Body mass index and tri-ponderal mass index of 1,453 healthy non-obese, non-undernourished millennial children. The Barcelona longitudinal growth study

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Estudio longitudinal de Barcelona" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2127 "Ancho" => 3176 "Tamanyo" => 413551 ] ] "descripcion" => array:1 [ "en" => "Mean values of body mass index (BMI) and tri-ponderal mass index (TMI) according to age at pubertal growth spurt onset." ] ] ] "textoCompleto" => "IntroductionBody mass index (BMI) (weight/height2) is used to measure underweight status and obesity in children and adolescents.<a class="elsevierStyleCrossRefs" href="#bib0150">1–8</a> However, exactly which BMI-for-age reference values should be used is a matter of debate. Today's BMI-for-age reference data are from cross-sectional growth studies which included obese and non-obese children,<a class="elsevierStyleCrossRefs" href="#bib0185">8–15</a> or were based on surveys carried out the last century, except for WHO reference values for the first five years of life.<a class="elsevierStyleCrossRefs" href="#bib0225">16–20</a> Thus, there is a lack of data coming from present healthy non-underweight and non-obese pediatric populations, which can be used as reference values.Recently, it has been reported that the tri-ponderal mass index (TMI) (weight/height3)<a class="elsevierStyleCrossRefs" href="#bib0150">1,21</a> estimates body fat levels more accurately than BMI in children aged 8–17 years and it has been suggested to replace BMI z score values with TMI values.<a class="elsevierStyleCrossRef" href="#bib0255">22</a>We aimed to obtain BMI-for-age and TMI-for-age (birth to 18 years of age in girls and 19 years of age in boys) reference values of healthy non-underweight and non-obese millennial children included in the Barcelona longitudinal growth study (1995–2017). In addition, as pubertal growth (height and weight gain rates) significantly differs according to age at pubertal growth spurt onset (PGSO),<a class="elsevierStyleCrossRefs" href="#bib0260">23–25</a> we also aimed to learn if the same occurs for BMI-for age and TMI-for age values.Subjects and methodsThe study group comprised 1,908 healthy children of the middle-to-upper socioeconomic district of Barcelona. Over the study period, 132 children were ruled out for obesity (physical examination and BMI >2.0 SDS of age- and sex-matched controls<a class="elsevierStyleCrossRef" href="#bib0205">12</a> and 323 were lost. Thus, 1,453 (743 girls, 710 boys) who reached adult height between January 2012 and March 2017 completed the study and data from their 25,851 length/height and weight measurements (12,818 in girls; 13,033 in boys) were analyzed. Adult height (growth velocity <1cm/year in two, 6–12 months, consecutive intervals) was reached by the age of 17 in all girls and by the age of 19 in all boys.<a class="elsevierStyleCrossRef" href="#bib0290">25</a>Population A (239 girls, 238 boys) was followed at four pediatric practices and data from their length/height and weight measurements were recorded from birth to 18 years of age in girls and 19 years of age in boys; birth weight and length were adequate for their gestational age.<a class="elsevierStyleCrossRef" href="#bib0270">26</a> Population B (504 girls; 472 boys) was followed at four schools and data from their height and weight measurements were recorded from 4 years of age to 18 years in girls and 19 years in boys. No chronic diseases, chronic drug therapies or underweight (BMI values <−2.0 SDS, age- and sex-matched controls<a class="elsevierStyleCrossRef" href="#bib0205">12</a> were documented in either population.Length/height and weight were recorded every 6–12 months by four researchers in population A and once a year by one of the four in population B, as reported previously.<a class="elsevierStyleCrossRefs" href="#bib0205">12,24</a> Length was measured during the first two years of life with a rigid infantometer, after which rigid wall-mounted stadiometers were used in population A and a portable rigid stadiometer in population B. Stadiometers were calibrated similarly throughout the study. Weight was recorded with a baby scale for the first 18 months of age and with a digital floor scale thereafter (population A in underwear; population B in T-shirt and skirt/trousers, the estimated weight of the T-shirt and skirt/trousers was subtracted from the overall weight). Measurements were taken to the nearest 0.1 centimeter (cm) for height and 0.1 kilogram (kg) for weight. BMI (kg/m2) and TMI (kg/m3) were calculated for each anthropometric measurement.The anthropometric growth program “Auxolog” based on data from our previous longitudinal growth study<a class="elsevierStyleCrossRefs" href="#bib0265">24,27</a> was used to construct BMI-for-age and TMI-for-age growth charts for each child. Children were considered very-early, early, intermediate, late and very-late matures according to their age at pubertal growth spurt onset.<a class="elsevierStyleCrossRefs" href="#bib0265">24,25</a> In each sex, mean BMI-for-age and TMI-for-age values were calculated for the whole population and for each of the five pubertal maturity groups.EthicsThe study was approved by the Ethics Committee of the University Children's Hospital Vall d’Hebron, Barcelona. Informed consent was obtained from children and their parents or legal guardians.Statistical analysisResults are expressed as mean±SD. Student’ t-test was used for comparisons of mean anthropometric-for-age values between sexes, and one-sample Student’ t-test for comparisons of mean anthropometric-for-age values of the whole population with each one of the five pubertal maturity groups in both sexes. SAS® 9.3 software (SAS Institute Inc., Cary, NC, USA) was used to analyze the data.ResultsFor both sexes, in the whole population and in each of the five pubertal maturity groups, mean BMI-for-age values were similar and did not differ statistically between populations A and B (data not shown). The same occurred for mean TMI-for-age values (data not shown). Thus, for each sex, joint data of both populations were analyzed as a single population.According to age at PGSO the 743 girls were considered: very-early matures (8–9 years, n=119), early matures (9–10 years, n=157), intermediate matures (10–11 years, n=238), late matures (11–12 years, n=127) and very-late matures (12–13 years, n=102). According to age at PGSO the 710 boys were considered: very-early matures (10–11 years, n=110), early matures (11–12 years, n=139), intermediate matures (12–13 years, n=225), late matures (13–14 years, n=133) and very-late matures (14–15 years, n=103).Body mass indexIn both sexes, mean BMI-for-age values of the whole population increase from birth to 1 year of age, decline thereafter until 5 years of age and increase progressively from then on to 18 years in girls and 19 years in boys (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Girls and boys had similar BMI-for-age values, although statistically-significant differences were observed at some ages (p<0.01 at 1, 4, 15, 16, 17 and 18 years). The greatest differences were observed at 18 years of age (0.7; 3.3%) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>BMI-for-age cut-off values of the whole population to define underweight (−2 SD) were similar to those proposed by Cole TJ and the WHO for both sexes.<a class="elsevierStyleCrossRefs" href="#bib0225">16,20</a> However, BMI-for-age cut-off values to define obesity (+2 SD) were lower in both sexes than those proposed by Cole TJ (1–18 years),<a class="elsevierStyleCrossRef" href="#bib0240">19</a> similar to those proposed by the WHO up to the age of 12 in girls and 14 in boys and lower from these ages onwards.<a class="elsevierStyleCrossRefs" href="#bib0230">17,18,20</a> Differences ranged from 1 to 5.3 with Cole TJ values and from 1 to 4.8 with WHO values.In both sexes, mean BMI-for-age values for each one of the five pubertal maturity groups were similar to those of the whole population (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), although statistically-significant differences (range: 0.3–0.8, p<0.05 to p<0.001) were observed at some ages (data not shown). The greatest differences were observed between the very-early group and the whole population: in girls from 8 to 14 years (0.8; 4.2%) p<0.001, and in boys at 18 years (0.7; 3.7%) p<0.001.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Tri-ponderal mass indexIn both sexes, mean TMI-for-age values of the whole population decreased abruptly during the first six years of age and slowly from then on to 18 years in girls and 19 years in boys (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). TMI-for-age values were similar in both sexes, although statistically significant differences (p=0.032 at 12 and 14 years and p<0.001 at 15, 16, 17 and 18 years) were observed. The greatest differences (0.5; 4%) were found at 15, 16, 17 and 18 years of age (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).In both sexes, mean TMI-for-age values for each one of the five pubertal maturity groups were similar to those of the whole population (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), although statistically significant differences (range: 0.2–0.5, p<0.05 to p<0.001) were observed at some ages (data not shown). The greatest differences (0.5; 4.0%) were observed between the very-early group and the whole population at 8 years of age in girls and at 14 and 15 years of age in boys.DiscussionCurrent BMI reference data to measure underweight status and obesity in children and adolescents came from cross-sectional growth studies which included obese and non-obese subjects,<a class="elsevierStyleCrossRefs" href="#bib0185">8–15</a> or were based on surveys carried out in the 19th century, except for WHO reference values for the first five years of life.<a class="elsevierStyleCrossRefs" href="#bib0225">16–20</a> Thus, there is a lack of data coming from present healthy millennial non-underweight and non-obese pediatric populations, which can be used as reference values to measure underweight and overweight status and obesity in the present pediatric populations.Although TMI-for-age values<a class="elsevierStyleCrossRefs" href="#bib0150">1,21,22</a> are not currently used to measure underweight status and obesity in children and adolescents, a recent work has underlined that TMI values estimate body fat levels more accurately than BMI in non-Hispanic white children aged 8–17 years and recommended the use of TMI values instead of BMI z score values. However, as the authors pointed out, this work needs to be extended to other racial/ethnic groups and then replicated in large cross-sectional and longitudinal studies.<a class="elsevierStyleCrossRef" href="#bib0255">22</a> Age-and-sex reference data of healthy non-underweight and non-obese millennial children have not been reported until now.Herein, we report BMI-for-age and TPI-for-age values of 1453 healthy non-underweight and non-obese children, followed in a longitudinal study from birth (n=477) or from 4 years of age (n=976) to adult height, which was reached between January 2012 and March 2017 and in whom the anthropometric measurements were taken by only four researchers using similarly adjusted equipment The study was designed with the aim of reducing the anthropometric values dispersion observed in growth studies owing to the heterogeneity of the populations evaluated, the number of researchers involved and the equipment used.Although a bias in our results can completely not be rule out, they represent the BMI-for-age and TMI-for-age values distribution of 1,453 healthy non-underweight and non-obese millennial children in whom 25,851 anthropometric measurement were recorded and in whom prepubertal and adult height<a class="elsevierStyleCrossRef" href="#bib0290">25</a> were similar to those of the current BMI reference data used to measure underweight status and obesity in children and adolescents.<a class="elsevierStyleCrossRefs" href="#bib0185">8–19</a> This suggests that our data may be considered as a reference to measure underweight status and obesity in present pediatric populations. Their clinical use may confirm or deny this assumption.Mean BMI-for age values tended to differ between sexes, at some ages; however, differences were scant and of poor clinical significance. The same occurred for TMI-for-age values. This suggests that the differences observed in weight-for-age values between both sexes were mainly related to the corresponding differences in height-for-age values<a class="elsevierStyleCrossRef" href="#bib0290">25</a>, and that this resulted in similar BMI-for-age and TMI-for-age values, which concur with the fact that non-underweight and non-obese children were included in our study. Our data also suggest that BMI-for-age values could be evaluated using the same reference-for-age values for both sexes. The same occurred for TMI-for-age values.While our BMI-for-age cut-off values to define underweight status (−2 SD) were similar to those proposed by Cole TJ and the WHO for both sexes<a class="elsevierStyleCrossRefs" href="#bib0225">16–18</a> our BMI-for-age cut-off values to define obesity differed in pubertal and adolescent years from those proposed by Cole TJ<a class="elsevierStyleCrossRef" href="#bib0240">19</a> and the WHO.<a class="elsevierStyleCrossRefs" href="#bib0230">17,18,20</a> Whether differences among the populations evaluated (present day vs. last century), secular growth<a class="elsevierStyleCrossRefs" href="#bib0190">9–15</a> and pubertal onset acceleration<a class="elsevierStyleCrossRefs" href="#bib0290">25,28–30</a> or other methodological aspects could explain the differences among these studies would be a matter of discussion.In both sexes, pubertal growth spurt onset occurs over a five years-period<a class="elsevierStyleCrossRefs" href="#bib0260">23–25</a> and it is a critical milestone determining growth rate (height and weight gains) of pubertal period, Tanner's stages development and, in girls, age at menarche and growth from menarche to adult height. Although, at some ages, mean BMI-for-age values tended to differ between the whole population and the very-early maturity pubertal group, differences were scant and of poor clinical significance. Each pubertal maturity group had a BMI-for-age pattern similar to that of the whole population. The same occurred for mean TMI-for-age values. This suggests that, in both sexes, the differences observed in weight-for-age values among the five pubertal maturity groups were mainly related to the corresponding differences in height-for-age values<a class="elsevierStyleCrossRef" href="#bib0290">25</a>, and that this resulted in similar BMI-for-age values, which support the fact that non-underweight and non-obese children were included in our study. The same occurred for TMI-for-age values.In summary, BMI-for-age and TMI-for-age reference values of healthy non-underweight and non-obese millennial children are provided for the first time, as far as we know. No pertinent and not clinically relevant differences were observed between sexes for BMI-for-age and for TMI-for age values. These values may be helpful for clinical evaluation of thinness and obesity during infancy, childhood and adolescence in present pediatric populations, and may contribute to confirm or deny the suggested use of TMI-for-age values instead of BMI-for-age z score values in a clinical setting.AddendumCharts for BMI-for-age and TMI-for-age values calculated by the LMS method will be available (centiles and SDS values) and downloaded free of charge from the web site: <a id="intr0010" class="elsevierStyleInterRef" href="http://www.millennialsgrowth.com/">http://www.millennialsgrowth.com</a> (available February 2018) (Cole TJ. The LMS method for constructing normalized growth standards. Eur J Clin Nutr 1990;44:45–60).FundingThis research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.Conflict of interestsThere is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1077223" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Subjects and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1023254" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1077224" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Sujetos y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1023255" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Subjects and methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Ethics" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0025" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Body mass index" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Tri-ponderal mass index" ] ] ] 7 => array:3 [ "identificador" => "sec0040" "titulo" => "Discussion" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Addendum" ] ] ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interests" ] 10 => array:2 [ "identificador" => "xack364948" "titulo" => "Acknowledgments" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-09-19" "fechaAceptado" => "2017-12-07" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1023254" "palabras" => array:4 [ 0 => "Body mass index" 1 => "Tri-ponderal mass index" 2 => "Healthy non-underweight millennials children" 3 => "Healthy non-obese millennials children" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1023255" "palabras" => array:4 [ 0 => "Índice de masa corporal" 1 => "Índice de masa triponderal" 2 => "Niños de la generación del milenio sanos sin bajo peso" 3 => "Niños de la generación del milenio sanos no obesos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionBody mass index-for age (BMI) and tri-ponderal mass index-for-age (TMI) values of healthy non-underweight, non-obese millennial children have not been reported until now. We aimed to obtain these values. Subjects and methodsLongitudinal growth study (1995–2017) of 1,453 healthy non-underweight, non-obese millennial children, from birth (n=477) or from 4 years of age (n=976) to 18 years in girls and 19 years in boys (25,851 anthropometric measurements). ResultsIn each sex, mean BMI-for-age values increased from birth to one year, declined until 5 and increased from then onwards. Mean TMI-for-age values decreased abruptly during the first 6 years of age and slowly thereafter, in both sexes. Although, at some ages, mean BMI-for age values differed statistically between sexes, differences were scant and of poor clinical significance. The same occurred for TMI-for-age values. BMI-for-age cut-off values to define underweight status (−2 SD) were similar to those proposed by Cole and the WHO for both sexes. However, BMI-for-age cut-off values to define obesity (+2 SD) were lower in both sexes (1.0–5.3) than those proposed by Cole and similar to those proposed by the WHO until 12 in girls and 14 in boys and lower (1.0–4.8) from these ages onwards. ConclusionsBMI-for-age and TMI-for-age values of healthy non-underweight, non-obese millennial children are provided. No clinically relevant differences were observed between sexes. These values may be used to measure underweight status and obesity in present pediatric populations and to evaluate the relationship between BMI-for-age and TMI-for-age in a clinical setting." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Subjects and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónHasta el momento no se han comunicado valores del índice de masa corporal (IMC) ni del índice de masa triponderal (IMT) de niños sanos sin malnutrición ni obesidad de la generación del milenio. Nuestro objetivo fue obtener estos valores. Sujetos y métodosEstudio longitudinal de crecimiento (1995-2017) en 1.453 niños sanos sin malnutrición ni obesidad de la generación del milenio desde el nacimiento (n = 477) o los 4 años de edad (n = 976) hasta los 18 años en mujeres y los 19 años en varones (25.851 mediciones antropométricas). ResultadosEn ambos sexos, los valores medios del IMC según la edad aumentaron entre el nacimiento y el año de edad, luego decrecieron hasta los 5 años de edad y finalmente aumentaron a partir de dicha edad. Los valores del IMT según la edad descendieron abruptamente en los 6 primeros años de vida y lentamente a partir de esa edad en ambos sexos. Aunque a algunas edades los valores medios del IMC difirieron de manera significativa entre los sexos, esas diferencias fueron pequeñas y de escasa relevancia clínica. Lo mismo ocurrió con los valores del IMT según la edad. Los puntos de corte del IMC según la edad obtenidos para definir la malnutrición (−2 DE) fueron similares a los propuestos por Cole y la OMS en ambos sexos. En cambio, los puntos de corte del IMC según la edad obtenidos para definir la obesidad (+2 DE) fueron menores en ambos sexos (1,0-5,3) en comparación con los propuestos por Cole y similares a los propuestos por la OMS hasta los 12 años en niñas y los 14 en niños, e inferiores (1,0-4,8) a los de la OMS a partir de dichas edades. ConclusionesPresentamos valores del IMC y el IMT según la edad de niños sanos sin malnutrición ni obesidad de la generación del milenio. No se observaron diferencias significativas entre los 2 sexos. Estos valores podrían emplearse para evaluar la malnutrición y la obesidad en poblaciones pediátricas actuales y para estudiar la relación entre el IMC y el IMT (según la edad) en la práctica clínica." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Sujetos y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Carrascosa A, Yeste D, Moreno-Galdó A, Gussinyé M, Ferrández Á, Clemente M, et al. Índice de masa corporal e índice de masa triponderal de 1.453 niños no obesos y sin malnutrición de la generación del milenio. Estudio longitudinal de Barcelona. An Pediatr (Barc). 2018;89:137–143." ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1014 "Ancho" => 3179 "Tamanyo" => 215235 ] ] "descripcion" => array:1 [ "en" => "Body mass index (BMI) and tri-ponderal mass index (TMI) according to age. Mean and SD values." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2127 "Ancho" => 3176 "Tamanyo" => 413551 ] ] "descripcion" => array:1 [ "en" => "Mean values of body mass index (BMI) and tri-ponderal mass index (TMI) according to age at pubertal growth spurt onset." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "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-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">BMI<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">BMI<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Age (years) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">TMI<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">TMI<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Girls n=743<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Boys n=710<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Girls n=743<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Boys n=710<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">13.2±1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.4±1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.6±2.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.8±2.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">17.6±1.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.9±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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.7±1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.7±1.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">16.5±1.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.7±1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.2±1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.2±1.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">16.0±0.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.2±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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.9±1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.9±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="char" valign="top">15.6±1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.9±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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.2±1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.3±1.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">15.6±1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.8±1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.3±1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.2±1.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">15.8±1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.9±1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.6±1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.6±1.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">16.2±1.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.2±1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.2±1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.1±1.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">16.7±1.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.7±1.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.0±1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.9±1.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">17.2±2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.3±2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.8±1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.8±1.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">17.7±2.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.9±2.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.7±1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.7±1.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">18.2±2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.4±2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.5±1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.6±1.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">18.7±2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.9±2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.3±1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.5±1.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">19.3±2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.4±2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.2±1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.3±1.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">19.8±2.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.9±2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.3±1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.1±1.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">20.2±2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.3±2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.4±1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.9±1.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">20.4±2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.7±2.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.4±1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.9±1.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">20.6±2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.1±2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.4±1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.0±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="char" valign="top">20.7±2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.4±2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.5±1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.1±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="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.6±2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.2±1.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1838751.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "BMI. Girls vs. Boys: p<0.01 at 1, 4, 15, 16, 17 and 18 years; ns at other ages." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "TMI. Girls vs. Boys: p=0.032 at 12 and 14 years and p<0.001 at 15, 16, 17 and 18 years; ns at other ages." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "Number of children at 0, 1, 2 and 3 years of age: Girls n=239; Boys n=238." ] ] ] "descripcion" => array:1 [ "en" => "Body mass index-for-age (BMI) and tri-ponderal mass index-for-age (TMI) values (mean±SD)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0150" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Weight/heightp compared to weight/height2 for assessing adiposity in childhood: influence of age and bone age on p during puberty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T.J. 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Original Article

Body mass index and tri-ponderal mass index of 1,453 healthy non-obese, non-undernourished millennial children. The Barcelona longitudinal growth study

Índice de masa corporal e índice de masa triponderal de 1.453 niños no obesos y sin malnutrición de la generación del milenio. Estudio longitudinal de Barcelona

Antonio Carrascosaa,b,

Corresponding author

ancarrascosa@vhebron.net

Corresponding author.

, Diego Yestea,b, Antonio Moreno-Galdób,c, Miquel Gussinyéa, Ángel Ferrándezd, María Clementea,b, Mónica Fernández-Cancioa,b

a Servicio de Endocrinología Pediátrica, Hospital Universitario Materno-Infantil Vall d’Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain

b CIBER de Enfermedades Raras (CIBERER) ISCIII, Pg Vall d’Hebron 119-129, Barcelona 08035, Spain

c Sección de Neumología Pediátrica, Hospital Universitario Materno-Infantil Vall d’Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain

d Centro Andrea Prader (Zaragoza), Pg Vall d’Hebron 119-129, Barcelona 08035, Spain

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there is a lack of data coming from present healthy non-underweight and non-obese pediatric populations&#44; which can be used as reference values&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Recently&#44; it has been reported that the tri-ponderal mass index &#40;TMI&#41; &#40;weight&#47;height<span class="elsevierStyleSup">3</span>&#41;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">1&#44;21</span></a> estimates body fat levels more accurately than BMI in children aged 8&#8211;17 years and it has been suggested to replace BMI <span class="elsevierStyleItalic">z</span> score values with TMI values&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We aimed to obtain BMI-for-age and TMI-for-age &#40;birth to 18 years of age in girls and 19 years of age in boys&#41; reference values of healthy non-underweight and non-obese millennial children included in the Barcelona longitudinal growth study &#40;1995&#8211;2017&#41;&#46; In addition&#44; as pubertal growth &#40;height and weight gain rates&#41; significantly differs according to age at pubertal growth spurt onset &#40;PGSO&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">23&#8211;25</span></a> we also aimed to learn if the same occurs for BMI-for age and TMI-for age values&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Subjects and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">The study group comprised 1&#44;908 healthy children of the middle-to-upper socioeconomic district of Barcelona&#46; Over the study period&#44; 132 children were ruled out for obesity &#40;physical examination and BMI &#62;2&#46;0 SDS of age- and sex-matched controls<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">12</span></a> and 323 were lost&#46; Thus&#44; 1&#44;453 &#40;743 girls&#44; 710 boys&#41; who reached adult height between January 2012 and March 2017 completed the study and data from their 25&#44;851 length&#47;height and weight measurements &#40;12&#44;818 in girls&#59; 13&#44;033 in boys&#41; were analyzed&#46; Adult height &#40;growth velocity &#60;1<span class="elsevierStyleHsp" style=""></span>cm&#47;year in two&#44; 6&#8211;12 months&#44; consecutive intervals&#41; was reached by the age of 17 in all girls and by the age of 19 in all boys&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">25</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Population A &#40;239 girls&#44; 238 boys&#41; was followed at four pediatric practices and data from their length&#47;height and weight measurements were recorded from birth to 18 years of age in girls and 19 years of age in boys&#59; birth weight and length were adequate for their gestational age&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">26</span></a> Population B &#40;504 girls&#59; 472 boys&#41; was followed at four schools and data from their height and weight measurements were recorded from 4 years of age to 18 years in girls and 19 years in boys&#46; No chronic diseases&#44; chronic drug therapies or underweight &#40;BMI values &#60;&#8722;2&#46;0 SDS&#44; age- and sex-matched controls<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">12</span></a> were documented in either population&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Length&#47;height and weight were recorded every 6&#8211;12 months by four researchers in population A and once a year by one of the four in population B&#44; as reported previously&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">12&#44;24</span></a> Length was measured during the first two years of life with a rigid infantometer&#44; after which rigid wall-mounted stadiometers were used in population A and a portable rigid stadiometer in population B&#46; Stadiometers were calibrated similarly throughout the study&#46; Weight was recorded with a baby scale for the first 18 months of age and with a digital floor scale thereafter &#40;population A in underwear&#59; population B in T-shirt and skirt&#47;trousers&#44; the estimated weight of the T-shirt and skirt&#47;trousers was subtracted from the overall weight&#41;&#46; Measurements were taken to the nearest 0&#46;1 centimeter &#40;cm&#41; for height and 0&#46;1 kilogram &#40;kg&#41; for weight&#46; BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41; and TMI &#40;kg&#47;m<span class="elsevierStyleSup">3</span>&#41; were calculated for each anthropometric measurement&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The anthropometric growth program &#8220;Auxolog&#8221; based on data from our previous longitudinal growth study<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">24&#44;27</span></a> was used to construct BMI-for-age and TMI-for-age growth charts for each child&#46; Children were considered very-early&#44; early&#44; intermediate&#44; late and very-late matures according to their age at pubertal growth spurt onset&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">24&#44;25</span></a> In each sex&#44; mean BMI-for-age and TMI-for-age values were calculated for the whole population and for each of the five pubertal maturity groups&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Ethics</span><p id="par0040" class="elsevierStylePara elsevierViewall">The study was approved by the Ethics Committee of the University Children&#39;s Hospital Vall d&#8217;Hebron&#44; Barcelona&#46; Informed consent was obtained from children and their parents or legal guardians&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">Results are expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#46; Student&#8217; <span class="elsevierStyleItalic">t</span>-test was used for comparisons of mean anthropometric-for-age values between sexes&#44; and one-sample Student&#8217; <span class="elsevierStyleItalic">t</span>-test for comparisons of mean anthropometric-for-age values of the whole population with each one of the five pubertal maturity groups in both sexes&#46; SAS<span class="elsevierStyleSup">&#174;</span> 9&#46;3 software &#40;SAS Institute Inc&#46;&#44; Cary&#44; NC&#44; USA&#41; was used to analyze the data&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">For both sexes&#44; in the whole population and in each of the five pubertal maturity groups&#44; mean BMI-for-age values were similar and did not differ statistically between populations A and B &#40;data not shown&#41;&#46; The same occurred for mean TMI-for-age values &#40;data not shown&#41;&#46; Thus&#44; for each sex&#44; joint data of both populations were analyzed as a single population&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">According to age at PGSO the 743 girls were considered&#58; very-early matures &#40;8&#8211;9 years&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>119&#41;&#44; early matures &#40;9&#8211;10 years&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>157&#41;&#44; intermediate matures &#40;10&#8211;11 years&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>238&#41;&#44; late matures &#40;11&#8211;12 years&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>127&#41; and very-late matures &#40;12&#8211;13 years&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>102&#41;&#46; According to age at PGSO the 710 boys were considered&#58; very-early matures &#40;10&#8211;11 years&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>110&#41;&#44; early matures &#40;11&#8211;12 years&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>139&#41;&#44; intermediate matures &#40;12&#8211;13 years&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>225&#41;&#44; late matures &#40;13&#8211;14 years&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>133&#41; and very-late matures &#40;14&#8211;15 years&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>103&#41;&#46;</p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Body mass index</span><p id="par0060" class="elsevierStylePara elsevierViewall">In both sexes&#44; mean BMI-for-age values of the whole population increase from birth to 1 year of age&#44; decline thereafter until 5 years of age and increase progressively from then on to 18 years in girls and 19 years in boys &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Girls and boys had similar BMI-for-age values&#44; although statistically-significant differences were observed at some ages &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01 at 1&#44; 4&#44; 15&#44; 16&#44; 17 and 18 years&#41;&#46; The greatest differences were observed at 18 years of age &#40;0&#46;7&#59; 3&#46;3&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">BMI-for-age cut-off values of the whole population to define underweight &#40;&#8722;2 SD&#41; were similar to those proposed by Cole TJ and the WHO for both sexes&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">16&#44;20</span></a> However&#44; BMI-for-age cut-off values to define obesity &#40;&#43;2 SD&#41; were lower in both sexes than those proposed by Cole TJ &#40;1&#8211;18 years&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a> similar to those proposed by the WHO up to the age of 12 in girls and 14 in boys and lower from these ages onwards&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">17&#44;18&#44;20</span></a> Differences ranged from 1 to 5&#46;3 with Cole TJ values and from 1 to 4&#46;8 with WHO values&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In both sexes&#44; mean BMI-for-age values for each one of the five pubertal maturity groups were similar to those of the whole population &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; although statistically-significant differences &#40;range&#58; 0&#46;3&#8211;0&#46;8&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 to <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; were observed at some ages &#40;data not shown&#41;&#46; The greatest differences were observed between the very-early group and the whole population&#58; in girls from 8 to 14 years &#40;0&#46;8&#59; 4&#46;2&#37;&#41; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#44; and in boys at 18 years &#40;0&#46;7&#59; 3&#46;7&#37;&#41; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Tri-ponderal mass index</span><p id="par0075" class="elsevierStylePara elsevierViewall">In both sexes&#44; mean TMI-for-age values of the whole population decreased abruptly during the first six years of age and slowly from then on to 18 years in girls and 19 years in boys &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; TMI-for-age values were similar in both sexes&#44; although statistically significant differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;032 at 12 and 14 years and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 at 15&#44; 16&#44; 17 and 18 years&#41; were observed&#46; The greatest differences &#40;0&#46;5&#59; 4&#37;&#41; were found at 15&#44; 16&#44; 17 and 18 years of age &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In both sexes&#44; mean TMI-for-age values for each one of the five pubertal maturity groups were similar to those of the whole population &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; although statistically significant differences &#40;range&#58; 0&#46;2&#8211;0&#46;5&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 to <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; were observed at some ages &#40;data not shown&#41;&#46; The greatest differences &#40;0&#46;5&#59; 4&#46;0&#37;&#41; were observed between the very-early group and the whole population at 8 years of age in girls and at 14 and 15 years of age in boys&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">Current BMI reference data to measure underweight status and obesity in children and adolescents came from cross-sectional growth studies which included obese and non-obese subjects&#44;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">8&#8211;15</span></a> or were based on surveys carried out in the 19th century&#44; except for WHO reference values for the first five years of life&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">16&#8211;20</span></a> Thus&#44; there is a lack of data coming from present healthy millennial non-underweight and non-obese pediatric populations&#44; which can be used as reference values to measure underweight and overweight status and obesity in the present pediatric populations&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Although TMI-for-age values<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">1&#44;21&#44;22</span></a> are not currently used to measure underweight status and obesity in children and adolescents&#44; a recent work has underlined that TMI values estimate body fat levels more accurately than BMI in non-Hispanic white children aged 8&#8211;17 years and recommended the use of TMI values instead of BMI <span class="elsevierStyleItalic">z</span> score values&#46; However&#44; as the authors pointed out&#44; this work needs to be extended to other racial&#47;ethnic groups and then replicated in large cross-sectional and longitudinal studies&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a> Age-and-sex reference data of healthy non-underweight and non-obese millennial children have not been reported until now&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Herein&#44; we report BMI-for-age and TPI-for-age values of 1453 healthy non-underweight and non-obese children&#44; followed in a longitudinal study from birth &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>477&#41; or from 4 years of age &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>976&#41; to adult height&#44; which was reached between January 2012 and March 2017 and in whom the anthropometric measurements were taken by only four researchers using similarly adjusted equipment The study was designed with the aim of reducing the anthropometric values dispersion observed in growth studies owing to the heterogeneity of the populations evaluated&#44; the number of researchers involved and the equipment used&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Although a bias in our results can completely not be rule out&#44; they represent the BMI-for-age and TMI-for-age values distribution of 1&#44;453 healthy non-underweight and non-obese millennial children in whom 25&#44;851 anthropometric measurement were recorded and in whom prepubertal and adult height<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">25</span></a> were similar to those of the current BMI reference data used to measure underweight status and obesity in children and adolescents&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">8&#8211;19</span></a> This suggests that our data may be considered as a reference to measure underweight status and obesity in present pediatric populations&#46; Their clinical use may confirm or deny this assumption&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Mean BMI-for age values tended to differ between sexes&#44; at some ages&#59; however&#44; differences were scant and of poor clinical significance&#46; The same occurred for TMI-for-age values&#46; This suggests that the differences observed in weight-for-age values between both sexes were mainly related to the corresponding differences in height-for-age values<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">25</span></a>&#44; and that this resulted in similar BMI-for-age and TMI-for-age values&#44; which concur with the fact that non-underweight and non-obese children were included in our study&#46; Our data also suggest that BMI-for-age values could be evaluated using the same reference-for-age values for both sexes&#46; The same occurred for TMI-for-age values&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">While our BMI-for-age cut-off values to define underweight status &#40;&#8722;2 SD&#41; were similar to those proposed by Cole TJ and the WHO for both sexes<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">16&#8211;18</span></a> our BMI-for-age cut-off values to define obesity differed in pubertal and adolescent years from those proposed by Cole TJ<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a> and the WHO&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">17&#44;18&#44;20</span></a> Whether differences among the populations evaluated &#40;present day vs&#46; last century&#41;&#44; secular growth<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">9&#8211;15</span></a> and pubertal onset acceleration<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">25&#44;28&#8211;30</span></a> or other methodological aspects could explain the differences among these studies would be a matter of discussion&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In both sexes&#44; pubertal growth spurt onset occurs over a five years-period<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">23&#8211;25</span></a> and it is a critical milestone determining growth rate &#40;height and weight gains&#41; of pubertal period&#44; Tanner&#39;s stages development and&#44; in girls&#44; age at menarche and growth from menarche to adult height&#46; Although&#44; at some ages&#44; mean BMI-for-age values tended to differ between the whole population and the very-early maturity pubertal group&#44; differences were scant and of poor clinical significance&#46; Each pubertal maturity group had a BMI-for-age pattern similar to that of the whole population&#46; The same occurred for mean TMI-for-age values&#46; This suggests that&#44; in both sexes&#44; the differences observed in weight-for-age values among the five pubertal maturity groups were mainly related to the corresponding differences in height-for-age values<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">25</span></a>&#44; and that this resulted in similar BMI-for-age values&#44; which support the fact that non-underweight and non-obese children were included in our study&#46; The same occurred for TMI-for-age values&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In summary&#44; BMI-for-age and TMI-for-age reference values of healthy non-underweight and non-obese millennial children are provided for the first time&#44; as far as we know&#46; No pertinent and not clinically relevant differences were observed between sexes for BMI-for-age and for TMI-for age values&#46; These values may be helpful for clinical evaluation of thinness and obesity during infancy&#44; childhood and adolescence in present pediatric populations&#44; and may contribute to confirm or deny the suggested use of TMI-for-age values instead of BMI-for-age <span class="elsevierStyleItalic">z</span> score values in a clinical setting&#46;</p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Addendum</span><p id="par0125" class="elsevierStylePara elsevierViewall">Charts for BMI-for-age and TMI-for-age values calculated by the LMS method will be available &#40;centiles and SDS values&#41; and downloaded free of charge from the web site&#58; <a id="intr0010" class="elsevierStyleInterRef" href="http://www.millennialsgrowth.com/">http&#58;&#47;&#47;www&#46;millennialsgrowth&#46;com</a> &#40;available February 2018&#41; &#40;Cole TJ&#46; The LMS method for constructing normalized growth standards&#46; Eur J Clin Nutr 1990&#59;44&#58;45&#8211;60&#41;&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Funding</span><p id="par0130" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from any funding agency in the public&#44; commercial or not-for-profit sector&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interests</span><p id="par0135" class="elsevierStylePara elsevierViewall">There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported&#46;</p></span></span>"
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            0 => "&#205;ndice de masa corporal"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Body mass index-for age &#40;BMI&#41; and tri-ponderal mass index-for-age &#40;TMI&#41; values of healthy non-underweight&#44; non-obese millennial children have not been reported until now&#46; We aimed to obtain these values&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Subjects and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Longitudinal growth study &#40;1995&#8211;2017&#41; of 1&#44;453 healthy non-underweight&#44; non-obese millennial children&#44; from birth &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>477&#41; or from 4 years of age &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>976&#41; to 18 years in girls and 19 years in boys &#40;25&#44;851 anthropometric measurements&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In each sex&#44; mean BMI-for-age values increased from birth to one year&#44; declined until 5 and increased from then onwards&#46; Mean TMI-for-age values decreased abruptly during the first 6 years of age and slowly thereafter&#44; in both sexes&#46; Although&#44; at some ages&#44; mean BMI-for age values differed statistically between sexes&#44; differences were scant and of poor clinical significance&#46; The same occurred for TMI-for-age values&#46; BMI-for-age cut-off values to define underweight status &#40;&#8722;2 SD&#41; were similar to those proposed by Cole and the WHO for both sexes&#46; However&#44; BMI-for-age cut-off values to define obesity &#40;&#43;2 SD&#41; were lower in both sexes &#40;1&#46;0&#8211;5&#46;3&#41; than those proposed by Cole and similar to those proposed by the WHO until 12 in girls and 14 in boys and lower &#40;1&#46;0&#8211;4&#46;8&#41; from these ages onwards&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">BMI-for-age and TMI-for-age values of healthy non-underweight&#44; non-obese millennial children are provided&#46; No clinically relevant differences were observed between sexes&#46; These values may be used to measure underweight status and obesity in present pediatric populations and to evaluate the relationship between BMI-for-age and TMI-for-age in a clinical setting&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Subjects and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      "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">Hasta el momento no se han comunicado valores del &#237;ndice de masa corporal &#40;IMC&#41; ni del &#237;ndice de masa triponderal &#40;IMT&#41; de ni&#241;os sanos sin malnutrici&#243;n ni obesidad de la generaci&#243;n del milenio&#46; Nuestro objetivo fue obtener estos valores&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Sujetos y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio longitudinal de crecimiento &#40;1995-2017&#41; en 1&#46;453 ni&#241;os sanos sin malnutrici&#243;n ni obesidad de la generaci&#243;n del milenio desde el nacimiento &#40;n &#61; 477&#41; o los 4 a&#241;os de edad &#40;n &#61; 976&#41; hasta los 18 a&#241;os en mujeres y los 19 a&#241;os en varones &#40;25&#46;851 mediciones antropom&#233;tricas&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En ambos sexos&#44; los valores medios del IMC seg&#250;n la edad aumentaron entre el nacimiento y el a&#241;o de edad&#44; luego decrecieron hasta los 5 a&#241;os de edad y finalmente aumentaron a partir de dicha edad&#46; Los valores del IMT seg&#250;n la edad descendieron abruptamente en los 6 primeros a&#241;os de vida y lentamente a partir de esa edad en ambos sexos&#46; Aunque a algunas edades los valores medios del IMC difirieron de manera significativa entre los sexos&#44; esas diferencias fueron peque&#241;as y de escasa relevancia cl&#237;nica&#46; Lo mismo ocurri&#243; con los valores del IMT seg&#250;n la edad&#46; Los puntos de corte del IMC seg&#250;n la edad obtenidos para definir la malnutrici&#243;n &#40;&#8722;2 DE&#41; fueron similares a los propuestos por Cole y la OMS en ambos sexos&#46; En cambio&#44; los puntos de corte del IMC seg&#250;n la edad obtenidos para definir la obesidad &#40;&#43;2 DE&#41; fueron menores en ambos sexos &#40;1&#44;0-5&#44;3&#41; en comparaci&#243;n con los propuestos por Cole y similares a los propuestos por la OMS hasta los 12 a&#241;os en ni&#241;as y los 14 en ni&#241;os&#44; e inferiores &#40;1&#44;0-4&#44;8&#41; a los de la OMS a partir de dichas edades&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Presentamos valores del IMC y el IMT seg&#250;n la edad de ni&#241;os sanos sin malnutrici&#243;n ni obesidad de la generaci&#243;n del milenio&#46; No se observaron diferencias significativas entre los 2 sexos&#46; Estos valores podr&#237;an emplearse para evaluar la malnutrici&#243;n y la obesidad en poblaciones pedi&#225;tricas actuales y para estudiar la relaci&#243;n entre el IMC y el IMT &#40;seg&#250;n la edad&#41; en la pr&#225;ctica cl&#237;nica&#46;</p></span>"
        "secciones" => array:4 [
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            "titulo" => "Introducci&#243;n"
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            "titulo" => "Sujetos y m&#233;todos"
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            "identificador" => "abst0035"
            "titulo" => "Resultados"
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            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Carrascosa A&#44; Yeste D&#44; Moreno-Gald&#243; A&#44; Gussiny&#233; M&#44; Ferr&#225;ndez &#193;&#44; Clemente M&#44; et al&#46; &#205;ndice de masa corporal e &#237;ndice de masa triponderal de 1&#46;453 ni&#241;os no obesos y sin malnutrici&#243;n de la generaci&#243;n del milenio&#46; Estudio longitudinal de Barcelona&#46; An Pediatr &#40;Barc&#41;&#46; 2018&#59;89&#58;137&#8211;143&#46;</p>"
      ]
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Body mass index &#40;BMI&#41; and tri-ponderal mass index &#40;TMI&#41; according to age&#46; Mean and SD values&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Mean values of body mass index &#40;BMI&#41; and tri-ponderal mass index &#40;TMI&#41; according to age at pubertal growth spurt onset&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">BMI<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 23412879
Original language: English

DOI:10.1016/j.anpede.2018.01.006

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Year/Month	Html	Pdf	Total

2024 November	7	9	16
2024 October	53	60	113
2024 September	53	45	98
2024 August	71	113	184
2024 July	50	72	122
2024 June	48	60	108
2024 May	58	76	134
2024 April	44	55	99
2024 March	47	38	85
2024 February	37	43	80
2024 January	34	40	74
2023 December	44	76	120
2023 November	46	53	99
2023 October	60	33	93
2023 September	44	32	76
2023 August	46	29	75
2023 July	65	39	104
2023 June	79	33	112
2023 May	56	31	87
2023 April	67	24	91
2023 March	101	40	141
2023 February	48	15	63
2023 January	43	34	77
2022 December	81	37	118
2022 November	65	27	92
2022 October	79	47	126
2022 September	45	37	82
2022 August	48	60	108
2022 July	51	43	94
2022 June	35	45	80
2022 May	40	38	78
2022 April	49	34	83
2022 March	62	52	114
2022 February	47	26	73
2022 January	56	47	103
2021 December	47	48	95
2021 November	42	47	89
2021 October	69	84	153
2021 September	30	27	57
2021 August	48	58	106
2021 July	50	42	92
2021 June	55	53	108
2021 May	66	47	113
2021 April	130	66	196
2021 March	112	50	162
2021 February	68	32	100
2021 January	58	39	97
2020 December	59	33	92
2020 November	37	20	57
2020 October	42	24	66
2020 September	63	33	96
2020 August	66	27	93
2020 July	43	16	59
2020 June	46	22	68
2020 May	69	26	95
2020 April	66	19	85
2020 March	111	26	137
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2020 January	421	29	450
2019 December	438	26	464
2019 November	313	21	334
2019 October	189	19	208
2019 September	107	18	125
2019 August	161	30	191
2019 July	82	43	125
2019 June	50	33	83
2019 May	74	34	108
2019 April	88	28	116
2019 March	58	27	85
2019 February	62	13	75
2019 January	82	39	121
2018 December	79	38	117
2018 November	99	46	145
2018 October	89	36	125
2018 September	96	63	159
2018 August	0	4	4
2018 July	0	2	2
2018 June	0	2	2
2018 May	0	6	6
2018 April	0	20	20
2018 March	0	52	52
2018 February	0	7	7

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