there was no statistically significant difference between the BMI z-scores obtained during M1 and M2 (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 1</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Anthropometric characteristics of the mothersBased on the SEEDO classification, 27% of mothers had normal weights, 36% were class I or class II overweight, and 37% were obese to some degree. When we compared the mean BMIs of the mothers with the Student t test we found statistically significant differences (P<.05) between the mothers of pubertal children and the mothers of prepubertal children (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 2</a>). Of the mothers of pubertal children, 46% were obese and up to 13% were morbidly obese; while only 28% of the mothers of prepubertal children had class I or II obesity, and none had morbid obesity.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>Anthropometric characteristics of the fathersOf all fathers, 12% had normal weight, 45% some degree of overweight, and up to 41% some degree of obesity, with 1% being morbidly obese and 1% extremely obese. We found no significant differences between groups in the comparison of the paternal anthropometric data (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 2</a>).Both parents were obese in 19 patients, only the mother was obese in 18, only the father was obese in 22, and in 41 patients neither parent was obese.Adherence to recommendationsTwenty-five patients did not show for the six-month visit when the second measurements were taken. Sixty-four percent of these patients (16/25) had one or two obese parents; only the mother was obese in four, only the father was obese in three, and both parents were obese in nine. <a class="elsevierStyleCrossRef" href="#tbl0025">Table 3</a> shows the data for the two groups of patients, those that adhered to treatment and those that did not. The mothers of non-adherent patients had higher BMIs (P<.05). When we compared the fathers, we found no statistically significant differences.<elsevierMultimedia ident="tbl0025"></elsevierMultimedia>When we compared the adherent and non-adherent groups in terms of having an obese mother, father or both by means of the χ2 test, we found that when the mother was not obese, even if the father was obese, adherence was higher than when both parents were obese (P=.013). We also observed that adherence to treatment was worse when both parents were obese than when they were not (P=.012). When both parents were obese, children were 3.65 times more likely (CI, 1.3–10.5) to not adhere to recommendations than if they were not (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Treatment successAfter six months of follow-up, the BMI z-scores of 23 patients had decreased by more than 1, the z-scores of 17 by 0.5–1, and those of 20 patients decreased by 0.1–0.5, while in 11 the z-scores increased by 0.5 or less, and in 4 they increased by more than 0.5. Thus, 40% of the patients included at the beginning of the study were significantly successful following the lifestyle and dietary recommendations.Of the group of 40 patients that were significantly successful, 19 (47.5%) did not have an obese parent, and in 3 (7.5%) only the mother was obese. When we analysed patient success based on the presence of parental obesity by means of the χ2 test, we found that the probability of not succeeding was significantly higher if the mother was the only obese parent (OR, 5.65 [1.4–22.4]; P=.008) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>DiscussionThe percentage of children in this study that adhered to the recommendations may seem low, as only 75% showed at the six-month checkup. In the study by Feliu et al.<a class="elsevierStyleCrossRef" href="#bib0205">15</a> adherence reached 78.2% at 12 months, and there are even studies in which losses to follow-up amount to only 9% and 7% at 12 months,<a class="elsevierStyleCrossRef" href="#bib0215">17</a> although in these studies the checkups were conducted at home or in the school. In our study, the checkups were performed in a tertiary hospital to which patients needed to travel, sometimes from towns more than 1h away and through mountainous terrain. The time available for the first visit was 20min, and subsequent visits lasted only 5min. Some studies have indicated that durations of less than 15min per visit could suffice for motivational modalities of obesity treatment.<a class="elsevierStyleCrossRef" href="#bib0220">18</a> At any rate, assessing the delivery of care with the means and time that are actually available in the endocrinology clinic of a public tertiary hospital can be useful for the purposes of considering possible changes in treatment strategies.In this study, we found a success percentage of 40%, which was lower than the percentages found by other studies that defined success as a z-score decrease of any size.<a class="elsevierStyleCrossRef" href="#bib0205">15</a> If our study had considered any decreases in z-scores a success, the success percentage would have reached 60% in patients that started the treatment, and 80% in patients that completed it, similar to the results of other studies that applied broader measures of treatment success. There is no consensus on the time that is needed to assess the response to obesity treatment, but it should be of at least six months.<a class="elsevierStyleCrossRef" href="#bib0225">19</a> Some studies have analysed periods of up to 12 and 24 months,<a class="elsevierStyleCrossRefs" href="#bib0210">16,17</a> so we cannot compare the data. However, initial response is a good prognostic factor, and patients that do not show an initial response are unlikely to show one at a later time.When it came to the family history, a high percentage of patients had at least one obese parent. The average BMI of the mothers ranged between 27.7kg/m2 in mothers of prepubertal children and 31.7kg/m2 in mothers of pubertal children, which were within the overweight and obesity ranges, respectively. The average BMI of the fathers ranged from 28.6kg/m2 to 30.9kg/m2, which also corresponded to the overweight and obesity ranges. This was consistent with the findings of Feliu Rovira et al.<a class="elsevierStyleCrossRef" href="#bib0205">15</a> It seems clear that a high proportion of children that are very obese have obese parents, demonstrating that the family plays an essential role in the prevention of childhood obesity. This association between obesity in children and obesity in their parents can be explained not only by environmental or behavioural factors (as they share dietary and physical activity habits), but also by genetic factors as well.<a class="elsevierStyleCrossRef" href="#bib0230">20</a>When we assessed the response to the lifestyle and dietary recommendations in relation to whether the parents were or were not obese, the importance of the mother's role stood out, for when the mother was obese, irrespective of the father being obese or not, the response to treatment was much worse. This may be related to the fact that mothers are mainly responsible for dietary habits. If the mother is obese, her dietary habits may not be healthy, and she may find it difficult to change her own diet, with fathers probably having a lesser involvement in their children's dietary habits. Other studies have shown that the immediate family, and especially mothers, has a significant influence on the child's dietary behaviours,<a class="elsevierStyleCrossRefs" href="#bib0235">21–23</a> and our study corroborates the role of the mother.Thus, it seems that it is very important that parents become more involved in their children's diet, and to try to change the dietary habits of the mother if she is obese, for otherwise, as our study suggests, the outcomes of their children will be worse. The findings of other studies have evinced that the treatment of childhood obesity and overweight must be firmly founded on the development of healthy habits and the promotion of physical activity, and that the awareness and level of involvement of the family are crucial factors in the development of healthy lifestyles by the young.<a class="elsevierStyleCrossRef" href="#bib0250">24</a>Another noteworthy finding is that the mother plays a key role in following through with checkups at the paediatrician's office, and therefore in adherence to treatment. The mothers of children that stopped showing for checkups were more obese. It may be that obese mothers are less likely to adhere to treatment because they do not consider obesity a health problem. Perhaps it would be convenient to implement treatment strategies that involve the mother as well as the child. An improvement in BMI in children is probably dependent on succeeding in improving the BMI in mothers, as noted by Limbers et al.<a class="elsevierStyleCrossRef" href="#bib0255">25</a> and Nyberg et al.<a class="elsevierStyleCrossRef" href="#bib0260">26</a> Unfortunately, our study did not collect the BMI of both parents after the period during which the child was followed up. These data would have provided information as to whether there had been a change in lifestyle and dietary habits in the family as a whole.In our study, the response to lifestyle and dietary recommendations was worse among pubertal children. This may be related to the fact that the mothers of pubertal children were the most obese, and we have seen that the mother plays an essential role in treatment success. This fact is also interesting in that it suggests that the influence of the mother concerning the development of healthy dietary habits extends into puberty.Another factor that may influence the response and adherence to treatment is the degree of obesity of the children under study. As noted by Feliu et al., children with high BMIs show worse adherence and response to obesity treatment.<a class="elsevierStyleCrossRef" href="#bib0205">15</a> A high percentage of the analysed sample had severe obesity, as our study was conducted in a specialty clinic, and thus the results of this study should only be applied to children of equal anthropometric characteristics. Thus, we still need to find out whether parental BMIs have a similar influence on the response to obesity treatment of children with less severe obesity, most of whom are probably being monitored by primary care paediatricians.In conclusion, this study corroborated that a high percentage of children that are very obese have obese parents, and that mothers have substantial influence on the adherence and response to obesity treatment in their children, at least if they have a significant degree of obesity. For all the above reasons, this study suggests the need to consider new therapeutic approaches against obesity that involve the entire family unit and the collaborative effort of endocrinologists and paediatric endocrinologists.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres585592" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec601453" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres585593" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec601454" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Anthropometric characteristics of the sample" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Anthropometric characteristics of the mothers" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Anthropometric characteristics of the fathers" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Adherence to recommendations" ] 4 => array:2 [ "identificador" => "sec0040" "titulo" => "Treatment success" ] ] ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-08-29" "fechaAceptado" => "2014-11-28" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec601453" "palabras" => array:4 [ 0 => "Family obesity" 1 => "Childhood obesity" 2 => "Obesity therapy" 3 => "Parental behaviour control" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec601454" "palabras" => array:4 [ 0 => "Obesidad familiar" 1 => "Obesidad infantil" 2 => "Tratamiento de la obesidad" 3 => "Educación" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionParental obesity is a risk factor for childhood obesity. The aim of this study was to determine if parental obesity influences the adherence and success of obesity treatment in a hospital paediatric endocrinology clinic. Material and methodsAn analytical, prospective, longitudinal study was conducted on obese children aged 4–14. An initial body mass index (BMI) was obtained, and again at 6 months after receiving health, hygiene and dietary recommendations. Success was considered as a decrease of 0.5 in the BMI z-score, and adherence to attending the 6-month review. Parental BMI was determined to identify overweight. The χ2 test was used for qualitative variables and the T-Student test for quantitative (significance, P<.05) variables. ResultsThe study included 100 children (52 male), 9.9±2.7 years old, BMI 28.1±4.5kg/m2 and BMI z-score 3.11±0.98 (85% had a BMI z-score>3). More than half (59%) of the children had one or both parents obese (41 fathers and 37 mothers were obese). Treatment was not adhered to by 25 children. Adherence was worse if both parents were obese, OR 3.65 (1.3–10.5) (P≤.01), and adherence was better if the mother was not obese, although the father was (P=.01). The treatment had significant success in 40 patients. If the mother was the only obese one in the family, the possibility of treatment failure was greater, OR 5.6 (1.4–22.4) (P<.01). ConclusionsA high percentage of children with severe obesity have obese parents. The mother has an important influence on adherence and response to treatment for the severely obese child." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónEl objetivo del estudio es conocer si tener padres obesos influye en la adherencia y el éxito del tratamiento frente a la obesidad en la consulta de endocrinología infantil de un hospital. Material y métodosEstudio analítico, prospectivo y longitudinal en obesos de 4–14 años. En ellos se determinó el IMC inicial y 6 meses después de que recibieran pautas higiénico-dietéticas saludables. Se consideró éxito significativo la disminución de 0,5 DE del IMC y adherencia que los pacientes acudieran a la revisión semestral. Se calculó el IMC de los padres para identificar a los obesos. Se utilizó el test de la χ2 para comparar las variables cualitativas y el test de la t de Student para las variables cuantitativas (significativo: p<0,05). ResultadosCien niños (52 varones), edad media±DE: 9,9±2,7 años, IMC 28,1±4,5kg/m2 y z-score del IMC 3,11±0,98 (el 85% tenía un z-score del IMC>3). Eran obesos 41 padres y 38 madres (el 59% tenía uno o los 2 padres obesos). No se adhirieron al tratamiento 25. La adherencia era peor si los 2 padres eran obesos, OR 3,65 (1,3–10,5) (p=0,01) y era mejor si la madre no era obesa, aunque el padre lo fuera (p=0,01). El tratamiento tuvo éxito significativo en 40 pacientes. Si la madre era la única obesa en la familia la posibilidad de no tener éxito era mayor, OR 5,6 (1,4–22,4) (p<0,01). ConclusionesUn alto porcentaje de niños con obesidad severa tienen padres obesos. La madre tiene gran influencia en la adherencia y respuesta al tratamiento frente a la obesidad del hijo muy obeso." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Regueras Santos L, Díaz Moro A, Iglesias Blázquez C, Rodríguez Fernández C, Quiroga González R, de Paz Fernández JA, et al. Tratamiento de la obesidad en la consulta de endocrinología de un hospital. Influencia del índice de masa corporal de los padres. An Pediatr (Barc). 2015;83:297–303." ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "Previous presentation: This study was presented at the XXXVI Congreso de la Sociedad EspaÒola de EndocrinologÌa Pedi·trica. (SEEP), 14–16 Mayo 2014 Sevilla." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:2 [ 0 => array:4 [ "apendice" => "<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>" "etiqueta" => "Appendix 1" "titulo" => "Lifestyle and dietary recommendations given to patients and their parents" "identificador" => "sec0055" ] 1 => array:4 [ "apendice" => "<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>" "etiqueta" => "Appendix 2" "titulo" => "Sheet that was given to the patient and parents with the classification of foods taken from the Niñ@s en movimiento programme by Gussinyer S, Garcia-Reyna NI, Alsina M, Gussinyer M, Carrascosa A (www.enmovimiento.net)" "identificador" => "sec0060" ] ] ] ] "multimedia" => array:8 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2596 "Ancho" => 1527 "Tamanyo" => 166319 ] ] "descripcion" => array:1 [ "en" => "Degree of obesity of the sample based on the BMI z-score at the time of the initial measurement (M1) and the measurement at six-month checkup (M2), applying the 2010 cross-sectional study charts. Source: Carrascosa et al.<a class="elsevierStyleCrossRef" href="#bib0190">12</a>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1300 "Ancho" => 1603 "Tamanyo" => 55975 ] ] "descripcion" => array:1 [ "en" => "Adherence to therapeutic recommendations according to whether both parents were or not obese. When both parents were obese, the adherence of children to obesity treatment was lesser (P=.01)." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1399 "Ancho" => 1646 "Tamanyo" => 62902 ] ] "descripcion" => array:1 [ "en" => "Success of therapeutic recommendations according to whether the mother was the only obese parent or not. When the mother was the only obese parent, children were less successful in their obesity treatment (P<.001)." ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "Student t test for dependent means comparing M1 and M2 in each group." "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 " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Girls</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Boys</th></tr><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 " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Prepubertal</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Pubertal</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Prepubertal</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Pubertal</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="left" valign="top" scope="col" style="border-bottom: 2px solid black">M1 \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">M2 \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">M1 \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">M2 \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">M1 \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">M2 \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">M1 \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">M2 \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">BMI z-score (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.4±1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.5±1.4<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.1±1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.5±1.4<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.7±0.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.1±0.9<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.9±0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.5±1.1 \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">Weight z-score (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.2±1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.7±1.9<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.4±1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.8±1.5<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.3±1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.7±1.5<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.6±1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.1±1.8<a class="elsevierStyleCrossRef" href="#tblfn0005">*</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">Height z-score (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5±1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5±1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.4±1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5±1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.4±1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5±1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.3±1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.2±1.7 \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">Waist circumference z-score (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.48±1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.95±1.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.8±1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.5±1.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.8±1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.3±1.3<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.8±1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.2±1.2<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab955919.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "P<.05." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "**" "nota" => "P<.01." ] ] ] "descripcion" => array:1 [ "en" => "Anthropometric measurements of the sample (mean±SD) at the time of measurement 1 (M1) and measurement 2 (M2) by patient group." ] ] 4 => array:7 [ "identificador" => "tbl0020" "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"> \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">Girls</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Boys</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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Prepubertal \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">Pubertal \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">Prepubertal \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">Pubertal \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">Maternal weight (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76.1±12.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.9±15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.4±13.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80±13.3 \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">Maternal height (m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6±0.1 \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">Paternal weight (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87.9±16.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88.6±15.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93.6±22.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87±14.9 \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">Paternal height (m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.8±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7±0.1 \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">Paternal BMI (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.6±4.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.9±5.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.6±6.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.5±3.8 \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">Maternal BMI (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.7±4.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.6±5.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.7±5.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.7±6.6<a class="elsevierStyleCrossRef" href="#tblfn0015">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab955922.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "*" "nota" => "P≤.05." ] ] ] "descripcion" => array:1 [ "en" => "Anthropometric measurements of the mothers and fathers of the patients (mean±SD) by patient group; Student t test for independent samples." ] ] 5 => array:7 [ "identificador" => "tbl0025" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "Student's t test." "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">Non-adherent \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">Adherent \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">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.8±2.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.6±2.7 \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">Maternal weight (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78.7±18.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.7±11.2 \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">Maternal height (m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6±0.1 \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">Maternal BMI (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.8±5.4<a class="elsevierStyleCrossRef" href="#tblfn0020">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.2±4.9 \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">Paternal weight (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93.7±23.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88.4±15.6 \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">Paternal height (m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7±0.1 \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">Paternal BMI (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.1±11.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.6±6.7 \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">Patient's BMI (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.7±3.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.6±4.6 \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">Patient's BMI z-score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.3±1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4±1.1 \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">Patient's height z-score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1±1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.3±1.2 \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">Patient's weight z-score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.4±1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.3±1.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab955918.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "*" "nota" => "P≤.05 for independent samples." ] ] ] "descripcion" => array:1 [ "en" => "Data for the adherent and non-adherent patient groups described as mean±SD." ] ] 6 => array:5 [ "identificador" => "tbl0005" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => false "mostrarDisplay" => true "tabla" => array:1 [ "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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lifestyle and dietary recommendations \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">1. Have 5 meals a day with no snacking between meals \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2. Do not skip meals, have breakfast every day \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">3. Have five pieces of fruit or vegetables a day \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">4. Drink water, no sugary drinks \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">5. Exercise for 1h a day \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">6. Limit the number of hours spent watching TV and playing videogames \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">7. Eat mostly foods in the on-demand and low-calorie groups \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">8. Avoid very high-calorie foods \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab955921.png" ] ] ] ] ] 7 => array:5 [ "identificador" => "tbl0010" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => false "mostrarDisplay" => true "tabla" => array:1 [ "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=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">On-demand foods: cabbage, pepper (spice), chard, peppers, water, Brussels sprouts, leek, artichoke, diet soft drinks, celery, cauliflower, radish, aubergine, spices, watercress, endive, mushrooms, broccoli, escarole, tomato, soy bean sprouts, asparagus, vinegar, courgette, spinach, carrot, pumpkin, green bean, vegetable broth, lettuce, onion, lemon, cucumber \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">Low-calorie foods: shellfish, green pea, boiled pasta, bread (pita, loaf, sliced), biscotti, potato (roasted, boiled, baked), fresh fruits, fresh fruit juices, turkey (skinless), rice (boiled), egg, tuna canned in water, Serrano ham, ham, fresh or frozen fish, squid (no oil), non-fat and low-fat milk, skinless chicken, goat, lentils, sugar-free cereal, pork tenderloin, fresh low-fat cheese, cherries, fresh corn, beets, low-fat cream cheese, rabbit, mango, vegetable purée, fat-free soup, rice salad, lean beef, pasta salad, low-fat yoghourt, rice crackers, Marie biscuits, chickpeas \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-calorie foods: avocado, creme brulee, duck, fried chicken wings, frankfurters, fried or breaded fish, whole-fat sugared rice pudding, fruits canned in syrup, pork and beef liver, lamb shank, sunflower seeds, fish sticks, fried egg, cake, whole-fat dairy products, fried squid, fried or breaded chicken or chicken with its skin, cannelloni, cream-based sauces, fatty minced meat, cupcakes, soft or hard cheeses, pork shoulder, custards and flans, cereals with added sugar or cocoa, popcorn, soft drinks, pork belly, spring rolls, chops, coconut, pastries, ribs, pies, juices with added sugar \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">Very high-calorie foods: cured meats (chorizo, salami), honey, sunflower oil, blood sausage, almonds, chocolate biscuits, cocoa spread, hazelnuts, butter biscuits, olives, sugar, ice cream, bacon, sweets, peanuts, lard, French fries, milk chocolate, butter, potato chips, margarine, patés, peanut butter, mayonnaise, aioli sauce, cream cheese, cream, marzipan, tarts, cheese dip, marmalade and jam, ketchup \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab955920.png" ] ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0135" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity, preventing and managing the global epidemic. Report of a WHO consultation. WHO technical report series 894" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "World Health Organization consultation on obesity" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2000" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0140" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diet, nutrition and the prevention of chronic diseases. WHO technical report series 916" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases WHO" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2003" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0145" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "WHO Regional Office for Europe, Participating States. European Childhood Obesity Surveillance Initiative, COSI. 2012." ] ] ] 3 => array:3 [ "identificador" => "bib0150" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio de prevalencia de obesidad infantil ALADINO" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Ministerio de Sanidad, Política Social e Igualdad" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2011" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0155" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multi-level influences on childhood obesity in Sweden: societal factors, parental determinants and child's lifestyle" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L. Moraeu" 1 => "L. Lissner" 2 => "A. Yngve" 3 => "E. Poortvliet" 4 => "U. Al-Ansar" 5 => "A. Sjöberg" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Obes" "fecha" => "2012" "volumen" => "36" "paginaInicial" => "969" "paginaFinal" => "976" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0160" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perinatal and parental determinants of childhood overweight in 6–12 years old children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Santiago" 1 => "I. Zazpe" 2 => "M. Cuervo" 3 => "J.A. Martínez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/S0212-16112012000200037" "Revista" => array:6 [ "tituloSerie" => "Nutr Hosp" "fecha" => "2012" "volumen" => "27" "paginaInicial" => "599" "paginaFinal" => "605" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22732989" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0165" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La percepción del sobrepeso y la obesidad infantil por parte de los progenitores" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Rodríguez" 1 => "J.P. Novalbos" 2 => "S. Villagran" 3 => "J.M. Martínez" 4 => "J.L. Lechuga" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4321/S1135-57272012000500003" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Salud Pública" "fecha" => "2012" "volumen" => "86" "paginaInicial" => "483" "paginaFinal" => "494" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23223761" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0170" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and risk factors for obesity in Balearic Islands adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.M. Bibiloni" 1 => "E. Marti¿nez" 2 => "R. Llull" 3 => "M.D. Juarez" 4 => "A. Pons" 5 => "J.A. Tur" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1017/S000711450999136X" "Revista" => array:6 [ "tituloSerie" => "Br J Nutr" "fecha" => "2010" "volumen" => "103" "paginaInicial" => "99" "paginaFinal" => "106" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19671204" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0175" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Desarrollo de la conducta alimentaria en la infancia y sus alteraciones" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Osorio" 1 => "G. Weisstaub" 2 => "C. Castillo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Chil Nutr" "fecha" => "2002" "volumen" => "29" "paginaInicial" => "280" "paginaFinal" => "285" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0180" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Observation of family functioning at mealtime: a comparison between families of children with and without overweight" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Moens" 1 => "C. Braet" 2 => "B. Soetens" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/jpepsy/jsl011" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Psychol" "fecha" => "2007" "volumen" => "32" "paginaInicial" => "52" "paginaFinal" => "63" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16801324" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0185" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevention of owerweight and obesity: a Spanish approach" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Aranceta" 1 => "C. Pérez" 2 => "L.L. Serra" 3 => "D. Bellido" 4 => "M.L. de la Torre" 5 => "X. Formiguera" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1017/S1368980007000699" "Revista" => array:6 [ "tituloSerie" => "Public Health Nutr" "fecha" => "2007" "volumen" => "10" "paginaInicial" => "1187" "paginaFinal" => "1193" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17903329" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0190" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Carrascosa A, Fernández JM, Fernández M, López-Siguero JP, López D, Sánchez E, Grupo Colaborador. Estudios españoles de crecimiento 2010. Available from: <a href="http://www.aeped.es/noticias/estudios-espanoles-crecimiento-2010">http://www.aeped.es/noticias/estudios-espanoles-crecimiento-2010</a> [accessed 27.07.14]." ] ] ] 12 => array:3 [ "identificador" => "bib0195" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Fernández C, Lorenzo H, Vrotsou K, Aresti U, Rica I, Sánchez E. Estudio de crecimiento de bilbao curvas y tablas de crecimiento, 2011 ed. Instituto de Investigación sobre Crecimiento y Desarrollo. Fundación Faustino Orbegozo Eizaguirre." ] ] ] 13 => array:3 [ "identificador" => "bib0200" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consenso SEEDO 2007 para la evaluación del sobrepesoy la obesidad y el establecimiento de criterios de intervención terapéutica" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Rubio" 1 => "J. Salas-Salvadó" 2 => "M. Barbany" 3 => "B. Moreno" 4 => "J. Aranceta" 5 => "D. Bellido" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Obes" "fecha" => "2007" "volumen" => "5" "paginaInicial" => "135" "paginaFinal" => "175" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0205" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eficacia clínica y metabólica de una nueva terapia motivacional (OBEMAT) para el tratamiento de la obesidad en la adolescencia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Feliu" 1 => "N. París" 2 => "M. Zaragoza-Jordanab" 3 => "N. Ferré" 4 => "M. Chiné" 5 => "F. Sabench" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2013" "volumen" => "78" "paginaInicial" => "157" "paginaFinal" => "166" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0210" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of pediatric overweight: an examination of feasibility and effectiveness in an applied clinical setting" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.A. Johnston" 1 => "R.G. Steele" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/jpepsy/jsl010" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Psychol" "fecha" => "2007" "volumen" => "32" "paginaInicial" => "106" "paginaFinal" => "110" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16809794" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0215" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A two year family based behaviour treatment for obese children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.X. Jang" 1 => "X.L. Xia" 2 => "T. Greiner" 3 => "G.L. Lian" 4 => "U. Rosenqvist" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/adc.2005.071753" "Revista" => array:6 [ "tituloSerie" => "Arch Dis Child" "fecha" => "2005" "volumen" => "90" "paginaInicial" => "1235" "paginaFinal" => "1238" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16188958" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0220" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How do parents child-feeding behaviours influence child weight? Implications for childhood obesity policy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H.R. Clark" 1 => "E. Goyder" 2 => "P. Bissell" 3 => "L. Blank" 4 => "J. Peters" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Pub Health (Oxf)" "fecha" => "2007" "volumen" => "29" "paginaInicial" => "132" "paginaFinal" => "141" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0225" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influencia del entorno familiar en el desarrollo del sobrepeso y la obesidad en una población de escolares de Granada (España)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. González Jiménez" 1 => "M.J. Aguilar Cordero" 2 => "C.J. Garci¿a Garci¿a" 3 => "P. Garci¿a Lo¿pez" 4 => "J. Álvarez Ferre" 5 => "C.A. Padilla Lo¿pez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/S0212-16112012000100021" "Revista" => array:6 [ "tituloSerie" => "Nutr Hosp" "fecha" => "2012" "volumen" => "27" "paginaInicial" => "177" "paginaFinal" => "184" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22566318" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0230" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesidades pediátricas: de la lactancia a la adolescecia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.A. Martos-Moreno" 1 => "J. Argente" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2011" "volumen" => "75" "paginaInicial" => "63.e1" "paginaFinal" => "63.e23" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0235" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development of eating behaviors among children and adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L.L. Birch" 1 => "J.O. Fisher" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "1998" "volumen" => "101" "paginaInicial" => "539" "paginaFinal" => "549" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12224660" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0240" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Social and cultural perspectives on hunger, appetite and satiety" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S.T. Kristensen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Clin Nutr" "fecha" => "2000" "volumen" => "54" "paginaInicial" => "473" "paginaFinal" => "478" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10878648" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0245" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A review of family and social determinants of children's eating patterns and diet quality" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Patrick" 1 => "T.A. Nicklas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Coll Nutr" "fecha" => "2005" "volumen" => "24" "paginaInicial" => "83" "paginaFinal" => "92" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15798074" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0250" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Role of parents in the determination of food preferences of children and the development of obesity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D. Benton" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Obes" "fecha" => "2004" "volumen" => "28" "paginaInicial" => "858" "paginaFinal" => "869" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0255" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Promoting healthy lifestyles: behavior modification and motivational interviewing in the treatment of childhood obesity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.A. Limbers" 1 => "E.A. Turner" 2 => "J.W. Varni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacl.2008.03.003" "Revista" => array:6 [ "tituloSerie" => "J Clin Lipidol" "fecha" => "2008" "volumen" => "2" "paginaInicial" => "169" "paginaFinal" => "178" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21291736" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0260" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A healthy school start—parental support to promote healthy dietary habits and physical activity in children: design and evaluation of a cluster-randomised intervention" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Nyberg" 1 => "E. Sundblom" 2 => "A. Norman" 3 => "L. Schäfer Elinder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2458-11-185" "Revista" => array:5 [ "tituloSerie" => "BMC Public Health" "fecha" => "2011" "volumen" => "11" "paginaInicial" => "185" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21439049" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008300000005/v1_201512040119/S2341287915001751/v1_201512040119/en/main.assets" "Apartado" => array:4 [ "identificador" => "26005" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008300000005/v1_201512040119/S2341287915001751/v1_201512040119/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001751?idApp=UINPBA00005H"]

Statistics

Original Article

Treatment of obesity in a hospital endocrinology clinic: Influence of parental body mass index

Tratamiento de la obesidad en la consulta de endocrinología de un hospital. Influencia del índice de masa corporal de los padres

L. Regueras Santosa,

Corresponding author

lregsan@gmail.com

Corresponding author.

, A. Díaz Moroa, C. Iglesias Blázqueza, C. Rodríguez Fernándeza, R. Quiroga Gonzáleza, J.A. de Paz Fernándezb, L.M. Rodríguez Fernándeza,b

a Complejo Asistencial Universitario de León (CAULE), León, Spain

b Instituto de Biomedicina (IBIOMED), Universidad de León, León, Spain

Read

5498

Times
was read the article

1975

Total PDF

3523

Total HTML

Share statistics

 array:24 [
  "pii" => "S2341287915001751"
  "issn" => "23412879"
  "doi" => "10.1016/j.anpede.2015.09.012"
  "estado" => "S300"
  "fechaPublicacion" => "2015-11-01"
  "aid" => "1794"
  "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
  "copyrightAnyo" => "2014"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "An Pediatr &#40;Barc&#41;. 2015;83:297-303"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 1764
    "formatos" => array:3 [
      "EPUB" => 140
      "HTML" => 1227
      "PDF" => 397
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1695403314005621"
      "issn" => "16954033"
      "doi" => "10.1016/j.anpedi.2014.11.019"
      "estado" => "S300"
      "fechaPublicacion" => "2015-11-01"
      "aid" => "1794"
      "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "An Pediatr &#40;Barc&#41;. 2015;83:297-303"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 4893
        "formatos" => array:3 [
          "EPUB" => 146
          "HTML" => 4080
          "PDF" => 667
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>"
        "titulo" => "Tratamiento de la obesidad en la consulta de endocrinolog&#237;a de un hospital&#46; Influencia del &#237;ndice de masa corporal de los padres"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "297"
            "paginaFinal" => "303"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Treatment of obesity in a hospital endocrinology clinic&#46; Influence of parental body mass index"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figura 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 1300
                "Ancho" => 1613
                "Tamanyo" => 55677
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Adherencia a las recomendaciones terap&#233;uticas seg&#250;n si ambos padres eran o no obesos&#46; Cuando los 2 padres son obesos&#44; los ni&#241;os tienen menor adherencia al tratamiento de la obesidad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "L&#46; Regueras Santos, A&#46; D&#237;az Moro, C&#46; Iglesias Bl&#225;zquez, C&#46; Rodr&#237;guez Fern&#225;ndez, R&#46; Quiroga Gonz&#225;lez, J&#46;A&#46; de Paz Fern&#225;ndez, L&#46;M&#46; Rodr&#237;guez Fern&#225;ndez"
            "autores" => array:7 [
              0 => array:2 [
                "nombre" => "L&#46;"
                "apellidos" => "Regueras Santos"
              ]
              1 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "D&#237;az Moro"
              ]
              2 => array:2 [
                "nombre" => "C&#46;"
                "apellidos" => "Iglesias Bl&#225;zquez"
              ]
              3 => array:2 [
                "nombre" => "C&#46;"
                "apellidos" => "Rodr&#237;guez Fern&#225;ndez"
              ]
              4 => array:2 [
                "nombre" => "R&#46;"
                "apellidos" => "Quiroga Gonz&#225;lez"
              ]
              5 => array:2 [
                "nombre" => "J&#46;A&#46;"
                "apellidos" => "de Paz Fern&#225;ndez"
              ]
              6 => array:2 [
                "nombre" => "L&#46;M&#46;"
                "apellidos" => "Rodr&#237;guez Fern&#225;ndez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2341287915001751"
          "doi" => "10.1016/j.anpede.2015.09.012"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001751?idApp=UINPBA00005H"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403314005621?idApp=UINPBA00005H"
      "url" => "/16954033/0000008300000005/v1_201510300037/S1695403314005621/v1_201510300037/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2341287915001994"
    "issn" => "23412879"
    "doi" => "10.1016/j.anpede.2014.12.004"
    "estado" => "S300"
    "fechaPublicacion" => "2015-11-01"
    "aid" => "1789"
    "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "An Pediatr &#40;Barc&#41;. 2015;83:304-10"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1967
      "formatos" => array:3 [
        "EPUB" => 130
        "HTML" => 1415
        "PDF" => 422
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Physical activity&#44; screen time and sleep patterns in Chilean girls"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "304"
          "paginaFinal" => "310"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Actividad f&#237;sica&#44; tiempo de pantalla y patrones de sue&#241;o en ni&#241;as chilenas"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46;M&#46; Aguilar, F&#46;A&#46; Vergara, E&#46;J&#46;A&#46; Vel&#225;squez, A&#46; Garc&#237;a-Hermoso"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "M&#46;M&#46;"
              "apellidos" => "Aguilar"
            ]
            1 => array:2 [
              "nombre" => "F&#46;A&#46;"
              "apellidos" => "Vergara"
            ]
            2 => array:2 [
              "nombre" => "E&#46;J&#46;A&#46;"
              "apellidos" => "Vel&#225;squez"
            ]
            3 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Garc&#237;a-Hermoso"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1695403314005578"
        "doi" => "10.1016/j.anpedi.2014.12.006"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403314005578?idApp=UINPBA00005H"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001994?idApp=UINPBA00005H"
    "url" => "/23412879/0000008300000005/v1_201512040119/S2341287915001994/v1_201512040119/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2341287915001982"
    "issn" => "23412879"
    "doi" => "10.1016/j.anpede.2015.07.019"
    "estado" => "S300"
    "fechaPublicacion" => "2015-11-01"
    "aid" => "1930"
    "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "An Pediatr &#40;Barc&#41;. 2015;83:295-6"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1723
      "formatos" => array:3 [
        "EPUB" => 142
        "HTML" => 1182
        "PDF" => 399
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "The development of Spanish paediatric cardiology and its impact on congenital heart disease management"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "295"
          "paginaFinal" => "296"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "El desarrollo de la cardiolog&#237;a pedi&#225;trica espa&#241;ola y su impacto en el manejo de las cardiopat&#237;as cong&#233;nitas"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "D&#46;C&#46; Albert Brotons"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "D&#46;C&#46;"
              "apellidos" => "Albert Brotons"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1695403315003033"
        "doi" => "10.1016/j.anpedi.2015.07.022"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403315003033?idApp=UINPBA00005H"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001982?idApp=UINPBA00005H"
    "url" => "/23412879/0000008300000005/v1_201512040119/S2341287915001982/v1_201512040119/en/main.assets"
  ]
  "en" => array:21 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Treatment of obesity in a hospital endocrinology clinic&#58; Influence of parental body mass index"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "297"
        "paginaFinal" => "303"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "L&#46; Regueras Santos, A&#46; D&#237;az Moro, C&#46; Iglesias Bl&#225;zquez, C&#46; Rodr&#237;guez Fern&#225;ndez, R&#46; Quiroga Gonz&#225;lez, J&#46;A&#46; de Paz Fern&#225;ndez, L&#46;M&#46; Rodr&#237;guez Fern&#225;ndez"
        "autores" => array:7 [
          0 => array:4 [
            "nombre" => "L&#46;"
            "apellidos" => "Regueras Santos"
            "email" => array:1 [
              0 => "lregsan&#64;gmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "D&#237;az Moro"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "C&#46;"
            "apellidos" => "Iglesias Bl&#225;zquez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "C&#46;"
            "apellidos" => "Rodr&#237;guez Fern&#225;ndez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "R&#46;"
            "apellidos" => "Quiroga Gonz&#225;lez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "J&#46;A&#46;"
            "apellidos" => "de Paz Fern&#225;ndez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "L&#46;M&#46;"
            "apellidos" => "Rodr&#237;guez Fern&#225;ndez"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Complejo Asistencial Universitario de Le&#243;n &#40;CAULE&#41;&#44; Le&#243;n&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Instituto de Biomedicina &#40;IBIOMED&#41;&#44; Universidad de Le&#243;n&#44; Le&#243;n&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Tratamiento de la obesidad en la consulta de endocrinolog&#237;a de un hospital&#46; Influencia del &#237;ndice de masa corporal de los padres"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2596
            "Ancho" => 1527
            "Tamanyo" => 166319
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Degree of obesity of the sample based on the BMI <span class="elsevierStyleItalic">z</span>-score at the time of the initial measurement &#40;M1&#41; and the measurement at six-month checkup &#40;M2&#41;&#44; applying the 2010 cross-sectional study charts&#46; <span class="elsevierStyleItalic">Source</span>&#58; Carrascosa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a></p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Childhood obesity is a public health problem in developed countries&#46; The World Health Organisation &#40;WHO&#41; has called obesity the XXI century epidemic due to the proportions it has acquired and its impact on morbidity&#44; mortality&#44; quality of life and health care costs&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;2</span></a> Europe has a surveillance system that has alerted us to the high prevalence of childhood obesity in countries in southern Europe&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">3</span></a> Spain ranks third in Europe&#44; with a 19&#46;1&#37; prevalence of childhood obesity and a 26&#46;1&#37; prevalence of childhood overweight&#44; according to the Estudio de Alimentaci&#243;n&#44; Actividad f&#237;sica&#44; Desarrollo Infantil y Obesidad &#40;Study on Nutrition&#44; Physical Activity&#44; Childhood Development and Obesity &#91;ALADINO&#93;&#41; conducted in 2011&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Childhood obesity is a multifactorial condition&#46; The literature has described many risk factors involved&#44; including parental obesity and sociocultural level&#46; A study conducted in Sweden by Moraeus et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">5</span></a> addressed the importance of the association between parental obesity and future obesity in their children&#46; The study conducted in Spain by Santiago et al&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">6</span></a> also referred to the importance of parental obesity&#44; which was the best predictor of childhood overweight in both sexes&#46; Rodriguez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a> reported that a high percentage of parents in Spain do not correctly assess the weight status of their overweight children&#44; especially at earlier ages&#46; This inadequate perception by overweight parents may also be a risk factor for childhood obesity&#46; Several studies have concluded that parents influence the dietary behaviours of their children concerning food preferences and the type&#44; amount&#44; and quality of consumed foods&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">It seems evident that there is a significant relationship between obesity in parents and obesity in their children&#46; However&#44; few studies have assessed whether obesity in the parents once children are already obese can influence the children&#39;s response and adherence to obesity treatment&#46; It is known that mothers are mainly responsible for passing on healthy dietary habits to their children&#44;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">9&#44;10</span></a> but it is not known whether the response to obesity treatment varies depending on which of the parents is obese&#46; There is also some degree of controversy as to whether parents influence the nutritional status of their children throughout their entire development&#44; or whether their influence reaches only as far as 10 years of age or the beginning of puberty&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a> Knowing this would help us implement more effective therapeutic strategies&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this study was to learn whether having obese parents influenced the response and adherence to treatment of obese children&#44; and to analyse the response to lifestyle and dietary recommendations given to the population under study at the paediatric endocrinology clinic&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">We conducted a prospective&#44; longitudinal analytical study&#46; We recruited children and adolescents aged 4&#8211;14 years referred by their paediatrician to the paediatric endocrinology clinic of a tertiary hospital between November 2010 and November 2012 for obesity treatment&#46; The children&#39;s weight &#40;kg&#41;&#44; height &#40;cm&#41; and waist circumference &#40;cm&#41; were measured at the clinic&#44; followed by calculation of their body mass index &#40;BMI&#44; kg&#47;m<span class="elsevierStyleSup">2</span>&#41; and <span class="elsevierStyleItalic">z</span>-scores for weight&#44; height&#44; BMI and waist circumference for their sex and age &#40;charts of the 2010 Spanish study by Carrascosa for weight&#44; height and BMI&#59; charts of the cross-sectional 2011 Fundaci&#243;n Orbegozo study for waist circumference&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">12&#44;13</span></a> The degree of pubertal development was assessed during the physical examination &#40;prepubertal&#58; Tanner stage 1&#44; and pubertal&#58; Tanner stage<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patients were included in the study as they were referred to the clinic by their paediatricians&#44; and the sole inclusion criterion was that they have a BMI <span class="elsevierStyleItalic">z</span>-score above 2 for their age and sex&#46; We excluded patients with neuropsychological disorders&#44; such as neurodevelopmental delay or autism&#44; as these disorders would influence response to lifestyle and dietary interventions&#44; and patients that received a diagnosis of clinical hypothyroidism or hypercortisolism based on the initial laboratory tests&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">During the first visit&#44; lifestyle and dietary recommendations were given to both the parents and the child &#40;<a class="elsevierStyleCrossRef" href="#sec0055">Appendix 1</a>&#41;&#44; recommending daily physical activity and a diet based on on-demand and light-calorie foods according to the classification of foods presented in <a class="elsevierStyleCrossRef" href="#sec0060">Appendix 2</a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Thereafter&#44; patients came for medical checkups at the paediatric endocrinology clinic of the hospital&#46; The first checkup was scheduled at one month&#44; and subsequent checkups every one to two months&#44; during which the lifestyle and dietary recommendations and the advice to perform physical activity for 1<span class="elsevierStyleHsp" style=""></span>h a day were reinforced&#46; At six months after the first visit&#44; patients were assessed once more&#44; measuring their weight&#44; height&#44; BMI and waist circumference and recalculating their <span class="elsevierStyleItalic">z</span>-scores for all parameters&#46; We defined <span class="elsevierStyleItalic">success</span> as a decrease of 0&#46;5 or more in the BMI <span class="elsevierStyleItalic">z</span>-score&#44; and <span class="elsevierStyleItalic">adherence</span> to treatment as showing up to the six-month checkup&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">During the first checkup&#44; the weight and height of both parents were measured&#44; and their BMI calculated &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#46; Based on their BMI&#44; parents were classified into&#58; underweight &#40;&#60;18&#46;5<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; normal weight &#40;18&#46;5&#8211;24&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; class I overweight &#40;25&#46;0&#8211;26&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41; or class II overweight &#40;27&#46;0&#8211;29&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; moderate obesity &#40;30&#46;0&#8211;34&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; severe obesity &#40;35&#46;0&#8211;39&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; morbid obesity &#40;40&#46;0&#8211;49&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41; and extreme obesity &#40;&#62;50<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; following the 2000 classification scheme of the Sociedad Espa&#241;ola para el Estudio de la Obesidad &#40;SEEDO&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a> In order to determine the association between the children&#39;s response to treatment and parental weight&#44; we divided parents into obese and not obese&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">We performed the statistical analysis of the results with the statistical package SPSS V&#46;19&#46; We have expressed qualitative variables as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation &#40;SD&#41; and compared them with the Student <span class="elsevierStyleItalic">t</span> test verifying that they followed a normal distribution by means of the Kolmogorov&#8211;Smirnov test&#46; We compared categorical variables with the <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span> test&#46; We set a confidence interval of 95&#37; &#40;significance&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46; We assessed risk by calculating the odds ratio &#40;OR&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The parents of the patients were informed and asked to agree to take part in the study when it was observed that the patients met the inclusion criteria&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">We studied a total of 100 obese children&#44; 47 girls and 53 boys&#44; with a mean age of 9&#46;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;73 years&#46; In terms of pubertal development&#44; there were 25 prepubertal and 28 pubertal girls&#44; and 31 prepubertal and 16 pubertal boys&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Anthropometric characteristics of the sample</span><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> presents the degree of obesity of the sample on the 2 occassions it was assessed &#40;M1 and M2&#41;&#44; which was determined on the basis of the BMI <span class="elsevierStyleItalic">z</span>-score&#46; A high percentage of children &#40;82&#37;&#41; had high-degree obesity at the beginning of the study &#40;BMI <span class="elsevierStyleItalic">z</span>-score<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>3&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 1</a> summarises the anthropometric characteristics &#40;height&#44; weight and BMI <span class="elsevierStyleItalic">z</span>-score&#41; of the patients at the time of the first measurement &#40;M1&#41; and the second measurement &#40;M2&#41;&#46; For each group&#44; we compared the data obtained at M1 and M2 by means of the Student <span class="elsevierStyleItalic">t</span> test for paired samples&#44; and found statistically significant differences&#44; with the group of pubertal boys being the only one in which there was no statistically significant difference between the BMI <span class="elsevierStyleItalic">z</span>-scores obtained during M1 and M2 &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Anthropometric characteristics of the mothers</span><p id="par0075" class="elsevierStylePara elsevierViewall">Based on the SEEDO classification&#44; 27&#37; of mothers had normal weights&#44; 36&#37; were class I or class II overweight&#44; and 37&#37; were obese to some degree&#46; When we compared the mean BMIs of the mothers with the Student <span class="elsevierStyleItalic">t</span> test we found statistically significant differences &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; between the mothers of pubertal children and the mothers of prepubertal children &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 2</a>&#41;&#46; Of the mothers of pubertal children&#44; 46&#37; were obese and up to 13&#37; were morbidly obese&#59; while only 28&#37; of the mothers of prepubertal children had class I or II obesity&#44; and none had morbid obesity&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Anthropometric characteristics of the fathers</span><p id="par0080" class="elsevierStylePara elsevierViewall">Of all fathers&#44; 12&#37; had normal weight&#44; 45&#37; some degree of overweight&#44; and up to 41&#37; some degree of obesity&#44; with 1&#37; being morbidly obese and 1&#37; extremely obese&#46; We found no significant differences between groups in the comparison of the paternal anthropometric data &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 2</a>&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Both parents were obese in 19 patients&#44; only the mother was obese in 18&#44; only the father was obese in 22&#44; and in 41 patients neither parent was obese&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Adherence to recommendations</span><p id="par0090" class="elsevierStylePara elsevierViewall">Twenty-five patients did not show for the six-month visit when the second measurements were taken&#46; Sixty-four percent of these patients &#40;16&#47;25&#41; had one or two obese parents&#59; only the mother was obese in four&#44; only the father was obese in three&#44; and both parents were obese in nine&#46; <a class="elsevierStyleCrossRef" href="#tbl0025">Table 3</a> shows the data for the two groups of patients&#44; those that adhered to treatment and those that did not&#46; The mothers of non-adherent patients had higher BMIs &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46; When we compared the fathers&#44; we found no statistically significant differences&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">When we compared the adherent and non-adherent groups in terms of having an obese mother&#44; father or both by means of the <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test&#44; we found that when the mother was not obese&#44; even if the father was obese&#44; adherence was higher than when both parents were obese &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;013&#41;&#46; We also observed that adherence to treatment was worse when both parents were obese than when they were not &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;012&#41;&#46; When both parents were obese&#44; children were 3&#46;65 times more likely &#40;CI&#44; 1&#46;3&#8211;10&#46;5&#41; to not adhere to recommendations than if they were not &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Treatment success</span><p id="par0100" class="elsevierStylePara elsevierViewall">After six months of follow-up&#44; the BMI <span class="elsevierStyleItalic">z</span>-scores of 23 patients had decreased by more than 1&#44; the <span class="elsevierStyleItalic">z</span>-scores of 17 by 0&#46;5&#8211;1&#44; and those of 20 patients decreased by 0&#46;1&#8211;0&#46;5&#44; while in 11 the <span class="elsevierStyleItalic">z</span>-scores increased by 0&#46;5 or less&#44; and in 4 they increased by more than 0&#46;5&#46; Thus&#44; 40&#37; of the patients included at the beginning of the study were significantly successful following the lifestyle and dietary recommendations&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Of the group of 40 patients that were significantly successful&#44; 19 &#40;47&#46;5&#37;&#41; did not have an obese parent&#44; and in 3 &#40;7&#46;5&#37;&#41; only the mother was obese&#46; When we analysed patient success based on the presence of parental obesity by means of the <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test&#44; we found that the probability of not succeeding was significantly higher if the mother was the only obese parent &#40;OR&#44; 5&#46;65 &#91;1&#46;4&#8211;22&#46;4&#93;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;008&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">The percentage of children in this study that adhered to the recommendations may seem low&#44; as only 75&#37; showed at the six-month checkup&#46; In the study by Feliu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a> adherence reached 78&#46;2&#37; at 12 months&#44; and there are even studies in which losses to follow-up amount to only 9&#37; and 7&#37; at 12 months&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a> although in these studies the checkups were conducted at home or in the school&#46; In our study&#44; the checkups were performed in a tertiary hospital to which patients needed to travel&#44; sometimes from towns more than 1<span class="elsevierStyleHsp" style=""></span>h away and through mountainous terrain&#46; The time available for the first visit was 20<span class="elsevierStyleHsp" style=""></span>min&#44; and subsequent visits lasted only 5<span class="elsevierStyleHsp" style=""></span>min&#46; Some studies have indicated that durations of less than 15<span class="elsevierStyleHsp" style=""></span>min per visit could suffice for motivational modalities of obesity treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a> At any rate&#44; assessing the delivery of care with the means and time that are actually available in the endocrinology clinic of a public tertiary hospital can be useful for the purposes of considering possible changes in treatment strategies&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In this study&#44; we found a success percentage of 40&#37;&#44; which was lower than the percentages found by other studies that defined success as a <span class="elsevierStyleItalic">z</span>-score decrease of any size&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a> If our study had considered any decreases in <span class="elsevierStyleItalic">z</span>-scores a success&#44; the success percentage would have reached 60&#37; in patients that started the treatment&#44; and 80&#37; in patients that completed it&#44; similar to the results of other studies that applied broader measures of treatment success&#46; There is no consensus on the time that is needed to assess the response to obesity treatment&#44; but it should be of at least six months&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a> Some studies have analysed periods of up to 12 and 24 months&#44;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">16&#44;17</span></a> so we cannot compare the data&#46; However&#44; initial response is a good prognostic factor&#44; and patients that do not show an initial response are unlikely to show one at a later time&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">When it came to the family history&#44; a high percentage of patients had at least one obese parent&#46; The average BMI of the mothers ranged between 27&#46;7<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> in mothers of prepubertal children and 31&#46;7<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> in mothers of pubertal children&#44; which were within the overweight and obesity ranges&#44; respectively&#46; The average BMI of the fathers ranged from 28&#46;6<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> to 30&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; which also corresponded to the overweight and obesity ranges&#46; This was consistent with the findings of Feliu Rovira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a> It seems clear that a high proportion of children that are very obese have obese parents&#44; demonstrating that the family plays an essential role in the prevention of childhood obesity&#46; This association between obesity in children and obesity in their parents can be explained not only by environmental or behavioural factors &#40;as they share dietary and physical activity habits&#41;&#44; but also by genetic factors as well&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">20</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">When we assessed the response to the lifestyle and dietary recommendations in relation to whether the parents were or were not obese&#44; the importance of the mother&#39;s role stood out&#44; for when the mother was obese&#44; irrespective of the father being obese or not&#44; the response to treatment was much worse&#46; This may be related to the fact that mothers are mainly responsible for dietary habits&#46; If the mother is obese&#44; her dietary habits may not be healthy&#44; and she may find it difficult to change her own diet&#44; with fathers probably having a lesser involvement in their children&#39;s dietary habits&#46; Other studies have shown that the immediate family&#44; and especially mothers&#44; has a significant influence on the child&#39;s dietary behaviours&#44;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">21&#8211;23</span></a> and our study corroborates the role of the mother&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Thus&#44; it seems that it is very important that parents become more involved in their children&#39;s diet&#44; and to try to change the dietary habits of the mother if she is obese&#44; for otherwise&#44; as our study suggests&#44; the outcomes of their children will be worse&#46; The findings of other studies have evinced that the treatment of childhood obesity and overweight must be firmly founded on the development of healthy habits and the promotion of physical activity&#44; and that the awareness and level of involvement of the family are crucial factors in the development of healthy lifestyles by the young&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">24</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Another noteworthy finding is that the mother plays a key role in following through with checkups at the paediatrician&#39;s office&#44; and therefore in adherence to treatment&#46; The mothers of children that stopped showing for checkups were more obese&#46; It may be that obese mothers are less likely to adhere to treatment because they do not consider obesity a health problem&#46; Perhaps it would be convenient to implement treatment strategies that involve the mother as well as the child&#46; An improvement in BMI in children is probably dependent on succeeding in improving the BMI in mothers&#44; as noted by Limbers et al&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">25</span></a> and Nyberg et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">26</span></a> Unfortunately&#44; our study did not collect the BMI of both parents after the period during which the child was followed up&#46; These data would have provided information as to whether there had been a change in lifestyle and dietary habits in the family as a whole&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In our study&#44; the response to lifestyle and dietary recommendations was worse among pubertal children&#46; This may be related to the fact that the mothers of pubertal children were the most obese&#44; and we have seen that the mother plays an essential role in treatment success&#46; This fact is also interesting in that it suggests that the influence of the mother concerning the development of healthy dietary habits extends into puberty&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Another factor that may influence the response and adherence to treatment is the degree of obesity of the children under study&#46; As noted by Feliu et al&#46;&#44; children with high BMIs show worse adherence and response to obesity treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a> A high percentage of the analysed sample had severe obesity&#44; as our study was conducted in a specialty clinic&#44; and thus the results of this study should only be applied to children of equal anthropometric characteristics&#46; Thus&#44; we still need to find out whether parental BMIs have a similar influence on the response to obesity treatment of children with less severe obesity&#44; most of whom are probably being monitored by primary care paediatricians&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">In conclusion&#44; this study corroborated that a high percentage of children that are very obese have obese parents&#44; and that mothers have substantial influence on the adherence and response to obesity treatment in their children&#44; at least if they have a significant degree of obesity&#46; For all the above reasons&#44; this study suggests the need to consider new therapeutic approaches against obesity that involve the entire family unit and the collaborative effort of endocrinologists and paediatric endocrinologists&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:10 [
        0 => array:3 [
          "identificador" => "xres585592"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Material and methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec601453"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres585593"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introducci&#243;n"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Material y m&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec601454"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Materials and methods"
        ]
        6 => array:3 [
          "identificador" => "sec0015"
          "titulo" => "Results"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Anthropometric characteristics of the sample"
            ]
            1 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Anthropometric characteristics of the mothers"
            ]
            2 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Anthropometric characteristics of the fathers"
            ]
            3 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Adherence to recommendations"
            ]
            4 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Treatment success"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conflicts of interest"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-08-29"
    "fechaAceptado" => "2014-11-28"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec601453"
          "palabras" => array:4 [
            0 => "Family obesity"
            1 => "Childhood obesity"
            2 => "Obesity therapy"
            3 => "Parental behaviour control"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec601454"
          "palabras" => array:4 [
            0 => "Obesidad familiar"
            1 => "Obesidad infantil"
            2 => "Tratamiento de la obesidad"
            3 => "Educaci&#243;n"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "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">Parental obesity is a risk factor for childhood obesity&#46; The aim of this study was to determine if parental obesity influences the adherence and success of obesity treatment in a hospital paediatric endocrinology clinic&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An analytical&#44; prospective&#44; longitudinal study was conducted on obese children aged 4&#8211;14&#46; An initial body mass index &#40;BMI&#41; was obtained&#44; and again at 6 months after receiving health&#44; hygiene and dietary recommendations&#46; Success was considered as a decrease of 0&#46;5 in the BMI <span class="elsevierStyleItalic">z</span>-score&#44; and adherence to attending the 6-month review&#46; Parental BMI was determined to identify overweight&#46; The <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test was used for qualitative variables and the <span class="elsevierStyleItalic">T</span>-Student test for quantitative &#40;significance&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; variables&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The study included 100 children &#40;52 male&#41;&#44; 9&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;7 years old&#44; BMI 28&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;5<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> and BMI <span class="elsevierStyleItalic">z</span>-score 3&#46;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;98 &#40;85&#37; had a BMI <span class="elsevierStyleItalic">z</span>-score<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>3&#41;&#46; More than half &#40;59&#37;&#41; of the children had one or both parents obese &#40;41 fathers and 37 mothers were obese&#41;&#46; Treatment was not adhered to by 25 children&#46; Adherence was worse if both parents were obese&#44; OR 3&#46;65 &#40;1&#46;3&#8211;10&#46;5&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#44; and adherence was better if the mother was not obese&#44; although the father was &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46; The treatment had significant success in 40 patients&#46; If the mother was the only obese one in the family&#44; the possibility of treatment failure was greater&#44; OR 5&#46;6 &#40;1&#46;4&#8211;22&#46;4&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A high percentage of children with severe obesity have obese parents&#46; The mother has an important influence on adherence and response to treatment for the severely obese child&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El objetivo del estudio es conocer si tener padres obesos influye en la adherencia y el &#233;xito del tratamiento frente a la obesidad en la consulta de endocrinolog&#237;a infantil de un hospital&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio anal&#237;tico&#44; prospectivo y longitudinal en obesos de 4&#8211;14 a&#241;os&#46; En ellos se determin&#243; el IMC inicial y 6 meses despu&#233;s de que recibieran pautas higi&#233;nico-diet&#233;ticas saludables&#46; Se consider&#243; &#233;xito significativo la disminuci&#243;n de 0&#44;5 DE del IMC y adherencia que los pacientes acudieran a la revisi&#243;n semestral&#46; Se calcul&#243; el IMC de los padres para identificar a los obesos&#46; Se utiliz&#243; el test de la <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> para comparar las variables cualitativas y el test de la t de Student para las variables cuantitativas &#40;significativo&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Cien ni&#241;os &#40;52 varones&#41;&#44; edad media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&#58; 9&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;7 a&#241;os&#44; IMC 28&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;5<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> y <span class="elsevierStyleItalic">z</span>-score del IMC 3&#44;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;98 &#40;el 85&#37; ten&#237;a un <span class="elsevierStyleItalic">z</span>-score del IMC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>3&#41;&#46; Eran obesos 41 padres y 38 madres &#40;el 59&#37; ten&#237;a uno o los 2 padres obesos&#41;&#46; No se adhirieron al tratamiento 25&#46; La adherencia era peor si los 2 padres eran obesos&#44; OR 3&#44;65 &#40;1&#44;3&#8211;10&#44;5&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; y era mejor si la madre no era obesa&#44; aunque el padre lo fuera &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; El tratamiento tuvo &#233;xito significativo en 40 pacientes&#46; Si la madre era la &#250;nica obesa en la familia la posibilidad de no tener &#233;xito era mayor&#44; OR 5&#44;6 &#40;1&#44;4&#8211;22&#44;4&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Un alto porcentaje de ni&#241;os con obesidad severa tienen padres obesos&#46; La madre tiene gran influencia en la adherencia y respuesta al tratamiento frente a la obesidad del hijo muy obeso&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as&#58; Regueras Santos L&#44; D&#237;az Moro A&#44; Iglesias Bl&#225;zquez C&#44; Rodr&#237;guez Fern&#225;ndez C&#44; Quiroga Gonz&#225;lez R&#44; de Paz Fern&#225;ndez JA&#44; et al&#46; Tratamiento de la obesidad en la consulta de endocrinolog&#237;a de un hospital&#46; Influencia del &#237;ndice de masa corporal de los padres&#46; An Pediatr &#40;Barc&#41;&#46; 2015&#59;83&#58;297&#8211;303&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Previous presentation&#58; This study was presented at the XXXVI Congreso de la Sociedad Espa&#210;ola de Endocrinolog&#204;a Pedi&#183;trica&#46; &#40;SEEP&#41;&#44; 14&#8211;16 Mayo 2014 Sevilla&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:2 [
          0 => array:4 [
            "apendice" => "<p id="par0160" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix 1"
            "titulo" => "Lifestyle and dietary recommendations given to patients and their parents"
            "identificador" => "sec0055"
          ]
          1 => array:4 [
            "apendice" => "<p id="par0165" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix 2"
            "titulo" => "Sheet that was given to the patient and parents with the classification of foods taken from the Ni&#241;&#64;s en movimiento programme by Gussinyer S&#44; Garcia-Reyna NI&#44; Alsina M&#44; Gussinyer M&#44; Carrascosa A &#40;<span class="elsevierStyleInterRef" id="intr0010" href="http://www.enmovimiento.net/">www&#46;enmovimiento&#46;net</span>&#41;"
            "identificador" => "sec0060"
          ]
        ]
      ]
    ]
    "multimedia" => array:8 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2596
            "Ancho" => 1527
            "Tamanyo" => 166319
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Degree of obesity of the sample based on the BMI <span class="elsevierStyleItalic">z</span>-score at the time of the initial measurement &#40;M1&#41; and the measurement at six-month checkup &#40;M2&#41;&#44; applying the 2010 cross-sectional study charts&#46; <span class="elsevierStyleItalic">Source</span>&#58; Carrascosa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a></p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1300
            "Ancho" => 1603
            "Tamanyo" => 55975
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Adherence to therapeutic recommendations according to whether both parents were or not obese&#46; When both parents were obese&#44; the adherence of children to obesity treatment was lesser &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1399
            "Ancho" => 1646
            "Tamanyo" => 62902
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Success of therapeutic recommendations according to whether the mother was the only obese parent or not&#46; When the mother was the only obese parent&#44; children were less successful in their obesity treatment &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Student <span class="elsevierStyleItalic">t</span> test for dependent means comparing M1 and M2 in each group&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Girls</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Boys</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\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">Prepubertal</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Pubertal</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Prepubertal</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Pubertal</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">M1&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">M2&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">M1&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">M2&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">M1&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">M2&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">M1&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">M2&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">BMI <span class="elsevierStyleItalic">z</span>-score &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1&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">Weight <span class="elsevierStyleItalic">z</span>-score &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;9<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;5<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;5<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;8<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</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">Height <span class="elsevierStyleItalic">z</span>-score &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;7&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">Waist circumference <span class="elsevierStyleItalic">z</span>-score &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;95<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab955919.png"
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "&#42;&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Anthropometric measurements of the sample &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41; at the time of measurement 1 &#40;M1&#41; and measurement 2 &#40;M2&#41; by patient group&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0020"
        "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">&nbsp;\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">Girls</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Boys</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Prepubertal&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">Pubertal&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">Prepubertal&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">Pubertal&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">Maternal weight &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;3&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">Maternal height &#40;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1&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">Paternal weight &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;9&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">Paternal height &#40;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1&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">Paternal BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;8&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">Maternal BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;6<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab955922.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#46;05&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Anthropometric measurements of the mothers and fathers of the patients &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41; by patient group&#59; Student <span class="elsevierStyleItalic">t</span> test for independent samples&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Student&#39;s <span class="elsevierStyleItalic">t</span> test&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Non-adherent&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">Adherent&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">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;7&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">Maternal weight &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;2&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">Maternal height &#40;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1&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">Maternal BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;4<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;9&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">Paternal weight &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;6&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">Paternal height &#40;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1&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">Paternal BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;7&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">Patient&#39;s BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;6&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">Patient&#39;s BMI <span class="elsevierStyleItalic">z</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1&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">Patient&#39;s height <span class="elsevierStyleItalic">z</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2&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">Patient&#39;s weight <span class="elsevierStyleItalic">z</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab955918.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#46;05 for independent samples&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Data for the adherent and non-adherent patient groups described as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#46;</p>"
        ]
      ]
      6 => array:5 [
        "identificador" => "tbl0005"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "tabla" => array:1 [
          "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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lifestyle and dietary recommendations&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">1&#46; Have 5 meals a day with no snacking between meals&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">2&#46; Do not skip meals&#44; have breakfast every day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">3&#46; Have five pieces of fruit or vegetables a day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">4&#46; Drink water&#44; no sugary drinks&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">5&#46; Exercise for 1<span class="elsevierStyleHsp" style=""></span>h a day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">6&#46; Limit the number of hours spent watching TV and playing videogames&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">7&#46; Eat mostly foods in the on-demand and low-calorie groups&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">8&#46; Avoid very high-calorie foods&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab955921.png"
              ]
            ]
          ]
        ]
      ]
      7 => array:5 [
        "identificador" => "tbl0010"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "tabla" => array:1 [
          "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=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">On-demand foods&#58;</span> cabbage&#44; pepper &#40;spice&#41;&#44; chard&#44; peppers&#44; water&#44; Brussels sprouts&#44; leek&#44; artichoke&#44; diet soft drinks&#44; celery&#44; cauliflower&#44; radish&#44; aubergine&#44; spices&#44; watercress&#44; endive&#44; mushrooms&#44; broccoli&#44; escarole&#44; tomato&#44; soy bean sprouts&#44; asparagus&#44; vinegar&#44; courgette&#44; spinach&#44; carrot&#44; pumpkin&#44; green bean&#44; vegetable broth&#44; lettuce&#44; onion&#44; lemon&#44; cucumber&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Low-calorie foods&#58;</span> shellfish&#44; green pea&#44; boiled pasta&#44; bread &#40;pita&#44; loaf&#44; sliced&#41;&#44; biscotti&#44; potato &#40;roasted&#44; boiled&#44; baked&#41;&#44; fresh fruits&#44; fresh fruit juices&#44; turkey &#40;skinless&#41;&#44; rice &#40;boiled&#41;&#44; egg&#44; tuna canned in water&#44; Serrano ham&#44; ham&#44; fresh or frozen fish&#44; squid &#40;no oil&#41;&#44; non-fat and low-fat milk&#44; skinless chicken&#44; goat&#44; lentils&#44; sugar-free cereal&#44; pork tenderloin&#44; fresh low-fat cheese&#44; cherries&#44; fresh corn&#44; beets&#44; low-fat cream cheese&#44; rabbit&#44; mango&#44; vegetable pur&#233;e&#44; fat-free soup&#44; rice salad&#44; lean beef&#44; pasta salad&#44; low-fat yoghourt&#44; rice crackers&#44; Marie biscuits&#44; chickpeas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">High-calorie foods&#58;</span> avocado&#44; creme brulee&#44; duck&#44; fried chicken wings&#44; frankfurters&#44; fried or breaded fish&#44; whole-fat sugared rice pudding&#44; fruits canned in syrup&#44; pork and beef liver&#44; lamb shank&#44; sunflower seeds&#44; fish sticks&#44; fried egg&#44; cake&#44; whole-fat dairy products&#44; fried squid&#44; fried or breaded chicken or chicken with its skin&#44; cannelloni&#44; cream-based sauces&#44; fatty minced meat&#44; cupcakes&#44; soft or hard cheeses&#44; pork shoulder&#44; custards and flans&#44; cereals with added sugar or cocoa&#44; popcorn&#44; soft drinks&#44; pork belly&#44; spring rolls&#44; chops&#44; coconut&#44; pastries&#44; ribs&#44; pies&#44; juices with added sugar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Very high-calorie foods&#58;</span> cured meats &#40;chorizo&#44; salami&#41;&#44; honey&#44; sunflower oil&#44; blood sausage&#44; almonds&#44; chocolate biscuits&#44; cocoa spread&#44; hazelnuts&#44; butter biscuits&#44; olives&#44; sugar&#44; ice cream&#44; bacon&#44; sweets&#44; peanuts&#44; lard&#44; French fries&#44; milk chocolate&#44; butter&#44; potato chips&#44; margarine&#44; pat&#233;s&#44; peanut butter&#44; mayonnaise&#44; aioli sauce&#44; cream cheese&#44; cream&#44; marzipan&#44; tarts&#44; cheese dip&#44; marmalade and jam&#44; ketchup&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab955920.png"
              ]
            ]
          ]
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:26 [
            0 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity&#44; preventing and managing the global epidemic&#46; Report of a WHO consultation&#46; WHO technical report series 894"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "World Health Organization consultation on obesity"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2000"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diet&#44; nutrition and the prevention of chronic diseases&#46; WHO technical report series 916"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "WHO&#47;FAO Expert Consultation on Diet&#44; Nutrition and the Prevention of Chronic Diseases WHO"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2003"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "WHO Regional Office for Europe&#44; Participating States&#46; European Childhood Obesity Surveillance Initiative&#44; COSI&#46; 2012&#46;"
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estudio de prevalencia de obesidad infantil ALADINO"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Ministerio de Sanidad&#44; Pol&#237;tica Social e Igualdad"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2011"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multi-level influences on childhood obesity in Sweden&#58; societal factors&#44; parental determinants and child&#39;s lifestyle"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46; Moraeu"
                            1 => "L&#46; Lissner"
                            2 => "A&#46; Yngve"
                            3 => "E&#46; Poortvliet"
                            4 => "U&#46; Al-Ansar"
                            5 => "A&#46; Sj&#246;berg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Obes"
                        "fecha" => "2012"
                        "volumen" => "36"
                        "paginaInicial" => "969"
                        "paginaFinal" => "976"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perinatal and parental determinants of childhood overweight in 6&#8211;12 years old children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Santiago"
                            1 => "I&#46; Zazpe"
                            2 => "M&#46; Cuervo"
                            3 => "J&#46;A&#46; Mart&#237;nez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/S0212-16112012000200037"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nutr Hosp"
                        "fecha" => "2012"
                        "volumen" => "27"
                        "paginaInicial" => "599"
                        "paginaFinal" => "605"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22732989"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "La percepci&#243;n del sobrepeso y la obesidad infantil por parte de los progenitores"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Rodr&#237;guez"
                            1 => "J&#46;P&#46; Novalbos"
                            2 => "S&#46; Villagran"
                            3 => "J&#46;M&#46; Mart&#237;nez"
                            4 => "J&#46;L&#46; Lechuga"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4321/S1135-57272012000500003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Salud P&#250;blica"
                        "fecha" => "2012"
                        "volumen" => "86"
                        "paginaInicial" => "483"
                        "paginaFinal" => "494"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23223761"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and risk factors for obesity in Balearic Islands adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;M&#46; Bibiloni"
                            1 => "E&#46; Marti¿nez"
                            2 => "R&#46; Llull"
                            3 => "M&#46;D&#46; Juarez"
                            4 => "A&#46; Pons"
                            5 => "J&#46;A&#46; Tur"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1017/S000711450999136X"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Nutr"
                        "fecha" => "2010"
                        "volumen" => "103"
                        "paginaInicial" => "99"
                        "paginaFinal" => "106"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19671204"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Desarrollo de la conducta alimentaria en la infancia y sus alteraciones"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Osorio"
                            1 => "G&#46; Weisstaub"
                            2 => "C&#46; Castillo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Chil Nutr"
                        "fecha" => "2002"
                        "volumen" => "29"
                        "paginaInicial" => "280"
                        "paginaFinal" => "285"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Observation of family functioning at mealtime&#58; a comparison between families of children with and without overweight"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46; Moens"
                            1 => "C&#46; Braet"
                            2 => "B&#46; Soetens"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/jpepsy/jsl011"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Psychol"
                        "fecha" => "2007"
                        "volumen" => "32"
                        "paginaInicial" => "52"
                        "paginaFinal" => "63"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16801324"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevention of owerweight and obesity&#58; a Spanish approach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Aranceta"
                            1 => "C&#46; P&#233;rez"
                            2 => "L&#46;L&#46; Serra"
                            3 => "D&#46; Bellido"
                            4 => "M&#46;L&#46; de la Torre"
                            5 => "X&#46; Formiguera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1017/S1368980007000699"
                      "Revista" => array:6 [
                        "tituloSerie" => "Public Health Nutr"
                        "fecha" => "2007"
                        "volumen" => "10"
                        "paginaInicial" => "1187"
                        "paginaFinal" => "1193"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17903329"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Carrascosa A&#44; Fern&#225;ndez JM&#44; Fern&#225;ndez M&#44; L&#243;pez-Siguero JP&#44; L&#243;pez D&#44; S&#225;nchez E&#44; Grupo Colaborador&#46; Estudios espa&#241;oles de crecimiento 2010&#46; Available from&#58; <a href="http://www.aeped.es/noticias/estudios-espanoles-crecimiento-2010">http&#58;&#47;&#47;www&#46;aeped&#46;es&#47;noticias&#47;estudios-espanoles-crecimiento-2010</a> &#91;accessed 27&#46;07&#46;14&#93;&#46;"
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Fern&#225;ndez C&#44; Lorenzo H&#44; Vrotsou K&#44; Aresti U&#44; Rica I&#44; S&#225;nchez E&#46; Estudio de crecimiento de bilbao curvas y tablas de crecimiento&#44; 2011 ed&#46; Instituto de Investigaci&#243;n sobre Crecimiento y Desarrollo&#46; Fundaci&#243;n Faustino Orbegozo Eizaguirre&#46;"
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consenso SEEDO 2007 para la evaluaci&#243;n del sobrepesoy la obesidad y el establecimiento de criterios de intervenci&#243;n terap&#233;utica"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;A&#46; Rubio"
                            1 => "J&#46; Salas-Salvad&#243;"
                            2 => "M&#46; Barbany"
                            3 => "B&#46; Moreno"
                            4 => "J&#46; Aranceta"
                            5 => "D&#46; Bellido"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Esp Obes"
                        "fecha" => "2007"
                        "volumen" => "5"
                        "paginaInicial" => "135"
                        "paginaFinal" => "175"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eficacia cl&#237;nica y metab&#243;lica de una nueva terapia motivacional &#40;OBEMAT&#41; para el tratamiento de la obesidad en la adolescencia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Feliu"
                            1 => "N&#46; Par&#237;s"
                            2 => "M&#46; Zaragoza-Jordanab"
                            3 => "N&#46; Ferr&#233;"
                            4 => "M&#46; Chin&#233;"
                            5 => "F&#46; Sabench"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "An Pediatr &#40;Barc&#41;"
                        "fecha" => "2013"
                        "volumen" => "78"
                        "paginaInicial" => "157"
                        "paginaFinal" => "166"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of pediatric overweight&#58; an examination of feasibility and effectiveness in an applied clinical setting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;A&#46; Johnston"
                            1 => "R&#46;G&#46; Steele"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/jpepsy/jsl010"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Psychol"
                        "fecha" => "2007"
                        "volumen" => "32"
                        "paginaInicial" => "106"
                        "paginaFinal" => "110"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16809794"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A two year family based behaviour treatment for obese children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;X&#46; Jang"
                            1 => "X&#46;L&#46; Xia"
                            2 => "T&#46; Greiner"
                            3 => "G&#46;L&#46; Lian"
                            4 => "U&#46; Rosenqvist"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/adc.2005.071753"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dis Child"
                        "fecha" => "2005"
                        "volumen" => "90"
                        "paginaInicial" => "1235"
                        "paginaFinal" => "1238"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16188958"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "How do parents child-feeding behaviours influence child weight&#63; Implications for childhood obesity policy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46;R&#46; Clark"
                            1 => "E&#46; Goyder"
                            2 => "P&#46; Bissell"
                            3 => "L&#46; Blank"
                            4 => "J&#46; Peters"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Pub Health &#40;Oxf&#41;"
                        "fecha" => "2007"
                        "volumen" => "29"
                        "paginaInicial" => "132"
                        "paginaFinal" => "141"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influencia del entorno familiar en el desarrollo del sobrepeso y la obesidad en una poblaci&#243;n de escolares de Granada &#40;Espa&#241;a&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Gonz&#225;lez Jim&#233;nez"
                            1 => "M&#46;J&#46; Aguilar Cordero"
                            2 => "C&#46;J&#46; Garci¿a Garci¿a"
                            3 => "P&#46; Garci¿a Lo¿pez"
                            4 => "J&#46; &#193;lvarez Ferre"
                            5 => "C&#46;A&#46; Padilla Lo¿pez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/S0212-16112012000100021"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nutr Hosp"
                        "fecha" => "2012"
                        "volumen" => "27"
                        "paginaInicial" => "177"
                        "paginaFinal" => "184"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22566318"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesidades pedi&#225;tricas&#58; de la lactancia a la adolescecia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46;A&#46; Martos-Moreno"
                            1 => "J&#46; Argente"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "An Pediatr &#40;Barc&#41;"
                        "fecha" => "2011"
                        "volumen" => "75"
                        "paginaInicial" => "63&#46;e1"
                        "paginaFinal" => "63&#46;e23"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development of eating behaviors among children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46;L&#46; Birch"
                            1 => "J&#46;O&#46; Fisher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "1998"
                        "volumen" => "101"
                        "paginaInicial" => "539"
                        "paginaFinal" => "549"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12224660"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Social and cultural perspectives on hunger&#44; appetite and satiety"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;T&#46; Kristensen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Clin Nutr"
                        "fecha" => "2000"
                        "volumen" => "54"
                        "paginaInicial" => "473"
                        "paginaFinal" => "478"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10878648"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A review of family and social determinants of children&#39;s eating patterns and diet quality"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Patrick"
                            1 => "T&#46;A&#46; Nicklas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Nutr"
                        "fecha" => "2005"
                        "volumen" => "24"
                        "paginaInicial" => "83"
                        "paginaFinal" => "92"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15798074"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Role of parents in the determination of food preferences of children and the development of obesity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46; Benton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Obes"
                        "fecha" => "2004"
                        "volumen" => "28"
                        "paginaInicial" => "858"
                        "paginaFinal" => "869"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Promoting healthy lifestyles&#58; behavior modification and motivational interviewing in the treatment of childhood obesity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;A&#46; Limbers"
                            1 => "E&#46;A&#46; Turner"
                            2 => "J&#46;W&#46; Varni"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacl.2008.03.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Lipidol"
                        "fecha" => "2008"
                        "volumen" => "2"
                        "paginaInicial" => "169"
                        "paginaFinal" => "178"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21291736"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A healthy school start&#8212;parental support to promote healthy dietary habits and physical activity in children&#58; design and evaluation of a cluster-randomised intervention"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46; Nyberg"
                            1 => "E&#46; Sundblom"
                            2 => "A&#46; Norman"
                            3 => "L&#46; Sch&#228;fer Elinder"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-2458-11-185"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Public Health"
                        "fecha" => "2011"
                        "volumen" => "11"
                        "paginaInicial" => "185"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21439049"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/23412879/0000008300000005/v1_201512040119/S2341287915001751/v1_201512040119/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "26005"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008300000005/v1_201512040119/S2341287915001751/v1_201512040119/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001751?idApp=UINPBA00005H"
]

Article information

ISSN: 23412879
Original language: English

DOI:10.1016/j.anpede.2015.09.012

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	8	5	13
2024 October	51	30	81
2024 September	44	13	57
2024 August	64	48	112
2024 July	85	34	119
2024 June	48	29	77
2024 May	42	30	72
2024 April	51	37	88
2024 March	46	21	67
2024 February	47	32	79
2024 January	34	22	56
2023 December	33	25	58
2023 November	29	21	50
2023 October	40	18	58
2023 September	19	21	40
2023 August	37	20	57
2023 July	29	26	55
2023 June	44	23	67
2023 May	41	19	60
2023 April	39	21	60
2023 March	57	33	90
2023 February	44	17	61
2023 January	26	20	46
2022 December	62	31	93
2022 November	53	32	85
2022 October	52	37	89
2022 September	38	32	70
2022 August	38	46	84
2022 July	60	31	91
2022 June	37	32	69
2022 May	37	36	73
2022 April	34	29	63
2022 March	50	47	97
2022 February	34	17	51
2022 January	31	34	65
2021 December	48	41	89
2021 November	43	54	97
2021 October	40	60	100
2021 September	27	44	71
2021 August	29	40	69
2021 July	75	24	99
2021 June	42	30	72
2021 May	35	24	59
2021 April	113	49	162
2021 March	47	41	88
2021 February	30	28	58
2021 January	23	12	35
2020 December	41	22	63
2020 November	28	15	43
2020 October	28	8	36
2020 September	28	20	48
2020 August	12	17	29
2020 July	26	17	43
2020 June	16	5	21
2020 May	22	20	42
2020 April	30	12	42
2020 March	19	15	34
2020 February	20	15	35
2020 January	28	14	42
2019 December	39	14	53
2019 November	18	10	28
2019 October	25	14	39
2019 September	17	17	34
2019 August	71	18	89
2019 July	25	18	43
2019 June	29	28	57
2019 May	52	19	71
2019 April	56	22	78
2019 March	32	17	49
2019 February	37	18	55
2019 January	27	19	46
2018 December	38	24	62
2018 November	76	35	111
2018 October	153	31	184
2018 September	56	16	72
2018 July	3	0	3
2018 June	3	0	3
2018 May	5	0	5
2018 April	18	0	18
2018 March	23	0	23
2018 February	15	0	15
2018 January	22	0	22
2017 December	15	0	15
2017 November	15	0	15
2017 October	22	0	22
2017 September	15	0	15
2017 August	18	0	18
2017 July	22	1	23
2017 June	24	7	31
2017 May	19	5	24
2017 April	13	5	18
2017 March	7	0	7
2017 February	15	5	20
2017 January	9	1	10
2016 December	25	6	31
2016 November	31	9	40
2016 October	28	10	38
2016 September	33	4	37
2016 August	27	4	31
2016 July	11	2	13

Show all

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter