Original Article
Prevalence of malnutrition in Spanish schoolchildren
Prevalencia de malnutrición en escolares españoles
Mónica Pérez-Ríosa,b,
, María Isolina Santiago-Péreza, Rosaura Leisc, Alberto Malvara, Jorge Suanzesd, Xurxo Hervadaa
Corresponding author
a Subdirección de Información sobre Saúde e Epidemioloxía, Dirección Xeral de Saúde Pública, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, La Coruña, Spain
b Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
c Servicio de Pediatría, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
d Subdirección de Programas de Fomento de Estilos de Vida Saudables, Dirección Xeral de Saúde Pública, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, La Coruña, Spain
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"apellidos" => "Hervada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Subdirección de Información sobre Saúde e Epidemioloxía, Dirección Xeral de Saúde Pública, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, La Coruña, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Pediatría, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Subdirección de Programas de Fomento de Estilos de Vida Saudables, Dirección Xeral de Saúde Pública, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, La Coruña, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prevalencia de malnutrición en escolares españoles" ] ] "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" => 1002 "Ancho" => 2221 "Tamanyo" => 74732 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Body mass index-for-age <−2 SD in Galician school children (% and 95% confidence interval).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Malnutrition is a term that may refer to a negative energy balance (undernutrition, or underweight) or to a positive energy balance (overnutrition, or obesity). At the population level, while the approach has some limitations, the prevalence of malnutrition can be estimated using anthropometrics.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">1</span></a> Thus, weight and height are the indicators used most frequently to assess nutritional status in children at the population level.</p><p id="par0010" class="elsevierStylePara elsevierViewall">There is evidence that in developed countries, socioeconomic differences are associated with malnutrition in children and adolescents, with the risk of malnutrition increasing with decreasing socioeconomic status.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">2,3</span></a> In Spain, there was an inflection point in employment trends in 2007, after which the level of unemployment increased.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a> As mean household incomes dropped, poverty increased and private consumption decreased. The economic crisis led to an increase in the number of households living below the poverty threshold,<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a> and in these households, the scarcity of resources may be associated with a decrease in the availability or quality of foods and an increase in the risk of malnutrition,<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">6</span></a> which is associated with significant nutritional deficiencies. This is a very important aspect to consider in relation to vulnerable groups, such as children.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In 2013, UNICEF published a report that ranked Spain among the European countries with percentages of children at risk of child poverty greater than the European average (29.8% vs 27.1%).<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a> In 2014, the at-risk-of-poverty rate in Spain based on data from the Encuesta de Condiciones de Vida (Survey of Living Conditions) was 22.2%, and the corresponding rate for children was 30.1%.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a> Based on the same survey, the at-risk-of poverty rate in Galicia was among the lowest in Spain at 15.4%. Nevertheless, these data indicated that 420<span class="elsevierStyleHsp" style=""></span>000 inhabitants were at risk in Galicia. Malnutrition does not occur in the entire population at risk of poverty. The data of the survey of living conditions revealed that in 2014, 3.3% of the Spanish population could not afford a meal with red meat, chicken or fish at least every 2 days, a percentage that rose to 4.2% in individuals aged less than 16 years. In Galicia, the percentage of the population that suffered material deprivation related to nutrition was 1.8%, and this was the autonomous community with the lowest percentage following Aragon and the Basque Country.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The prevalence of child malnutrition at the population level in Galicia has not been determined to date. The aim of our study was to establish the prevalence of malnutrition in Galician schoolchildren aged 6–15 years during the 2013–2014 school year using objective anthropometric measures based on weight and height.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">In order to estimate the prevalence of malnutrition in Galician children and adolescents, we designed a cross-sectional study among schoolchildren aged 6–15 years enrolled in any of the 6 years of Primary Education (PE) or the 4 years of Compulsory Secondary Education (Educación Secundaria Obligatoria [ESO]) in public or private schools in Galicia during the 2013–2014 school year. We selected participants by stratified two-stage cluster sampling. In the first stage, we selected schools offering PE and/or ESO, and in the second stage, we selected 3 classrooms of PE and/or 2 of ESO in each of the previously selected schools. We included in the study all students of the selected classes aged 6–15 years. We calculated the sample size separately for each school year under simple random sampling assumption. In all sample calculations, we assumed that 22<span class="elsevierStyleHsp" style=""></span>000 children were enrolled in each school year in Galicia and a prevalence of obesity of 10%, and we made the calculation for a 95% confidence interval, a precision of 2.8% and a design effect of 1.5. We increased the estimated sample sizes by 10% for PE students and 15% for ESO students to compensate for potential missing data due to refusal to participate. The final target sample sizes were 4500 PE students and 3200 ESO students. Based on these targets, we determined that we needed to select 417 classrooms and 137 schools.</p><p id="par0030" class="elsevierStylePara elsevierViewall">After requesting the informed consent of parents, 9 teams, each composed of 2 previously trained members, visited the sites during school hours. The schoolchildren were weighed wearing light clothing and with bare feet with a Seca scale accurate to 0.1<span class="elsevierStyleHsp" style=""></span>kg, and their heights measured with the head in the Frankfort plane using a portable Tanita stadiometer with a fixed base plate accurate to 0.1<span class="elsevierStyleHsp" style=""></span>cm. The fieldwork was conducted in October and November 2013.</p><p id="par0035" class="elsevierStylePara elsevierViewall">We estimated malnutrition using the obtained anthropometric measurements and applying the cut-off points proposed by the World Health Organisation (WHO): short stature (weight for age and sex <−2 SD) and underweight (body mass index [BMI] for age and sex <−2 SD). We estimated malnutrition by excess based on the prevalence of obesity (BMI for age and sex ≥+2 SD).<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">We present the calculated prevalence values with their 95% confidence intervals (CIs). We compared proportions by means of the Pearson chi square test weighted to adjust for the sampling design. We performed the statistical analysis with the software STATA 12. We have presented the estimates by sex, age, and age group (6–11 years; 12–15 years).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">We obtained data for 7438 students, of whom 4434 were aged 6–11 years, the age range corresponding to PE, and 3004 were aged 12–15 years, the range corresponding to ESO. The proportion of students that accepted to participate in the study was 91.4%.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Overall, 16.4% (15.2–17.5) of Galician schoolchildren had obesity, underweight or stunted growth. The prevalence was higher in male students (19.2% [17.8–20.7%] vs 13.3% [11.9–14.8%]) and children aged 6–11 years (18.5% [16.9–20.0%] vs 13.1% [11.6–14.4%]).</p><p id="par0055" class="elsevierStylePara elsevierViewall">Short stature for age was present in 1.0% (0.8–1.3%) of Galician students aged 6–15 years, and we found no difference between sexes (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>.05). When it came to age, we found that short stature was less frequent in schoolchildren aged 6–11 years (0.6% vs 1.7%). We found differences between the sexes in the 6–11 years age group, with a higher prevalence in girls (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Taking age into account, we found that the prevalence of short stature in boys peaked at 13–14 years of age, while in girls it peaked at 11–12 years of age (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Underweight was detected in 0.7% (0.5–0.9%) of Galician schoolchildren aged 6–15 years. The prevalence was higher in girls (0.4% [0.2–0.6%] vs 1% [0.6–1.3%]). By age group, the prevalence was higher in students aged 12–15 years, with no difference between the sexes (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>.05); in the 6–11 years age group, the prevalence was higher in girls (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Taking sex into account showed that the prevalence peaked at age 11 years in girls and at age 13–14 years in boys (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">We found obesity in 14.8% (13.7–15.9%) of Galician schoolchildren aged 6–15 years, and the prevalence was higher in boys (18.0% [16.6–19.5%] vs 11.4% [9.9–12.8%]; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05), regardless of age group. The prevalence of obesity was 66% higher (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05) in schoolchildren aged 6–11 year (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). By age, we found that the prevalence of obesity peaked between ages 7 and 11 years in boys, and ages 8 and 9 years in girls (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">We found no differences in the prevalence of malnutrition based on the type of school (public vs private) or between provinces (data not shown).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">We estimate that 16 out of 100 schoolchildren aged 6–15 years in Galicia had malnutrition (manifesting as obesity, underweight or stunted growth). Although the prevalence of short stature and underweight did not exceed 1% at any age, based on the 2013 population census data, we estimate that 1683 (1262–2104) schoolchildren aged 6–15 years had short stature and 1266 (871–1660) were underweight for their age. When it came to overnutrition, our estimates were cause for concern, as the prevalence of obesity was 15% using the cut-off point recommended by the WHO, which means that 29<span class="elsevierStyleHsp" style=""></span>040 (25<span class="elsevierStyleHsp" style=""></span>934–32<span class="elsevierStyleHsp" style=""></span>147) schoolchildren in Galicia aged 6–15 years would have been obese.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Height gain, whose assessment is essential in paediatric checkups, is an indicator influenced by multiple factors, such as chronic or metabolic disease and environmental factors, which include social factors with an impact on the child, such as emotional or economic deprivation. It is also important to consider constitutional growth delay. Deficiencies in the intake of micronutrients could also play a role in height gain, although a lesser one, so their inclusion as indicators of malnutrition in developed countries may be questionable. Most published studies on short stature for age have been conducted in children aged 0–5 years or in developing countries,<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a> which makes it difficult to compare their findings with ours. A cross-sectional study published in 2003 analysed the weight and height measurements reported by parents of schoolchildren aged 11 years and older in 9 European countries.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">11</span></a> This study identified Spain—represented by 745 Spanish schoolchildren—as the country with the highest prevalence of short stature for age following Portugal. The study estimated that 5.1% (3.1–7.8%) of girls and 3.4% (1.8–5.7%) of boys in Spain had short stature at age 11 years. The overall prevalence in the included European countries was 2.8% in girls and 1.4% in boys. When we estimated the prevalence of short stature in Galicia 12 years later using the same cut-off points<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">12</span></a> and in children aged 11 years (789 schoolchildren in our sample), the prevalence of short stature was lower than the prevalence estimated in the study by Yngve et al.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">11</span></a> for Spain overall, and similar to the overall prevalence in the studied European countries (3.8% [1.6–5.9%] in girls and 1.4% [0.1–2.6%] in boys).</p><p id="par0085" class="elsevierStylePara elsevierViewall">The prevalence of underweight in Galician schoolchildren increased with age, although it only exceeded 2% in girls aged 11 years (2.3%). The values we obtained were similar to those estimated in populations of similar age in other developed countries,<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">13,14</span></a> although making comparisons is difficult, as the definition of underweight varies between studies. Thus, in a study conducted in France in 2000,<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a> the estimated prevalence of underweight, using the 5th percentile of the CDC tables as the threshold,<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">12</span></a> was 4.3% in girls and 4% in boys at age 7 years; in our study in Galicia, if we were to apply the same cut-off point, the prevalence 13 years later would be lower (1.3% in boys and 2.5% in girls). The study in France found that the prevalence of underweight increased with age, reaching 7.7% in girls and 7.9% in boys at age 9 years. In our study in Galicia, the prevalence also increased with age in girls, reaching 2.3% at age 9 years; however, boys exhibited a decreasing trend, with the prevalence dropping to 2.1% at this age.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In recent years, the prevalence of obesity in children and adolescents has increased in developed countries,<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a> and several studies have evinced the considerable impact of social inequalities on obesity.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a> Obesity, considered to reflect overnutrition, constitutes the manifestation of the most frequent type of malnutrition in developed countries both in adults and children. In Galicia, obesity affects approximately 15 out of 100 schoolchildren. When we compared our results with those of other studies that applied the same cut-off points, we found that the percentages were similar to those calculated for Spain in 2012 (12.6% in children aged 8–17 years),<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a> for Catalonia for the 2010–2012 period (15.4% in children aged 2–14 years)<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a> and those in the United States for the 2011–2012 period (with a prevalence of obesity of 17.3% in individuals aged 2–19 years).<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a> Previous studies in Galicia have estimated the prevalence of obesity, although they were conducted in specific age groups,<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a> specific geographical areas<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a> or provided data that need to be updated.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">22</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Some authors question the approach of estimating the prevalence of malnutrition in developed countries based on height- or BMI-for-age, as the resulting estimates are not robust. Using a combination of indicators is one possible way of increasing accuracy.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">23</span></a> If undernutrition were defined as a combination of short stature and low weight for age, the prevalence would be near 0; in our study, for instance, only 2 children met both criteria. If we considered short stature and obesity for age and sex, the prevalence in our study would be 0.1%, with 7 children fulfilling both criteria.</p><p id="par0100" class="elsevierStylePara elsevierViewall">There are various limitations to this study. Our results are based on a cross-sectional study with a single measurement per child, and we do not have follow-up data to assess weight and height gains, which could reveal changes or reductions in individual growth rates. Our results are estimates of various parameters in different age groups, although we have presented our findings as if they corresponded to a cohort. Furthermore, we must underscore that the indicators analysed cannot be used to identify the cause of malnutrition, which in some cases could be associated to an underlying disease. Another important limitation is that the cut-off points to assess differences in anthropometric measurements in the paediatric age group are not universal, so that reported prevalences vary according to the standard applied. For instance, we showed estimates calculated with the reference standards provided by the CDC earlier in this discussion. The prevalences obtained with these standards were 3.8% (1.6–5.9%) in girls and 1.4% (0.1–2.6%) in boys at age 11 years, compared to 2.4% (0.8–4.0%) in girls and 0.3% (0–0.8%) in boys using the WHO cut-off points, which were the reference used in our study. Another limitation is the potential for selection bias due to differential participation, as schoolchildren that deviate from average in weight or height may be less likely to participate. In our study, 91.4% of children agreed to participate, and we verified that the impact of non-participation on the estimation of prevalence was low.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">24</span></a> Given the cross-sectional design of our study and the lack of previous data, we were unable to determine whether the economic crisis had an impact on the estimated prevalences, although we would expect it to be so, as several studies have found increases in the prevalence of malnutrition, especially in terms of an increase in adiposity in individuals of low socioeconomic level.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">There are several strengths to our study. The sample size is one of them, as we calculated it to guarantee accurate estimates by school year and therefore by age. The age distribution of the final sample matched our expectations, with a mean sample size per year of 744 schoolchildren, a minimum of 592 at age 8 years and a maximum of 909 at age 6 years. This guarantees that the sample is representative for both sexes and for every age included in the estimates. Our estimates were calculated using objective measurements obtained by previously trained individuals, which guaranteed the quality of the data and low intra- and inter-rater variability. The sampling frame consisted of the schools in Galicia, which gave us access to the study universe, the population aged 6–15 years, as schooling is legally mandated in this age group.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Determining the prevalence of malnutrition at the population level in developed countries poses challenges, but it should nevertheless be attempted. The prevalence of malnutrition in a population should be assessed by specific studies conducted in the clinical setting. Despite its intrinsic limitations, anthropometry is the only approach that allows us to obtain estimates at the population level, and collecting anthropometric data is of vital importance, as it can inform the development of health promotion and disease prevention programmes and identify vulnerable groups. In this regard, schools play a key role both in the detection of cases and in their management,<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">25</span></a> so we need to raise awareness in educators about malnutrition and engage them in the early detection and management of this health problem.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1066014" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and aims" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1013883" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1066013" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1013882" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-03-29" "fechaAceptado" => "2017-09-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1013883" "palabras" => array:5 [ 0 => "Malnutrition" 1 => "Child" 2 => "Underweight" 3 => "Overweight" 4 => "Obesity" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1013882" "palabras" => array:5 [ 0 => "Malnutrición" 1 => "Niños" 2 => "Bajo peso" 3 => "Sobrepeso" 4 => "Obesidad" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and aims</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The term malnutrition includes malnutrition due to excess or obesity, underweight as well as stunted growth. Its prevalence in a population can be estimated using anthropometric variables. The aim of this study is to estimate the prevalence of malnutrition in Galician schoolchildren aged 6–15 years in the school year 2013–2014.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional study was conducted on a representative sample by gender and age of the Galician population of 6–15 years old. The prevalence of obesity, underweight, and short stature was estimated by age and gender using the reference standards proposed by the World Health Organisation.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">7438 schoolchildren weighed and measured 16,4% presented malnutrition. The prevalence of obesity was 14.8%, underweight was 0.7%, and short stature for age was estimated at 1%. Obesity was more prevalent among boys. As regards underweight and short stature, when there were differences, prevalence was higher among girls.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In Galicia, 16 out of every 100 schoolchildren aged 6–15 years had malnutrition, with that due to excess or obesity being the most frequent. Prevalence of underweight and short stature did not exceed 1%. This data shows that primary prevention measures should be promoted at an early age to reduce malnutrition due to excess or adiposity, in particular.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and aims" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "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">Introducción y objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Bajo el término malnutrición se agrupa la malnutrición por exceso, por defecto y por retraso en el crecimiento. Su prevalencia, a nivel poblacional, se puede estimar mediante variables antropométricas. El objetivo de este trabajo es estimar la prevalencia de malnutrición en los escolares gallegos de 6 a 15 años en el curso escolar 2013–2014.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal sobre una muestra representativa por sexo y edad de la población gallega de 6 a 15 años. Se estimó la prevalencia de obesidad, bajo peso y baja estatura en función del sexo y la edad utilizando los criterios de referencia propuestos por la Organización Mundial de la Salud.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se pesaron y midieron 7.438 escolares. En global, el 16,4% de los escolares presentaban malnutrición. La prevalencia de obesidad fue del 14,8%, la de bajo peso, del 0,7%, y la de baja estatura para la edad, del 1%. La obesidad fue más prevalente entre los niños; respecto al bajo peso o baja estatura cuando aparecieron diferencias, las prevalencias fueron más altas entre las niñas.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En Galicia, 16 de cada 100 escolares de 6 a 15<span class="elsevierStyleHsp" style=""></span>años presentaban malnutrición, siendo la malnutrición por exceso u obesidad la manifestación más frecuente. La prevalencia de bajo peso y baja estatura no superaron el 1%. Estos datos ponen de manifiesto que se deben promover medidas de prevención primaria a edades tempranas encaminadas a disminuir la malnutrición, especialmente por exceso o adiposidad.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Pérez-Ríos M, Santiago-Pérez MI, Leis R, Malvar A, Suanzes J, Hervada X. Prevalencia de malnutrición en escolares españoles. An Pediatr (Barc). 2018;89:44–49.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1005 "Ancho" => 2214 "Tamanyo" => 76996 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Height-for-age <−2 SD in Galician school children (% and 95% confidence interval).</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" => 1002 "Ancho" => 2221 "Tamanyo" => 74732 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Body mass index-for-age <−2 SD in Galician school children (% and 95% confidence interval).</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" => 1010 "Ancho" => 2240 "Tamanyo" => 84125 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Body mass index-for-age ≥+2 SD in Galician school children (% and 95% confidence interval).</p>" ] ] 3 => 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" 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">Total</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Boys</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 " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">P</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></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="" 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">% \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">95% CI \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">% \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">95% CI \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">% \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">95% CI \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></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="8" align="left" valign="top"><span class="elsevierStyleItalic">6–11 years</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Underweight (BMI<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>−2 SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3–0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1–0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4–1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.014 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Obesity (BMI<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>2 SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16–18.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.1–22.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.7–15.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Height-for-age<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>−2 SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4–0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2–0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5–1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.033 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="8" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="8" align="left" valign="top"><span class="elsevierStyleItalic">12–15 years</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Underweight (BMI<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>−2 SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5–1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2–1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.6–1.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.135 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Obesity (BMI<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>2 SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.3–11.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.4–15.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.9–9.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Height-for-age<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>−2 SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.2–2.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.1–2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1–2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.883 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1817917.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Chi square test (boys vs girls).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Prevalence of malnutrition (underweight, obesity or short stature) by age group, overall and by sex. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 2 | 8 |
| 2024 October | 95 | 43 | 138 |
| 2024 September | 58 | 32 | 90 |
| 2024 August | 62 | 62 | 124 |
| 2024 July | 74 | 33 | 107 |
| 2024 June | 56 | 38 | 94 |
| 2024 May | 55 | 34 | 89 |
| 2024 April | 51 | 29 | 80 |
| 2024 March | 40 | 36 | 76 |
| 2024 February | 23 | 24 | 47 |
| 2024 January | 31 | 21 | 52 |
| 2023 December | 23 | 27 | 50 |
| 2023 November | 30 | 25 | 55 |
| 2023 October | 36 | 33 | 69 |
| 2023 September | 35 | 21 | 56 |
| 2023 August | 36 | 23 | 59 |
| 2023 July | 51 | 40 | 91 |
| 2023 June | 45 | 30 | 75 |
| 2023 May | 72 | 26 | 98 |
| 2023 April | 57 | 27 | 84 |
| 2023 March | 113 | 37 | 150 |
| 2023 February | 93 | 29 | 122 |
| 2023 January | 33 | 27 | 60 |
| 2022 December | 112 | 32 | 144 |
| 2022 November | 121 | 36 | 157 |
| 2022 October | 93 | 56 | 149 |
| 2022 September | 75 | 37 | 112 |
| 2022 August | 95 | 58 | 153 |
| 2022 July | 85 | 52 | 137 |
| 2022 June | 74 | 40 | 114 |
| 2022 May | 76 | 34 | 110 |
| 2022 April | 41 | 35 | 76 |
| 2022 March | 81 | 61 | 142 |
| 2022 February | 61 | 37 | 98 |
| 2022 January | 67 | 41 | 108 |
| 2021 December | 70 | 47 | 117 |
| 2021 November | 54 | 45 | 99 |
| 2021 October | 91 | 97 | 188 |
| 2021 September | 65 | 52 | 117 |
| 2021 August | 55 | 52 | 107 |
| 2021 July | 64 | 39 | 103 |
| 2021 June | 72 | 50 | 122 |
| 2021 May | 172 | 53 | 225 |
| 2021 April | 176 | 119 | 295 |
| 2021 March | 115 | 39 | 154 |
| 2021 February | 69 | 14 | 83 |
| 2021 January | 70 | 25 | 95 |
| 2020 December | 71 | 21 | 92 |
| 2020 November | 81 | 22 | 103 |
| 2020 October | 70 | 17 | 87 |
| 2020 September | 153 | 22 | 175 |
| 2020 August | 41 | 19 | 60 |
| 2020 July | 70 | 13 | 83 |
| 2020 June | 62 | 11 | 73 |
| 2020 May | 74 | 23 | 97 |
| 2020 April | 63 | 33 | 96 |
| 2020 March | 67 | 16 | 83 |
| 2020 February | 102 | 17 | 119 |
| 2020 January | 73 | 14 | 87 |
| 2019 December | 127 | 17 | 144 |
| 2019 November | 160 | 9 | 169 |
| 2019 October | 133 | 14 | 147 |
| 2019 September | 98 | 16 | 114 |
| 2019 August | 92 | 23 | 115 |
| 2019 July | 65 | 24 | 89 |
| 2019 June | 86 | 42 | 128 |
| 2019 May | 177 | 9 | 186 |
| 2019 April | 131 | 21 | 152 |
| 2019 March | 104 | 23 | 127 |
| 2019 February | 90 | 28 | 118 |
| 2019 January | 51 | 11 | 62 |
| 2018 December | 60 | 33 | 93 |
| 2018 November | 143 | 17 | 160 |
| 2018 October | 206 | 29 | 235 |
| 2018 September | 108 | 16 | 124 |
| 2018 August | 1 | 0 | 1 |
| 2018 June | 0 | 4 | 4 |
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