Parental obesity is associated with the severity of childhood obesity and its comorbidities

array:25 ["pii" => "S2341287919300365" "issn" => "23412879" "doi" => "10.1016/j.anpede.2018.06.010" "estado" => "S300" "fechaPublicacion" => "2019-04-01" "aid" => "2483" "copyright" => "Asociación Española de Pediatría" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2019;90:224-31" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1091 "formatos" => array:3 [ "EPUB" => 80 "HTML" => 728 "PDF" => 283 ] ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S1695403318303011" "issn" => "16954033" "doi" => "10.1016/j.anpedi.2018.06.013" "estado" => "S300" "fechaPublicacion" => "2019-04-01" "aid" => "2483" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2019;90:224-31" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4633 "formatos" => array:3 [ "EPUB" => 152 "HTML" => 3161 "PDF" => 1320 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "La obesidad parental se asocia con la gravedad de la obesidad infantil y de sus comorbilidades" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "224" "paginaFinal" => "231" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Parental obesity is associated with the severity of childhood obesity and its comorbidities" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2117 "Ancho" => 1944 "Tamanyo" => 103292 ] ] "descripcion" => array:1 [ "es" => "Comparación entre los grupos con antecedente de obesidad paterna (P) y con antecedente de obesidad materna (M). Datos representados como media±EE. EE: error estándar; HOMA: homeostatic model assessment; SDS: standard deviation score." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Julián Martínez-Villanueva, Rocío González-Leal, Jesús Argente, Gabriel Ángel Martos-Moreno" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Julián" "apellidos" => "Martínez-Villanueva" ] 1 => array:2 [ "nombre" => "Rocío" "apellidos" => "González-Leal" ] 2 => array:2 [ "nombre" => "Jesús" "apellidos" => "Argente" ] 3 => array:2 [ "nombre" => "Gabriel Ángel" "apellidos" => "Martos-Moreno" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341287919300365" "doi" => "10.1016/j.anpede.2018.06.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287919300365?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403318303011?idApp=UINPBA00005H" "url" => "/16954033/0000009000000004/v1_201904020610/S1695403318303011/v1_201904020610/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2341287919300353" "issn" => "23412879" "doi" => "10.1016/j.anpede.2018.06.009" "estado" => "S300" "fechaPublicacion" => "2019-04-01" "aid" => "2477" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2019;90:232-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1045 "formatos" => array:3 [ "EPUB" => 108 "HTML" => 691 "PDF" => 246 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Diagnostic efficiency of renal ultrasound after the first urine infection in infants" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "232" "paginaFinal" => "236" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Rentabilidad diagnóstica de la ecografía renal tras la primera infección de orina en los lactantes" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 697 "Ancho" => 1269 "Tamanyo" => 79846 ] ] "descripcion" => array:1 [ "en" => "Flow chart of the study. DUS, disease of the urinary system; US, ultrasound; UTI, urinary tract infection." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Anna Faura Morros, Adriana Cuaresma González, Susanna Hernández-Bou, Victoria Trenchs Sainz de la Maza, Juan Antonio Camacho Diaz, Carles Luaces Cubells" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Anna" "apellidos" => "Faura Morros" ] 1 => array:2 [ "nombre" => "Adriana" "apellidos" => "Cuaresma González" ] 2 => array:2 [ "nombre" => "Susanna" "apellidos" => "Hernández-Bou" ] 3 => array:2 [ "nombre" => "Victoria" "apellidos" => "Trenchs Sainz de la Maza" ] 4 => array:2 [ "nombre" => "Juan Antonio" "apellidos" => "Camacho Diaz" ] 5 => array:2 [ "nombre" => "Carles" "apellidos" => "Luaces Cubells" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S169540331830287X" "doi" => "10.1016/j.anpedi.2018.06.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S169540331830287X?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287919300353?idApp=UINPBA00005H" "url" => "/23412879/0000009000000004/v1_201904020615/S2341287919300353/v1_201904020615/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341287918301443" "issn" => "23412879" "doi" => "10.1016/j.anpede.2018.05.004" "estado" => "S300" "fechaPublicacion" => "2019-04-01" "aid" => "2484" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2019;90:219-23" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2410 "formatos" => array:3 [ "EPUB" => 139 "HTML" => 1861 "PDF" => 410 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "What is the optimal dose of clopidogrel in paediatric patients?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "219" "paginaFinal" => "223" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Cuál es la dosis óptima de clopidogrel en pacientes pediátricos?" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Cristina Mondelo García, Cristina Martínez Roca, Fernando Rueda Núñez, María Isabel Martín Herranz" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Cristina Mondelo" "apellidos" => "García" ] 1 => array:2 [ "nombre" => "Cristina Martínez" "apellidos" => "Roca" ] 2 => array:2 [ "nombre" => "Fernando Rueda" "apellidos" => "Núñez" ] 3 => array:2 [ "nombre" => "María Isabel Martín" "apellidos" => "Herranz" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403318303023" "doi" => "10.1016/j.anpedi.2018.05.020" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403318303023?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287918301443?idApp=UINPBA00005H" "url" => "/23412879/0000009000000004/v1_201904020615/S2341287918301443/v1_201904020615/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Parental obesity is associated with the severity of childhood obesity and its comorbidities" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "224" "paginaFinal" => "231" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Julián Martínez-Villanueva, Rocío González-Leal, Jesús Argente, Gabriel Ángel Martos-Moreno" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Julián" "apellidos" => "Martínez-Villanueva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Rocío" "apellidos" => "González-Leal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Jesús" "apellidos" => "Argente" "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 3 => array:4 [ "nombre" => "Gabriel Ángel" "apellidos" => "Martos-Moreno" "email" => array:2 [ 0 => "gabrielangel.martos@salud.madrid.org" 1 => "gabrielangelmartos@yahoo.es" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Pediatría, Universidad Autónoma de Madrid, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "IMDEA Food Institute, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La obesidad parental se asocia con la gravedad de la obesidad infantil y de sus comorbilidades" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1721 "Ancho" => 2269 "Tamanyo" => 132039 ] ] "descripcion" => array:1 [ "en" => "Comparison of the group without an obese parent (NO) and the group with obesity in at least 1 parent (OB). Data expressed as mean±standard error." ] ] ] "textoCompleto" => "IntroductionThe socioeconomic changes that have taken place in recent decades have led to the development of new dietary habits and more sedentary lifestyles, which in turn facilitate the development of obesity in current generations of children and adolescents.<a class="elsevierStyleCrossRef" href="#bib0190">1</a> In addition, children of obese parents may be at an even higher risk of obesity due to the combination of the inluence of dietary habits in the household and a greater genetic susceptibility to the disease. In fact, a considerable percentage of the children and adolescents that are currently obese have obese parents.It has been well established that certain dietary and nutritional patterns in families can trigger obesity in their younger members. Methods involving direct observation have been used to identify behavioural components in family meals (interpersonal relationships and relationships with food) that are beneficial or deleterious as concerns childhood obesity,<a class="elsevierStyleCrossRef" href="#bib0195">2</a> evidencing that the influence of the family extends beyond the parents. Children who live with grandparents, figures who are increasingly involved in their care, are at greater risk of developing obesity.<a class="elsevierStyleCrossRef" href="#bib0200">3</a> Grandparents tend to indulge and overfeed their grandchildren and to spare them from physical tasks, increasing their risk of obesity. The underlying motivation for this behaviour is their affection for the child and is influenced by personal experiences, misunderstandings and a low awareness of the adverse health effects of obesity.<a class="elsevierStyleCrossRef" href="#bib0200">3</a>Parents and their weight status influence the development of obesity in their children as well as the outcome of treatment. Various studies have highlighted differences between parents in their perception of paediatric obesity as a disease and in their attitude towards obesity in their children, but did not assess the presence of obesity in the parents themselves. Broadly speaking, a large percentage of parents have an inaccurate perception of the weight status of their children, which is associated with a 12-fold increase in the probability of having an obese child,<a class="elsevierStyleCrossRef" href="#bib0205">4</a> and delegate the responsibilities associated with paediatric obesity to schools and public institutions.<a class="elsevierStyleCrossRef" href="#bib0210">5</a> Recent studies in children and adolescents enrolled in weight loss programmes with parental involvement have reported that non-obese parents have a better understanding of the interventions involved in the treatment of obesity associated with better communication with the provider, including more careful listening and spending the necessary time to explain the recommendations on the part of the latter.<a class="elsevierStyleCrossRef" href="#bib0215">6</a> There are also studies demonstrating that weight loss programmes are less likely to be successful in children with obese parents or siblings, and some have described a poorer response to treatment in association with maternal obesity. Parental comorbidities correlated to obesity have also been associated with poorer outcomes of treatment of paediatric obesity, with a stronger association when both parents had comorbidities. Other studies have established that parental weight loss has a significant impact on treatment outcomes in obese children. Overall, a small number of studies suggest that parental obesity may influence the outcomes of treatment of obesity in children and adolescents. However, the role of parental obesity in the severity of paediatric obesity and its associated comorbidities is still under debate, and its potential impact on treatment outcomes has yet to be adequately established.<a class="elsevierStyleCrossRef" href="#bib0220">7</a>For this reason, the main goal of our study was to analyse the severity of obesity, the presence of metabolic comorbidities and the response to treatment in obese children and adolescents in relation to the presence of obesity in one or both parents, additionally assessing the potential influence of the specific parent affected by obesity.Patients and methodsWe conducted a retrospective study in 800 obese patients (361 [45.2%] female and 439 [54.8%] male) aged 10.35±3.40 years (range, 0.33–17.84 years) and with a body mass index (BMI) z-score of 4.22±1.68 managed in the obesity clinic of the Department of Endocrinology in a tertiary care hospital between 2009 and 2014, recording the BMI of parents after measuring the weight and height of both parents, and with a 1-year follow-up. Of all the included patients, 434 (54.2%) were in the prepubertal stage (Tanner stage I) and 366 (45.8%) in the pubertal stage (Tanner stage≥II). Most of the patients in the cohort were Caucasian (n=599; 72.7%) or Hispanic (n=179; 21.7%).In every patient, the following variables were recorded and standardised in the initial visit to the clinic: weight, height, BMI<a class="elsevierStyleCrossRefs" href="#bib0225">8,9</a> and systolic and diastolic blood pressures<a class="elsevierStyleCrossRef" href="#bib0235">10</a> (mean of 3 measurements taken with a Critikon®-Dinamap™ 8100 vital signs monitor). We considered patients obese if their BMI z-score was 2 or greater based on Spanish reference growth Charts<a class="elsevierStyleCrossRef" href="#bib0225">8</a> and the standards of the International Obesity Task Force (IOTF).<a class="elsevierStyleCrossRef" href="#bib0230">9</a> We retrieved the age at onset of obesity and the birth weight (BW), which we standardised for sex and gestational age.<a class="elsevierStyleCrossRef" href="#bib0240">11</a> The initial evaluation included measurement of the serum levels of glucose, insulin, glycated haemoglobin (HbA1c), uric acid, total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, triglycerides, 25-hydroxy vitamin D, thyroid-stimulating hormone (TSH) and free thyroxine (fT4) after 12h fasting. AWe did not find significant differences between the groups(OGTT; 1.75mg glucose/kg weight to a maximum of 75g). We calculated the area under the curve (AUC) of glucose and insulin applying the following formula: 0.25×basal level+0.5×half-hour value+0.75×1-hour value+0.5 2-hour value. We calculated the Homeostatic Model Assessment (HOMA) index as basal glucose (mg/dL)×basal insulin (μIU/mL)/405, and the whole-body insulin sensitivity index (WBISI) as 10000/(fasting glucose×fasting insulin×mean OGTT glucose×mean OGTT insulin)1/2.<a class="elsevierStyleCrossRef" href="#bib0245">12</a> Metabolic syndrome (MS) was diagnosed in patients aged more than 10 years (n=454; 56.8%) according to the criteria proposed by the International Diabetes Federation (IDF).<a class="elsevierStyleCrossRef" href="#bib0250">13</a>Once obesity was diagnosed and underlying organic diseases excluded, all patients were managed with conservative treatment based on 3 main components: (1) behavioural modification with the aim of eating slower, eating smaller portions and organising the timing of meals (based on classical conditioning, reinforcement theory and the identification and control of negative automatic thoughts); (2) dietary recommendations (adequate distribution of food groups in a weekly programme without specific calorie restrictions, with energy restriction pursued indirectly through slower eating), and (3) physical indication (prescription of 1h a day of aerobic play or exercise adapted to the age and circumstances of the patient, recommending a progressive increase in intensity). Follow-up clinical evaluations were scheduled as follows, independently of the severity of obesity: initial visit, first follow-up evaluation at 1 month, and follow-up evaluations every three months thereafter. We encouraged all members of the family to get involved in implementing the given recommendations with the aim of facilitating adherence in the patient.We considered that patients had achieved significant weight loss if they succeeded in decreasing their BMI z-score by 1.5 points and/or their weight by 10% or more in the 12 months of follow-up.We compared patients based on parental obesity (BMI>30kg/m2)<a class="elsevierStyleCrossRef" href="#bib0255">14</a> initially classifying them in 2 groups (no parent with obesity [NO group, n=347] versus at least 1 parent with obesity [OB group, n=453]), subsequently comparing patients in the OB group based on whether obesity was present in only 1 parent (1-OB; n=336) or in both (2-OB; n=117). In the subset with only 1 obese parent, we compared patients with an obese father (F, n=185) to patients with an obese mother (M; n=151).We performed the statistical analysis with the Statistical Package for Social Sciences (SPSS) version 15.0 (MapInfo Corporation, Troy, NY, USA). We used the Kolmogorov–Smirnov test to assess the normality of the distribution of the variables under study (the variables fitting a normal distribution were blood glucose, TC and LDL cholesterol). For normally-distributed variables, we compared independent groups by means of the Student t test, and for all others (with a non-normal distribution) we used the Mann–Whitney U test. We compared the proportions of patients with MS in different groups using the χ2 test. We defined statistical significance as a P-value of less than .05.Although the study was to include every patient meeting the specified criteria managed in the 2009–2014 period, we still estimated the sample size required to achieve the established objectives. Assuming a prevalence of hyperinsulinaemia of 30% in the group of patients without obese parents, the size required per group to detect an expected increase of 10% in the prevalence of hyperinsulinaemia in patients with at least 1 obese parent versus those without obese parents with an alfa error of 5% and a beta error of 10% was n=362.ResultsWe did not find significant differences between the groups (NO vs OB; 1-OB vs 2-OB; F vs M) in sex, ethnicity and pubertal development distributions or in the ages at onset of obesity and at the initial visit (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Presence vs absence of parental obesity parental (NO vs OB)Patients in the OB group, that is, with at least one obese parent (father, mother or both) had higher BW z-scores and higher BMI z-scores at the time of the first visit compared to those without an obese parent (NO vs OB, P<.01). We also found a higher frequency of carbohydrate metabolism abnormalities in the OB group, with higher values of blood insulin, the insulin AUC, the HOMA index and HbA1c (all with P<.01) and lower values of the WBISI (P<0.05), although the blood glucose levels and the glucose AUC were similar in both groups (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>; <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Triglyceride levels tended to be higher in patients in the OB group, but the difference was not statistically significant (P=.076). We did not find any differences in any of the other variables under study. When we compared patients without obese parents with patients whose parents were both obese (NO vs 2-OB), we found similar results (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Number of obese parentsWe found a higher prevalence of MS (χ2=5.96; P<.05) in patients with 2 obese parents (23.08%) compared to patients with one obese parent (15.77%) and patients without obese parents (13.54%). Patients with 2 obese parents had higher BW z-scores (P<.01) and higher BMI z-scores in the initial visit (P<.05) compared to patients with a single obese parent. When it came to metabolic comorbidities, patients with 2 obese parents had higher TC/HDL ratios (P<.05) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>; <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). We did not find any significant differences in any of the other variables under study (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Influence of the affected parentIn the group of patients with 1 obese parent, we found higher BW z-scores, insulin levels, and HOMA index values and lower levels of 25-hydroxy vitamin D in the subset in whom the obese parent was the mother (P<.05 for all analyses). Patients with an obese mother also tended to have higher BMI z-scores, but this difference was not significant (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>; <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). We did not find statistically significant differences in any of the other variables under study.<elsevierMultimedia ident="fig0015"></elsevierMultimedia>Response to treatmentOf the total patients in the cohort (n=800), 132 (16.5%) achieved a significant weight loss in 12 months of treatment (reduction of BMI z≥1.5 points and/or body weight≥10%), and we found no significant differences in the percentage of patients that achieved significant weight loss based on the number of parents with obesity (0, 1 or 2).DiscussionThe results of our study show that parental BMI has an impact on some characteristics of paediatric obesity and its comorbidities.Children and adolescents with at least one obese parent had higher BWs and more severe obesity (based on the BMI) at the time of the initial consultation. These 2 features were exacerbated in patients with 2 obese parents. Although this association is controversial, it is supported by the work of other authors, especially as concerns the impact on younger children (age<10 years), and it may also be important in the development or persistence of obesity in adulthood.<a class="elsevierStyleCrossRefs" href="#bib0260">15–17</a>In the group with a single obese parent, when the affected parent was the mother, children and adolescents had higher BWs and tended to have a higher BMI at the time of seeking care for obesity. The association of maternal obesity with foetal macrosomia and an increased risk of obesity and metabolic comorbidities later in life is well established.<a class="elsevierStyleCrossRefs" href="#bib0275">18,19</a> Our study suggests that this association is stronger when the mother is affected as opposed to the father. This maternal influence may be explained—at least in part—by the presence of prenatal and perinatal factors associated to the development of obesity in future stages of life.<a class="elsevierStyleCrossRefs" href="#bib0285">20–22</a>As for the disorders of carbohydrate metabolism associated with obesity, insulin resistance (IR) was more severe in patients in the OB group. However, this was not the case of blood glucose levels, which were similar across de sample and independent of parental obesity. Despite the challenges in defining IR described by some authors,<a class="elsevierStyleCrossRef" href="#bib0300">23</a> previous studies conducted by our group<a class="elsevierStyleCrossRefs" href="#bib0305">24,25</a> and collaborative studies conducted in Spain<a class="elsevierStyleCrossRef" href="#bib0315">26</a> have demonstrated that IR is much more frequent than abnormal glucose levels in obese children (a feature that differentiates this population from adults). Furthermore, this outcome corroborates the findings of previous studies that have also described an increased risk of IR and a higher prevalence of hyperinsulinaemia in patients with obese parents, associating this factor with other cardiovascular risk factors (obesity, dyslipidaemia and high blood pressure) characteristic of MS, which in our cohort was more prevalent in patients whose parents were both obese,<a class="elsevierStyleCrossRefs" href="#bib0320">27–29</a> although it is important to consider that Halvorsen et al. also found an association between the presence of cardiovascular risk factors and MS in parents and children, independently of the BMI of either. In the opinion of Monzani et al., parental obesity is the sole risk factor required for the development of MS in childhood, unlike adolescence, when obesogenic habits are also at play.We ought to mention that the definition of MS used in our study was restricted to patients aged more than 10 years, and that the prevalence found would have been higher had we applied paediatric criteria covering a broader age range. We chose to apply the criteria of the IDF to define MS due to the current lack of consensus in the international literature regarding the appropriateness of diagnosing MS in the paediatric age group. Thus, while specific scientific criteria have been proposed for its definition in the paediatric population, there are also authors that disagree with the use of this diagnosis at early ages and instead recommend (as does the IDF) the diagnosis and treatment of each individual metabolic disorder, refraining from the use of MS as a diagnostic category.<a class="elsevierStyleCrossRef" href="#bib0250">13</a>In our sample, parental obesity was also associated with a higher prevalence of MS, an association that was strongest when both parents were obese, thus representing an increased risk of future cardiovascular and metabolic disease in children and adolescents. In fact, the prevalence of MS in our cohort was higher compared to other studies that have also found an association between MS and obesity in one or both parents.<a class="elsevierStyleCrossRefs" href="#bib0335">30,31</a> This could be related to the greater severity of obesity in the patients included in our study (as evinced by the high mean BMI z-score) and to our sample coming from a hospital cohort where the detection of metabolic disturbances by the primary care clinicians that refer patients to specialty care may have been a source of bias. In spite of this, we found no significant differences between groups in the lipid profile, save for a higher TC/HDL ratio in patients with two obese parents, contrary to other studies that did find higher triglyceride and LDL-cholesterol levels and lower levels of HDL-cholesterol in children and adolescents with obese parents and with MS,<a class="elsevierStyleCrossRefs" href="#bib0320">27,28</a> although this could have been due to the lower mean age of the patients in our study.The comparison of metabolic comorbidities in patients with one obese parent showed that IR was more severe in cases associated with maternal obesity. This finding corroborates previous evidence demonstrating the influence of maternal obesity on the development of IR and obesity, even in children born with a normal weight for gestational age,<a class="elsevierStyleCrossRef" href="#bib0345">32</a> and contributes novel information on the difference in comparison with paternal obesity.Another salient finding was that the levels of 25-hydroxy vitamin D were lower in patients whose mothers were obese. The association between obesity and vitamin D is a subject that currently attracts considerable interest, including obesity in the collection of risk factors for vitamin D insufficiency and deficiency.<a class="elsevierStyleCrossRef" href="#bib0350">33</a> These risk factors may affect several members of a family sharing similar dietary and leisure habits. However, the association between maternal obesity and the levels of 25-hydroxy vitamin D in children has not been studied extensively, although there is evidence that the presence of vitamin D deficiency in the mother secondary to obesity during pregnancy may play a role in this association, among other possible factors.<a class="elsevierStyleCrossRef" href="#bib0355">34</a>Contrary to expectations, a novel finding of our study was that a positive parental history of obesity had no impact on the likelihood of responding favourably to conservative treatment, as previously described, in the 12 months of follow-up. This finding diverged from the scarce data on the subject reported in the literature, which suggests that parental obesity is associated with poorer outcomes of treatment in obese children and adolescents.<a class="elsevierStyleCrossRef" href="#bib0220">7</a> There is no question that the involvement of the family, independently of the BMI, is one of the key factors that determine a satisfactory response to treatment.<a class="elsevierStyleCrossRefs" href="#bib0360">35–37</a> However, our results suggest that parents with obesity are also capable of promoting healthy habits in their offspring, with a success rate similar to that found in non-obese parents. Furthermore, witnessing the challenges and the comorbidities experienced by their parents may inspire children (especially older ones) to take measures for weight control independently. However, keeping records of the degree to which the parents of patients implemented the recommendations and of changes in the weight status of the former would have provided additional information on this aspect, and the lack of such records was a limitation of our study.Our study is not free from the limitations intrinsic to cohort studies, including the impossibility of establishing causal relationships (only association can be established) and the time required to achieve the necessary sample size and complete the follow-up, which may have an impact on the homogeneity of the conditions under which subjects participate in the study.In conclusion, the results of our retrospective study on a large cohort of paediatric patients with obesity demonstrate that a history of obesity in a parent is associated with greater severity of paediatric obesity and the associated IR in their obese offspring, an association that is stronger when it is the mother or both parents who are obese. Nevertheless, a positive parental history of obesity does not have a negative impact on the probability of successful treatment.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1173362" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1097413" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1173361" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1097414" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Presence vs absence of parental obesity parental (NO vs OB)" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Number of obese parents" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Influence of the affected parent" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Response to treatment" ] ] ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-03-02" "fechaAceptado" => "2018-06-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1097413" "palabras" => array:7 [ 0 => "Childhood obesity" 1 => "Adolescent" 2 => "Parental obesity" 3 => "Maternal obesity" 4 => "Metabolic comorbidities" 5 => "Carbohydrate metabolism" 6 => "Metabolic syndrome" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1097414" "palabras" => array:7 [ 0 => "Obesidad pediátrica" 1 => "Adolescente" 2 => "Obesidad parental" 3 => "Obesidad materna" 4 => "Comorbilidades metabólicas" 5 => "Metabolismo hidrocarbonado" 6 => "Síndrome metabólico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionThe influence of parental obesity on their obese offsprings is acknowledged but insufficiently characterised. Patients and methodsRetrospective study of 800 obese patients (45.2% girls; age: 10.35±3.40 years, body mass index [BMI]: +4.22±1.68 standard deviation score [SDS]). Group comparison according to the presence of obesity in none (n=347) or any of the parents (n=453), and then whether the obese parent was the father (n=185), the mother (n=151), or both parents (n=117) were performed. The parameters analysed were: Age at the onset of the obesity and at their first visit, birth weight (BW), BMI-SDS, blood glucose, insulin level, homeostatic model assessment (HOMA) index, total cholesterol (TC), HDL, LDL, triglycerides, 25-OH-vitamin-D, area under the curve (AUC) for insulin in the oral glucose tolerance test (OGTT), whole body insulin sensitivity index (WBISI), LDL/HDL and TC/HDL ratios, and weight loss after 12 month follow-up. ResultsNo differences were observed between groups as regarding gender, ethnic background, or pubertal stage. Patients with one obese parent showed higher BW-SDS and BMI-SDS (P<.01), more severe impairment of carbohydrate metabolism (blood insulin, insulin-AUC, HOMA, HbA1c [P<.01] and lower WBISI [P<.05]) than those with no obese parent. Among those patients with a single obese parent, higher BW-SDS, insulin, HOMA, and lower 25-OH-vitamin D (P<.05) was observed when obesity was present in the mother. There was a higher prevalence of metabolic syndrome when both parents were obese (χ2=5.96, P<.05). A total of 132 patients reduced their BMI by ≥1.5 SDS, or their weight by ≥10%, with no influence of the background of parental obesity. ConclusionsObesity in any parent determines a higher severity of their offspring obesity and metabolic comorbidities, more importantly when obesity is present in the mother or in both parents, but without interference in the options of therapeutic success." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa influencia de la obesidad parental sobre la de los hijos y sus comorbilidades, aunque asumida, está insuficientemente caracterizada. Pacientes y métodosEstudio retrospectivo de 800 pacientes obesos (45,2% niñas; edad: 10,35±3,40 años, índice de masa corporal [IMC]:+4,22±1,68 standard deviation score[SDS]). Se realizaron comparaciones entre grupos según la presencia de obesidad en ningún (n=347) o algún progenitor (n=453), diferenciando entre presencia de obesidad en el padre (n=185), la madre (n=151) o ambos progenitores (n=117). Variables consideradas: edad al inicio de la obesidad y en primera consulta, peso neonatal (PRN), IMC-SDS, glucemia, insulinemia, índice homeostatic model assessment (HOMA), colesterol total (CT), HDL, LDL, triglicéridos, 25-OH-vitaminaD, área bajo la curva (AUC) de insulinemia en el test de tolerancia oral a la glucosa (TTOG), whole body insulin sensitivity index (WBISI), cocientes LDL/HDL y CT/HDL y reducción ponderal en los 12 primeros meses de seguimiento. ResultadosNo hubo diferencias en la distribución por sexo, etnia y pubertad entre grupos. Aquellos pacientes con algún progenitor obeso presentaron mayor PRN-SDS e IMC-SDS (p<0,01), mayor afectación del metabolismo hidrocarbonado (insulinemia, AUC-insulina, HOMA, HbA1c [p<0,01] y menor WBISI [p<0,05]) que aquellos sin ningún progenitor obeso. Entre aquellos con un único progenitor obeso, se observó mayor PRN-SDS, insulinemia y HOMA y menor 25-OH-vitaminaD (p<0,05) cuando el antecedente era materno. Existía mayor prevalencia de síndrome metabólico cuando ambos progenitores eran obesos (χ2=5,96, p<0,05). De todos ellos, 132 disminuyeron el IMC≥1,5SDS y/o el peso ≥10%, sin influencia del antecedente de obesidad parental. ConclusionesLa obesidad en algún progenitor determina mayor gravedad de la obesidad y de las alteraciones del metabolismo hidrocarbonado en sus hijos; acentuándose cuando la obesidad es materna o de ambos progenitores, pero sin influir en la posibilidad de éxito terapéutico." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Martínez-Villanueva J, González-Leal R, Argente J, Martos-Moreno GÁ. La obesidad parental se asocia con la gravedad de la obesidad infantil y de sus comorbilidades. An Pediatr (Barc). 2019;90:224–231." ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "Previous presentation: This study was presented at the 37th Congress of the Sociedad Española de Endocrinología Pediátrica (SEEP), Valencia, Spain, 2015." ] ] "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" => 1721 "Ancho" => 2269 "Tamanyo" => 132039 ] ] "descripcion" => array:1 [ "en" => "Comparison of the group without an obese parent (NO) and the group with obesity in at least 1 parent (OB). Data expressed as mean±standard error." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 787 "Ancho" => 2331 "Tamanyo" => 74264 ] ] "descripcion" => array:1 [ "en" => "Comparison of the group with 1 obese parent (1-OB) and the group with 2 obese parents (2-OB). Data expressed as mean±standard error." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2117 "Ancho" => 1944 "Tamanyo" => 99009 ] ] "descripcion" => array:1 [ "en" => "Comparison of the group with paternal obesity (F) versus the group with maternal obesity (M). Data expressed as mean±standard error." ] ] 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 [ "leyenda" => "AUC, area under the curve; BMI, body mass index; BW, birth weight; WBISI, whole body insulin sensitivity index; z, z-score." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2 non-obese parents (n=347) \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">At least 1 obese parent (n=453) \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">2 obese parents (n=117) \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">Obese father (n=185) \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">Obese mother (n=151) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.27±3.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.37±3.31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.06±3.61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.39±3.27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.59±3.11 \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">Age at onset of obesity (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.41±3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.25±3.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.28±3.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.99±3.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.55±2.9 \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">BW z \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.14±1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.39±1.45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7±1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.13±1.26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.45±1.5 \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">Height z \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.94±1.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.04±1.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.97±1.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.09±1.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.03±1.23 \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">Target height z \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.26±0.97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.34±0.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.23±0.96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.23±0.96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.40±1.00 \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">BMI z \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.91±1.46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.46±1.80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.82±2.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.20±1.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.52±1.87 \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">Basal glucose (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.60±6.53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.89±7.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.02±7.17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.87±6.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93.59±7.55 \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">Basal insulin (μU/mL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.05±6.80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.45±11.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.52±12.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.02±7.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.31±13.10 \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">HOMA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.01±1.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.59±2.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.80±3.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.23±1.87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.84±3.35 \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">Insulin AUC (μU/mL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84.50±49.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">101.49±64.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">103.47±61.85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93.52±56.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">109.17±73.23 \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">WBISI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.79±1.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.41±1.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.18±1.65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.64±1.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.31±1.78 \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">Total cholesterol (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">158.44±28.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">159.04±31.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">158.98±32.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">161.29±31.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">156.26±29.54 \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">LDL cholesterol (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96.34±24.29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96.76±25.97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98.09±28.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97.74±24.36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94.49±25.71 \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">Triglycerides (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.97±50.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82.94±52.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82.53±48.46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.37±56.10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82.72±49.76 \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">25-hydroxy vitamin D (ng/mL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.05±9.45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.15±8.31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.37±10.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.89±7.96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.40±8.35 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2002675.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of patients by parental obesity group." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:37 [ 0 => array:3 [ "identificador" => "bib0190" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Globesity: the root causes of the obesity epidemic in the USA and now worldwide" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Lifshitz" 1 => "J.Z. Lifshitz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Pediatr Endocrinol Rev" "fecha" => "2014" "volumen" => "12" "paginaInicial" => "17" "paginaFinal" => "34" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0195" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Childhood obesity and interpersonal dynamics during family meals" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.M. Berge" 1 => "S. Rowley" 2 => "A. Trofholz" 3 => "C. Hanson" 4 => "M. Rueter" 5 => "R.F. MacLehose" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2014-1936" "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "2014" "volumen" => "134" "paginaInicial" => "923" "paginaFinal" => "932" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25311603" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0200" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of grandparents in childhood obesity in China – evidence from a mixed methods study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B. Li" 1 => "P. Adab" 2 => "K.K. Cheng" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Int J Behav Nutr Phys Act" "fecha" => "2015" "volumen" => "12" "paginaInicial" => "91" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0205" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of parental misperception of child's body weight in childhood obesity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. McKee" 1 => "L. Long" 2 => "L.H. Southward" 3 => "B. Walker" 4 => "J. McCown" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Pediatr Nurs" "fecha" => "2016" "volumen" => "31" "paginaInicial" => "196" "paginaFinal" => "203" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0210" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of parents in public views of strategies to address childhood obesity in the United States" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.A. Wolfson" 1 => "S.E. Gollust" 2 => "J. Niederdeppe" 3 => "C.L. Barry" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/1468-0009.12106" "Revista" => array:6 [ "tituloSerie" => "Milbank Q" "fecha" => "2015" "volumen" => "93" "paginaInicial" => "73" "paginaFinal" => "111" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25752351" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0215" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The association between parent-reported provider communication quality and child obesity status: Variation by parent obesity and child race/ethnicity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.S. Wong" 1 => "N.N. Showell" 2 => "S.N. Bleich" 3 => "K.A. Gudzune" 4 => "K.S. Chan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pec.2017.03.015" "Revista" => array:6 [ "tituloSerie" => "Patient Educ Couns" "fecha" => "2017" "volumen" => "100" "paginaInicial" => "1588" "paginaFinal" => "1597" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28318844" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0220" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of familial predisposition to obesity and cardiovascular disease on childhood obesity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L.A. Nielsen" 1 => "T.R. Nielsen" 2 => "J.C. Holm" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Obes Facts" "fecha" => "2015" "volumen" => "8" "paginaInicial" => "319" "paginaFinal" => "328" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0225" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Curvas y tablas de crecimiento. Instituto de Investigación sobre Crecimiento y Desarrollo, Fundación Faustino Orbegozo" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Hernández" 1 => "J. Castellet" 2 => "J.L. Narvaiza" 3 => "J.M. Rincón" 4 => "I. Ruiz" 5 => "E. Sánchez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1988" "editorial" => "Editorial Garsi" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0230" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Establishing a standard definition for child overweight and obesity world-wide: international survey" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T.J. Cole" 1 => "M.C. Bellizzi" 2 => "K.M. Flegal" 3 => "W.H. Dietz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2000" "volumen" => "320" "paginaInicial" => "1240" "paginaFinal" => "1245" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0235" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Fourth Report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Pediatrics" "fecha" => "2004" "volumen" => "114" "paginaInicial" => "555" "paginaFinal" => "576" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0240" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio transversal español de crecimiento 2008, Parte I: valores de peso y longitud en recién nacidos de 26-42 semanas de edad gestacional" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Carrascosa Lezcano" 1 => "A. Fernández Longás" 2 => "D. Yeste Fernández" 3 => "J. García-Dihinx Villanova" 4 => "A. Romo Montejo" 5 => "A. Copil Copil" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr" "fecha" => "2008" "volumen" => "68" "paginaInicial" => "544" "paginaFinal" => "551" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0245" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Serum visfatin and vaspin levels in prepubertal children: effect of obesity and weight loss after behavior modifications on their secretion and relationship with glucose metabolism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "GÁ Martos-Moreno" 1 => "J. Kratzsch" 2 => "A. Körner" 3 => "V. Barrios" 4 => "F. Hawkins" 5 => "W. Kiess" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Obes (Lond)" "fecha" => "2011" "volumen" => "35" "paginaInicial" => "1355" "paginaFinal" => "1362" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0250" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The IDF consensus definition of the metabolic syndrome in children and adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Alberti" 1 => "P. Zimmet" 2 => "F. Kaufman" 3 => "N. Tajima" 4 => "M. Silink" 5 => "S. Arslanian" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2007" "editorial" => "IDF Communications" "editorialLocalizacion" => "Brussels, Belgium" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0255" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Organización Mundial de la Salud. Obesidad y sobrepeso. Nota descriptiva N.o 311. Junio de 2016 [consultado 18 Abr 2018]. Disponible en: <a id="intr0010" class="elsevierStyleInterRef" href="http://www.who.int/mediacentre/factsheets/fs311/es/">http://www.who.int/mediacentre/factsheets/fs311/es/</a>" ] ] ] 14 => array:3 [ "identificador" => "bib0260" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predicting obesity in young adulthood from childhood and parental obesity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.C. Whitaker" 1 => "J.A. Wright" 2 => "M.S. Pepe" 3 => "K.D. Seidel" 4 => "W.H. Dietz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199709253371301" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1997" "volumen" => "337" "paginaInicial" => "869" "paginaFinal" => "873" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9302300" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0265" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of parental BMI on the manifestation of overweight 5–7 year old children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Danielzik" 1 => "K. Langnäse" 2 => "M. Mast" 3 => "C. Spethmann" 4 => "M.J. Müller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00394-002-0367-1" "Revista" => array:6 [ "tituloSerie" => "Eur J Nutr" "fecha" => "2002" "volumen" => "41" "paginaInicial" => "132" "paginaFinal" => "138" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12111051" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0270" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intergenerational influences on childhood body mass index: the effect of parental body mass index trajectories" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Li" 1 => "C. Law" 2 => "R.L. Conte" 3 => "C. Power" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Clin Nutr" "fecha" => "2009" "volumen" => "89" "paginaInicial" => "551" "paginaFinal" => "557" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0275" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of maternal obesity on perinatal and childhood outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Santangeli" 1 => "N. Sattar" 2 => "S.S. Huda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bpobgyn.2014.10.009" "Revista" => array:6 [ "tituloSerie" => "Best Pract Res Clin Obstet Gynaecol" "fecha" => "2015" "volumen" => "29" "paginaInicial" => "438" "paginaFinal" => "448" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25497183" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0280" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The early origins of obesity and insulin resistance: timing, programming and mechanisms" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L.M. Nicholas" 1 => "J.L. Morrison" 2 => "L. Rattanatray" 3 => "S. Zhang" 4 => "S.E. Ozanne" 5 => "I.C. McMillen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Obes (Lond)" "fecha" => "2016" "volumen" => "40" "paginaInicial" => "229" "paginaFinal" => "238" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0285" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prenatal parental separation and body weight, including development of overweight and obesity later in childhood" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L. Hohwü" 1 => "J.L. Zhu" 2 => "L. Graversen" 3 => "J. Li" 4 => "T.I.A. Sørensen" 5 => "C. Obel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "PLOS ONE" "fecha" => "2015" "volumen" => "10" "paginaInicial" => "e0119138" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0290" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Modifiable early-life risk factors for childhood adiposity and overweight: an analysis of their combined impact and potential for prevention" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.M. Robinson" 1 => "S.R. Crozier" 2 => "N.C. Harvey" 3 => "B.D. Barton" 4 => "C.M. Law" 5 => "K.M. Godfrey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3945/ajcn.114.094268" "Revista" => array:6 [ "tituloSerie" => "Am J Clin Nutr" "fecha" => "2015" "volumen" => "101" "paginaInicial" => "368" "paginaFinal" => "375" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25646335" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0295" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity in adolescence is associated with perinatal risk factors, parental BMI and sociodemographic characteristics" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Healthy Growth Study Group" "etal" => false "autores" => array:4 [ 0 => "M. Birbilis" 1 => "G. Moschonis" 2 => "V. Mougios" 3 => "Y. Manios" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ejcn.2012.176" "Revista" => array:6 [ "tituloSerie" => "Eur J Clin Nutr" "fecha" => "2013" "volumen" => "67" "paginaInicial" => "115" "paginaFinal" => "121" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23232586" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0300" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity and the metabolic syndrome in children and adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Weiss" 1 => "J. Dziura" 2 => "T.S. Burgert" 3 => "W.V. Tamborlane" 4 => "S.E. Taksali" 5 => "C.W. Yeckel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa031049" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2004" "volumen" => "350" "paginaInicial" => "2362" "paginaFinal" => "2374" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15175438" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0305" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin resistance in prepubertal obese children correlates with sex-dependent early onset metabolomic alterations" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Mastrangelo" 1 => "G.Á. Martos-Moreno" 2 => "A. García" 3 => "V. Barrios" 4 => "F.J. Rupérez" 5 => "J.A. Chowen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Obes (Lond)" "fecha" => "2016" "volumen" => "40" "paginaInicial" => "1494" "paginaFinal" => "1502" "itemHostRev" => array:3 [ "pii" => "S0140673603152683" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0310" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metabolomics allows the discrimination of the pathophysiological relevance of hyperinsulinism in obese prepubertal children" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.Á. Martos-Moreno" 1 => "A. Mastrangelo" 2 => "V. Barrios" 3 => "A. García" 4 => "J.A. Chowen" 5 => "F.J. Rupérez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Obes (Lond)" "fecha" => "2017" "volumen" => "41" "paginaInicial" => "1473" "paginaFinal" => "1480" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0315" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Las alteraciones metabólicas asociadas a la obesidad están ya presentes en los primeros años de vida: estudio colaborativo español" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Grupo de Trabajo de Obesidad de la Sociedad Española de Endocrinología Pediátrica (SEEP)" "etal" => true "autores" => array:6 [ 0 => "G.Á. Martos-Moreno" 1 => "M. Gil-Campos" 2 => "G. Bueno" 3 => "P. Bahillo" 4 => "S. Bernal" 5 => "A. Feliu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Nutr Hosp" "fecha" => "2014" "volumen" => "30" "paginaInicial" => "787" "paginaFinal" => "793" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0320" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The association of cardiovascular risk factor clustering related to insulin resistance syndrome (Syndrome X) between young parents and their offspring: the Bogalusa Heart Study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "W. Chen" 1 => "S.R. Srinivasan" 2 => "A. Elkasabany" 3 => "G.S. Berenson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Atherosclerosis" "fecha" => "1999" "volumen" => "145" "paginaInicial" => "197" "paginaFinal" => "205" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10428311" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0325" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relation of cardiometabolic risk factors between parents and children" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Halvorsen" 1 => "A. Moran" 2 => "D.R. Jacobs Jr." 3 => "L.M. Steffen" 4 => "A.R. Sinaiko" 5 => "X. Zhou" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Pediatr" "fecha" => "2015" "volumen" => "167" "paginaInicial" => "1049" "paginaFinal" => "1056.e2" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0330" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metabolic syndrome is strictly associated with parental obesity beginning from childhood" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Monzani" 1 => "A. Rapa" 2 => "N. Fuiano" 3 => "G. Diddi" 4 => "F. Prodam" 5 => "S. Bellone" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Endocrinol (Oxf)" "fecha" => "2014" "volumen" => "81" "paginaInicial" => "45" "paginaFinal" => "51" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0335" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metabolic syndrome in Spanish adolescents and its association with birth weight, breastfeeding duration, maternal smoking, and maternal obesity: a cross-sectional study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. González-Jiménez" 1 => "M.A. Montero-Alonso" 2 => "J. Schmidt-RioValle" 3 => "C.J. García-García" 4 => "C. Padez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00394-014-0740-x" "Revista" => array:6 [ "tituloSerie" => "Eur J Nutr" "fecha" => "2015" "volumen" => "54" "paginaInicial" => "589" "paginaFinal" => "597" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25052543" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0340" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metabolic syndrome in adolescence: can it be predicted from natal and parental profile? The Prediction of Metabolic Syndrome in Adolescence (PREMA) study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.P. Efstathiou" 1 => "I.I. Skeva" 2 => "E. Zorbala" 3 => "E. Georgiou" 4 => "T.D. Mountokalakis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Circulation" "fecha" => "2012" "volumen" => "125" "paginaInicial" => "902" "paginaFinal" => "910" ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0345" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influence of maternal obesity on insulin sensitivity and secretion in offspring" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Mingrone" 1 => "M. Manco" 2 => "M.E. Mora" 3 => "C. Guidone" 4 => "A. Iaconelli" 5 => "D. Gniuli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/dc08-0432" "Revista" => array:6 [ "tituloSerie" => "Diabetes Care" "fecha" => "2008" "volumen" => "31" "paginaInicial" => "1872" "paginaFinal" => "1876" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18535193" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0350" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vitamin D status and childhood health" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Y.H. Shin" 1 => "H.J. Shin" 2 => "Y.J. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Korean J Pediatr" "fecha" => "2013" "volumen" => "56" "paginaInicial" => "417" "paginaFinal" => "423" ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0355" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Maternal vitamin D in pregnancy may influence not only offspring bone mass but other aspects of musculoskeletal health and adiposity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.A. Pasco" 1 => "J.D. Wark" 2 => "J.B. Carlin" 3 => "A.L. Ponsonby" 4 => "P.J. Vuillermin" 5 => "R. Morley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.mehy.2008.01.033" "Revista" => array:6 [ "tituloSerie" => "Med Hypotheses" "fecha" => "2008" "volumen" => "71" "paginaInicial" => "266" "paginaFinal" => "269" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18448261" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0360" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The empowerment of low-income parents engaged in a childhood obesity intervention" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.M. Jurkowski" 1 => "H.A. Lawson" 2 => "L.L. Green Mills" 3 => "P.G. Wilner 3rd" 4 => "K.K. Davison" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/FCH.0000000000000024" "Revista" => array:6 [ "tituloSerie" => "Fam Community Health" "fecha" => "2014" "volumen" => "37" "paginaInicial" => "104" "paginaFinal" => "118" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24569157" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0365" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Role modeling as an early childhood obesity prevention strategy: effect of parents and teachers on preschool children's healthy lifestyle habits" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.A. Natale" 1 => "S.E. Messiah" 2 => "L. Asfour" 3 => "S.B. Uhlhorn" 4 => "A. Delamater" 5 => "K.L. Arheart" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Dev Behav Pediatr" "fecha" => "2014" "volumen" => "35" "paginaInicial" => "378" "paginaFinal" => "387" ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0370" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of motivation in family-based guided self-help treatment for pediatric obesity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E.C. Accurso" 1 => "G.J. Norman" 2 => "S.J. Crow" 3 => "C.L. Rock" 4 => "K.N. Boutelle" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Child Obes" "fecha" => "2014" "volumen" => "10" "paginaInicial" => "392" "paginaFinal" => "399" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000009000000004/v1_201904020615/S2341287919300365/v1_201904020615/en/main.assets" "Apartado" => array:4 [ "identificador" => "26005" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000009000000004/v1_201904020615/S2341287919300365/v1_201904020615/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287919300365?idApp=UINPBA00005H"]

Statistics

Original Article

Parental obesity is associated with the severity of childhood obesity and its comorbidities

La obesidad parental se asocia con la gravedad de la obesidad infantil y de sus comorbilidades

Julián Martínez-Villanuevaa, Rocío González-Leala, Jesús Argentea,b,c,d, Gabriel Ángel Martos-Morenoa,b,c,

Corresponding author

gabrielangel.martos@salud.madrid.org
gabrielangelmartos@yahoo.es

Corresponding author.

a Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Madrid, Spain

b Departamento de Pediatría, Universidad Autónoma de Madrid, Madrid, Spain

c Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain

d IMDEA Food Institute, Madrid, Spain

Read

7094

Times
was read the article

2374

Total PDF

4720

Total HTML

Share statistics

 array:25 [
  "pii" => "S2341287919300365"
  "issn" => "23412879"
  "doi" => "10.1016/j.anpede.2018.06.010"
  "estado" => "S300"
  "fechaPublicacion" => "2019-04-01"
  "aid" => "2483"
  "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
  "copyrightAnyo" => "2018"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "An Pediatr &#40;Barc&#41;. 2019;90:224-31"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1091
    "formatos" => array:3 [
      "EPUB" => 80
      "HTML" => 728
      "PDF" => 283
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:20 [
      "pii" => "S1695403318303011"
      "issn" => "16954033"
      "doi" => "10.1016/j.anpedi.2018.06.013"
      "estado" => "S300"
      "fechaPublicacion" => "2019-04-01"
      "aid" => "2483"
      "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "An Pediatr &#40;Barc&#41;. 2019;90:224-31"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 4633
        "formatos" => array:3 [
          "EPUB" => 152
          "HTML" => 3161
          "PDF" => 1320
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
        "titulo" => "La obesidad parental se asocia con la gravedad de la obesidad infantil y de sus comorbilidades"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "224"
            "paginaFinal" => "231"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Parental obesity is associated with the severity of childhood obesity and its comorbidities"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0015"
            "etiqueta" => "Figura 3"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr3.jpeg"
                "Alto" => 2117
                "Ancho" => 1944
                "Tamanyo" => 103292
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Comparaci&#243;n entre los grupos con antecedente de obesidad paterna &#40;P&#41; y con antecedente de obesidad materna &#40;M&#41;&#46; Datos representados como media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>EE&#46;</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">EE&#58; error est&#225;ndar&#59; HOMA&#58; <span class="elsevierStyleItalic">homeostatic model assessment</span>&#59; SDS&#58; standard deviation score&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Juli&#225;n Mart&#237;nez-Villanueva, Roc&#237;o Gonz&#225;lez-Leal, Jes&#250;s Argente, Gabriel &#193;ngel Martos-Moreno"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Juli&#225;n"
                "apellidos" => "Mart&#237;nez-Villanueva"
              ]
              1 => array:2 [
                "nombre" => "Roc&#237;o"
                "apellidos" => "Gonz&#225;lez-Leal"
              ]
              2 => array:2 [
                "nombre" => "Jes&#250;s"
                "apellidos" => "Argente"
              ]
              3 => array:2 [
                "nombre" => "Gabriel &#193;ngel"
                "apellidos" => "Martos-Moreno"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2341287919300365"
          "doi" => "10.1016/j.anpede.2018.06.010"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287919300365?idApp=UINPBA00005H"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403318303011?idApp=UINPBA00005H"
      "url" => "/16954033/0000009000000004/v1_201904020610/S1695403318303011/v1_201904020610/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S2341287919300353"
    "issn" => "23412879"
    "doi" => "10.1016/j.anpede.2018.06.009"
    "estado" => "S300"
    "fechaPublicacion" => "2019-04-01"
    "aid" => "2477"
    "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "An Pediatr &#40;Barc&#41;. 2019;90:232-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1045
      "formatos" => array:3 [
        "EPUB" => 108
        "HTML" => 691
        "PDF" => 246
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Diagnostic efficiency of renal ultrasound after the first urine infection in infants"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "232"
          "paginaFinal" => "236"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Rentabilidad diagn&#243;stica de la ecograf&#237;a renal tras la primera infecci&#243;n de orina en los lactantes"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 697
              "Ancho" => 1269
              "Tamanyo" => 79846
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flow chart of the study&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">DUS&#44; disease of the urinary system&#59; US&#44; ultrasound&#59; UTI&#44; urinary tract infection&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Anna Faura Morros, Adriana Cuaresma Gonz&#225;lez, Susanna Hern&#225;ndez-Bou, Victoria Trenchs Sainz de la Maza, Juan Antonio Camacho Diaz, Carles Luaces Cubells"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Anna"
              "apellidos" => "Faura Morros"
            ]
            1 => array:2 [
              "nombre" => "Adriana"
              "apellidos" => "Cuaresma Gonz&#225;lez"
            ]
            2 => array:2 [
              "nombre" => "Susanna"
              "apellidos" => "Hern&#225;ndez-Bou"
            ]
            3 => array:2 [
              "nombre" => "Victoria"
              "apellidos" => "Trenchs Sainz de la Maza"
            ]
            4 => array:2 [
              "nombre" => "Juan Antonio"
              "apellidos" => "Camacho Diaz"
            ]
            5 => array:2 [
              "nombre" => "Carles"
              "apellidos" => "Luaces Cubells"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S169540331830287X"
        "doi" => "10.1016/j.anpedi.2018.06.007"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S169540331830287X?idApp=UINPBA00005H"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287919300353?idApp=UINPBA00005H"
    "url" => "/23412879/0000009000000004/v1_201904020615/S2341287919300353/v1_201904020615/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2341287918301443"
    "issn" => "23412879"
    "doi" => "10.1016/j.anpede.2018.05.004"
    "estado" => "S300"
    "fechaPublicacion" => "2019-04-01"
    "aid" => "2484"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "An Pediatr &#40;Barc&#41;. 2019;90:219-23"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2410
      "formatos" => array:3 [
        "EPUB" => 139
        "HTML" => 1861
        "PDF" => 410
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "What is the optimal dose of clopidogrel in paediatric patients&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "219"
          "paginaFinal" => "223"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "&#191;Cu&#225;l es la dosis &#243;ptima de clopidogrel en pacientes pedi&#225;tricos&#63;"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Cristina Mondelo Garc&#237;a, Cristina Mart&#237;nez Roca, Fernando Rueda N&#250;&#241;ez, Mar&#237;a Isabel Mart&#237;n Herranz"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Cristina Mondelo"
              "apellidos" => "Garc&#237;a"
            ]
            1 => array:2 [
              "nombre" => "Cristina Mart&#237;nez"
              "apellidos" => "Roca"
            ]
            2 => array:2 [
              "nombre" => "Fernando Rueda"
              "apellidos" => "N&#250;&#241;ez"
            ]
            3 => array:2 [
              "nombre" => "Mar&#237;a Isabel Mart&#237;n"
              "apellidos" => "Herranz"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1695403318303023"
        "doi" => "10.1016/j.anpedi.2018.05.020"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403318303023?idApp=UINPBA00005H"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287918301443?idApp=UINPBA00005H"
    "url" => "/23412879/0000009000000004/v1_201904020615/S2341287918301443/v1_201904020615/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Parental obesity is associated with the severity of childhood obesity and its comorbidities"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "224"
        "paginaFinal" => "231"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Juli&#225;n Mart&#237;nez-Villanueva, Roc&#237;o Gonz&#225;lez-Leal, Jes&#250;s Argente, Gabriel &#193;ngel Martos-Moreno"
        "autores" => array:4 [
          0 => array:3 [
            "nombre" => "Juli&#225;n"
            "apellidos" => "Mart&#237;nez-Villanueva"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Roc&#237;o"
            "apellidos" => "Gonz&#225;lez-Leal"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Jes&#250;s"
            "apellidos" => "Argente"
            "referencia" => array:4 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          3 => array:4 [
            "nombre" => "Gabriel &#193;ngel"
            "apellidos" => "Martos-Moreno"
            "email" => array:2 [
              0 => "gabrielangel&#46;martos&#64;salud&#46;madrid&#46;org"
              1 => "gabrielangelmartos&#64;yahoo&#46;es"
            ]
            "referencia" => array:4 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Servicio de Endocrinolog&#237;a&#44; Hospital Infantil Universitario Ni&#241;o Jes&#250;s&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Departamento de Pediatr&#237;a&#44; Universidad Aut&#243;noma de Madrid&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Centro de Investigaci&#243;n Biom&#233;dica en Red-Fisiopatolog&#237;a de la Obesidad y la Nutrici&#243;n &#40;CIBERobn&#41;&#44; Instituto de Salud Carlos III&#44; Madrid&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "IMDEA Food Institute&#44; Madrid&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "La obesidad parental se asocia con la gravedad de la obesidad infantil y de sus comorbilidades"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1721
            "Ancho" => 2269
            "Tamanyo" => 132039
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Comparison of the group without an obese parent &#40;NO&#41; and the group with obesity in at least 1 parent &#40;OB&#41;&#46; Data expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard error&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The socioeconomic changes that have taken place in recent decades have led to the development of new dietary habits and more sedentary lifestyles&#44; which in turn facilitate the development of obesity in current generations of children and adolescents&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a> In addition&#44; children of obese parents may be at an even higher risk of obesity due to the combination of the inluence of dietary habits in the household and a greater genetic susceptibility to the disease&#46; In fact&#44; a considerable percentage of the children and adolescents that are currently obese have obese parents&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">It has been well established that certain dietary and nutritional patterns in families can trigger obesity in their younger members&#46; Methods involving direct observation have been used to identify behavioural components in family meals &#40;interpersonal relationships and relationships with food&#41; that are beneficial or deleterious as concerns childhood obesity&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">2</span></a> evidencing that the influence of the family extends beyond the parents&#46; Children who live with grandparents&#44; figures who are increasingly involved in their care&#44; are at greater risk of developing obesity&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> Grandparents tend to indulge and overfeed their grandchildren and to spare them from physical tasks&#44; increasing their risk of obesity&#46; The underlying motivation for this behaviour is their affection for the child and is influenced by personal experiences&#44; misunderstandings and a low awareness of the adverse health effects of obesity&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Parents and their weight status influence the development of obesity in their children as well as the outcome of treatment&#46; Various studies have highlighted differences between parents in their perception of paediatric obesity as a disease and in their attitude towards obesity in their children&#44; but did not assess the presence of obesity in the parents themselves&#46; Broadly speaking&#44; a large percentage of parents have an inaccurate perception of the weight status of their children&#44; which is associated with a 12-fold increase in the probability of having an obese child&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">4</span></a> and delegate the responsibilities associated with paediatric obesity to schools and public institutions&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">5</span></a> Recent studies in children and adolescents enrolled in weight loss programmes with parental involvement have reported that non-obese parents have a better understanding of the interventions involved in the treatment of obesity associated with better communication with the provider&#44; including more careful listening and spending the necessary time to explain the recommendations on the part of the latter&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">6</span></a> There are also studies demonstrating that weight loss programmes are less likely to be successful in children with obese parents or siblings&#44; and some have described a poorer response to treatment in association with maternal obesity&#46; Parental comorbidities correlated to obesity have also been associated with poorer outcomes of treatment of paediatric obesity&#44; with a stronger association when both parents had comorbidities&#46; Other studies have established that parental weight loss has a significant impact on treatment outcomes in obese children&#46; Overall&#44; a small number of studies suggest that parental obesity may influence the outcomes of treatment of obesity in children and adolescents&#46; However&#44; the role of parental obesity in the severity of paediatric obesity and its associated comorbidities is still under debate&#44; and its potential impact on treatment outcomes has yet to be adequately established&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">For this reason&#44; the main goal of our study was to analyse the severity of obesity&#44; the presence of metabolic comorbidities and the response to treatment in obese children and adolescents in relation to the presence of obesity in one or both parents&#44; additionally assessing the potential influence of the specific parent affected by obesity&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">We conducted a retrospective study in 800 obese patients &#40;361 &#91;45&#46;2&#37;&#93; female and 439 &#91;54&#46;8&#37;&#93; male&#41; aged 10&#46;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;40 years &#40;range&#44; 0&#46;33&#8211;17&#46;84 years&#41; and with a body mass index &#40;BMI&#41; <span class="elsevierStyleItalic">z</span>-score of 4&#46;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;68 managed in the obesity clinic of the Department of Endocrinology in a tertiary care hospital between 2009 and 2014&#44; recording the BMI of parents after measuring the weight and height of both parents&#44; and with a 1-year follow-up&#46; Of all the included patients&#44; 434 &#40;54&#46;2&#37;&#41; were in the prepubertal stage &#40;Tanner stage I&#41; and 366 &#40;45&#46;8&#37;&#41; in the pubertal stage &#40;Tanner stage<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>II&#41;&#46; Most of the patients in the cohort were Caucasian &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>599&#59; 72&#46;7&#37;&#41; or Hispanic &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>179&#59; 21&#46;7&#37;&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In every patient&#44; the following variables were recorded and standardised in the initial visit to the clinic&#58; weight&#44; height&#44; BMI<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">8&#44;9</span></a> and systolic and diastolic blood pressures<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">10</span></a> &#40;mean of 3 measurements taken with a Critikon<span class="elsevierStyleSup">&#174;</span>-Dinamap&#8482; 8100 vital signs monitor&#41;&#46; We considered patients obese if their BMI <span class="elsevierStyleItalic">z</span>-score was 2 or greater based on Spanish reference growth Charts<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">8</span></a> and the standards of the International Obesity Task Force &#40;IOTF&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">9</span></a> We retrieved the age at onset of obesity and the birth weight &#40;BW&#41;&#44; which we standardised for sex and gestational age&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">11</span></a> The initial evaluation included measurement of the serum levels of glucose&#44; insulin&#44; glycated haemoglobin &#40;HbA1c&#41;&#44; uric acid&#44; total cholesterol &#40;TC&#41;&#44; high-density lipoprotein &#40;HDL&#41; cholesterol&#44; low density lipoprotein &#40;LDL&#41; cholesterol&#44; triglycerides&#44; 25-hydroxy vitamin D&#44; thyroid-stimulating hormone &#40;TSH&#41; and free thyroxine &#40;fT4&#41; after 12<span class="elsevierStyleHsp" style=""></span>h fasting&#46; AWe did not find significant differences between the groups&#40;OGTT&#59; 1&#46;75<span class="elsevierStyleHsp" style=""></span>mg glucose&#47;kg weight to a maximum of 75<span class="elsevierStyleHsp" style=""></span>g&#41;&#46; We calculated the area under the curve &#40;AUC&#41; of glucose and insulin applying the following formula&#58; 0&#46;25<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>basal level<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#46;5<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>half-hour value<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#46;75<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>1-hour value<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#46;5 2-hour value&#46; We calculated the Homeostatic Model Assessment &#40;HOMA&#41; index as basal glucose &#40;mg&#47;dL&#41;<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>basal insulin &#40;&#956;IU&#47;mL&#41;&#47;405&#44; and the whole-body insulin sensitivity index &#40;WBISI&#41; as 10<span class="elsevierStyleHsp" style=""></span>000&#47;&#40;fasting glucose<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>fasting insulin<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>mean OGTT glucose<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>mean OGTT insulin&#41;<span class="elsevierStyleSup">1&#47;2</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">12</span></a> Metabolic syndrome &#40;MS&#41; was diagnosed in patients aged more than 10 years &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>454&#59; 56&#46;8&#37;&#41; according to the criteria proposed by the International Diabetes Federation &#40;IDF&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">13</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Once obesity was diagnosed and underlying organic diseases excluded&#44; all patients were managed with conservative treatment based on 3 main components&#58; &#40;1&#41; behavioural modification with the aim of eating slower&#44; eating smaller portions and organising the timing of meals &#40;based on classical conditioning&#44; reinforcement theory and the identification and control of negative automatic thoughts&#41;&#59; &#40;2&#41; dietary recommendations &#40;adequate distribution of food groups in a weekly programme without specific calorie restrictions&#44; with energy restriction pursued indirectly through slower eating&#41;&#44; and &#40;3&#41; physical indication &#40;prescription of 1<span class="elsevierStyleHsp" style=""></span>h a day of aerobic play or exercise adapted to the age and circumstances of the patient&#44; recommending a progressive increase in intensity&#41;&#46; Follow-up clinical evaluations were scheduled as follows&#44; independently of the severity of obesity&#58; initial visit&#44; first follow-up evaluation at 1 month&#44; and follow-up evaluations every three months thereafter&#46; We encouraged all members of the family to get involved in implementing the given recommendations with the aim of facilitating adherence in the patient&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We considered that patients had achieved significant weight loss if they succeeded in decreasing their BMI <span class="elsevierStyleItalic">z</span>-score by 1&#46;5 points and&#47;or their weight by 10&#37; or more in the 12 months of follow-up&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">We compared patients based on parental obesity &#40;BMI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">14</span></a> initially classifying them in 2 groups &#40;no parent with obesity &#91;NO group&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>347&#93; versus at least 1 parent with obesity &#91;OB group&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>453&#93;&#41;&#44; subsequently comparing patients in the OB group based on whether obesity was present in only 1 parent &#40;1-OB&#59; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>336&#41; or in both &#40;2-OB&#59; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>117&#41;&#46; In the subset with only 1 obese parent&#44; we compared patients with an obese father &#40;F&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>185&#41; to patients with an obese mother &#40;M&#59; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>151&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">We performed the statistical analysis with the Statistical Package for Social Sciences &#40;SPSS&#41; version 15&#46;0 &#40;MapInfo Corporation&#44; Troy&#44; NY&#44; USA&#41;&#46; We used the Kolmogorov&#8211;Smirnov test to assess the normality of the distribution of the variables under study &#40;the variables fitting a normal distribution were blood glucose&#44; TC and LDL cholesterol&#41;&#46; For normally-distributed variables&#44; we compared independent groups by means of the Student <span class="elsevierStyleItalic">t</span> test&#44; and for all others &#40;with a non-normal distribution&#41; we used the Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test&#46; We compared the proportions of patients with MS in different groups using the <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test&#46; We defined statistical significance as a <span class="elsevierStyleItalic">P</span>-value of less than &#46;05&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Although the study was to include every patient meeting the specified criteria managed in the 2009&#8211;2014 period&#44; we still estimated the sample size required to achieve the established objectives&#46; Assuming a prevalence of hyperinsulinaemia of 30&#37; in the group of patients without obese parents&#44; the size required per group to detect an expected increase of 10&#37; in the prevalence of hyperinsulinaemia in patients with at least 1 obese parent versus those without obese parents with an alfa error of 5&#37; and a beta error of 10&#37; was <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>362&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">We did not find significant differences between the groups &#40;NO vs OB&#59; 1-OB vs 2-OB&#59; F vs M&#41; in sex&#44; ethnicity and pubertal development distributions or in the ages at onset of obesity and at the initial visit &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Presence vs absence of parental obesity parental &#40;NO vs OB&#41;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Patients in the OB group&#44; that is&#44; with at least one obese parent &#40;father&#44; mother or both&#41; had higher BW <span class="elsevierStyleItalic">z</span>-scores and higher BMI <span class="elsevierStyleItalic">z</span>-scores at the time of the first visit compared to those without an obese parent &#40;NO vs OB&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46; We also found a higher frequency of carbohydrate metabolism abnormalities in the OB group&#44; with higher values of blood insulin&#44; the insulin AUC&#44; the HOMA index and HbA1c &#40;all with <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#46;</span>01&#41; and lower values of the WBISI &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; although the blood glucose levels and the glucose AUC were similar in both groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#59; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Triglyceride levels tended to be higher in patients in the OB group&#44; but the difference was not statistically significant &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;076&#41;&#46; We did not find any differences in any of the other variables under study&#46; When we compared patients without obese parents with patients whose parents were both obese &#40;NO vs 2-OB&#41;&#44; we found similar results &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Number of obese parents</span><p id="par0070" class="elsevierStylePara elsevierViewall">We found a higher prevalence of MS &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#46;96&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#46;</span>05&#41; in patients with 2 obese parents &#40;23&#46;08&#37;&#41; compared to patients with one obese parent &#40;15&#46;77&#37;&#41; and patients without obese parents &#40;13&#46;54&#37;&#41;&#46; Patients with 2 obese parents had higher BW <span class="elsevierStyleItalic">z</span>-scores &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#46;</span>01&#41; and higher BMI <span class="elsevierStyleItalic">z</span>-scores in the initial visit &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#46;</span>05&#41; compared to patients with a single obese parent&#46; When it came to metabolic comorbidities&#44; patients with 2 obese parents had higher TC&#47;HDL ratios &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#46;</span>05&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#59; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; We did not find any significant differences in any of the other variables under study &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Influence of the affected parent</span><p id="par0075" class="elsevierStylePara elsevierViewall">In the group of patients with 1 obese parent&#44; we found higher BW <span class="elsevierStyleItalic">z</span>-scores&#44; insulin levels&#44; and HOMA index values and lower levels of 25-hydroxy vitamin D in the subset in whom the obese parent was the mother &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#46;</span>05 for all analyses&#41;&#46; Patients with an obese mother also tended to have higher BMI <span class="elsevierStyleItalic">z</span>-scores&#44; but this difference was not significant &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#59; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; We did not find statistically significant differences in any of the other variables under study&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Response to treatment</span><p id="par0080" class="elsevierStylePara elsevierViewall">Of the total patients in the cohort &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>800&#41;&#44; 132 &#40;16&#46;5&#37;&#41; achieved a significant weight loss in 12 months of treatment &#40;reduction of BMI <span class="elsevierStyleItalic">z</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1&#46;5 points and&#47;or body weight<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10&#37;&#41;&#44; and we found no significant differences in the percentage of patients that achieved significant weight loss based on the number of parents with obesity &#40;0&#44; 1 or 2&#41;&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">The results of our study show that parental BMI has an impact on some characteristics of paediatric obesity and its comorbidities&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Children and adolescents with at least one obese parent had higher BWs and more severe obesity &#40;based on the BMI&#41; at the time of the initial consultation&#46; These 2 features were exacerbated in patients with 2 obese parents&#46; Although this association is controversial&#44; it is supported by the work of other authors&#44; especially as concerns the impact on younger children &#40;age<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10 years&#41;&#44; and it may also be important in the development or persistence of obesity in adulthood&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">15&#8211;17</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In the group with a single obese parent&#44; when the affected parent was the mother&#44; children and adolescents had higher BWs and tended to have a higher BMI at the time of seeking care for obesity&#46; The association of maternal obesity with foetal macrosomia and an increased risk of obesity and metabolic comorbidities later in life is well established&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">18&#44;19</span></a> Our study suggests that this association is stronger when the mother is affected as opposed to the father&#46; This maternal influence may be explained&#8212;at least in part&#8212;by the presence of prenatal and perinatal factors associated to the development of obesity in future stages of life&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">20&#8211;22</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">As for the disorders of carbohydrate metabolism associated with obesity&#44; insulin resistance &#40;IR&#41; was more severe in patients in the OB group&#46; However&#44; this was not the case of blood glucose levels&#44; which were similar across de sample and independent of parental obesity&#46; Despite the challenges in defining IR described by some authors&#44;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">23</span></a> previous studies conducted by our group<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">24&#44;25</span></a> and collaborative studies conducted in Spain<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">26</span></a> have demonstrated that IR is much more frequent than abnormal glucose levels in obese children &#40;a feature that differentiates this population from adults&#41;&#46; Furthermore&#44; this outcome corroborates the findings of previous studies that have also described an increased risk of IR and a higher prevalence of hyperinsulinaemia in patients with obese parents&#44; associating this factor with other cardiovascular risk factors &#40;obesity&#44; dyslipidaemia and high blood pressure&#41; characteristic of MS&#44; which in our cohort was more prevalent in patients whose parents were both obese&#44;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">27&#8211;29</span></a> although it is important to consider that Halvorsen et al&#46; also found an association between the presence of cardiovascular risk factors and MS in parents and children&#44; independently of the BMI of either&#46; In the opinion of Monzani et al&#46;&#44; parental obesity is the sole risk factor required for the development of MS in childhood&#44; unlike adolescence&#44; when obesogenic habits are also at play&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">We ought to mention that the definition of MS used in our study was restricted to patients aged more than 10 years&#44; and that the prevalence found would have been higher had we applied paediatric criteria covering a broader age range&#46; We chose to apply the criteria of the IDF to define MS due to the current lack of consensus in the international literature regarding the appropriateness of diagnosing MS in the paediatric age group&#46; Thus&#44; while specific scientific criteria have been proposed for its definition in the paediatric population&#44; there are also authors that disagree with the use of this diagnosis at early ages and instead recommend &#40;as does the IDF&#41; the diagnosis and treatment of each individual metabolic disorder&#44; refraining from the use of MS as a diagnostic category&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">13</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">In our sample&#44; parental obesity was also associated with a higher prevalence of MS&#44; an association that was strongest when both parents were obese&#44; thus representing an increased risk of future cardiovascular and metabolic disease in children and adolescents&#46; In fact&#44; the prevalence of MS in our cohort was higher compared to other studies that have also found an association between MS and obesity in one or both parents&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">30&#44;31</span></a> This could be related to the greater severity of obesity in the patients included in our study &#40;as evinced by the high mean BMI <span class="elsevierStyleItalic">z</span>-score&#41; and to our sample coming from a hospital cohort where the detection of metabolic disturbances by the primary care clinicians that refer patients to specialty care may have been a source of bias&#46; In spite of this&#44; we found no significant differences between groups in the lipid profile&#44; save for a higher TC&#47;HDL ratio in patients with two obese parents&#44; contrary to other studies that did find higher triglyceride and LDL-cholesterol levels and lower levels of HDL-cholesterol in children and adolescents with obese parents and with MS&#44;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">27&#44;28</span></a> although this could have been due to the lower mean age of the patients in our study&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The comparison of metabolic comorbidities in patients with one obese parent showed that IR was more severe in cases associated with maternal obesity&#46; This finding corroborates previous evidence demonstrating the influence of maternal obesity on the development of IR and obesity&#44; even in children born with a normal weight for gestational age&#44;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">32</span></a> and contributes novel information on the difference in comparison with paternal obesity&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Another salient finding was that the levels of 25-hydroxy vitamin D were lower in patients whose mothers were obese&#46; The association between obesity and vitamin D is a subject that currently attracts considerable interest&#44; including obesity in the collection of risk factors for vitamin D insufficiency and deficiency&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">33</span></a> These risk factors may affect several members of a family sharing similar dietary and leisure habits&#46; However&#44; the association between maternal obesity and the levels of 25-hydroxy vitamin D in children has not been studied extensively&#44; although there is evidence that the presence of vitamin D deficiency in the mother secondary to obesity during pregnancy may play a role in this association&#44; among other possible factors&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">34</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Contrary to expectations&#44; a novel finding of our study was that a positive parental history of obesity had no impact on the likelihood of responding favourably to conservative treatment&#44; as previously described&#44; in the 12 months of follow-up&#46; This finding diverged from the scarce data on the subject reported in the literature&#44; which suggests that parental obesity is associated with poorer outcomes of treatment in obese children and adolescents&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">7</span></a> There is no question that the involvement of the family&#44; independently of the BMI&#44; is one of the key factors that determine a satisfactory response to treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">35&#8211;37</span></a> However&#44; our results suggest that parents with obesity are also capable of promoting healthy habits in their offspring&#44; with a success rate similar to that found in non-obese parents&#46; Furthermore&#44; witnessing the challenges and the comorbidities experienced by their parents may inspire children &#40;especially older ones&#41; to take measures for weight control independently&#46; However&#44; keeping records of the degree to which the parents of patients implemented the recommendations and of changes in the weight status of the former would have provided additional information on this aspect&#44; and the lack of such records was a limitation of our study&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Our study is not free from the limitations intrinsic to cohort studies&#44; including the impossibility of establishing causal relationships &#40;only association can be established&#41; and the time required to achieve the necessary sample size and complete the follow-up&#44; which may have an impact on the homogeneity of the conditions under which subjects participate in the study&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In conclusion&#44; the results of our retrospective study on a large cohort of paediatric patients with obesity demonstrate that a history of obesity in a parent is associated with greater severity of paediatric obesity and the associated IR in their obese offspring&#44; an association that is stronger when it is the mother or both parents who are obese&#46; Nevertheless&#44; a positive parental history of obesity does not have a negative impact on the probability of successful treatment&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:10 [
        0 => array:3 [
          "identificador" => "xres1173362"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Patients and methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1097413"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1173361"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introducci&#243;n"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Pacientes y m&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1097414"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Patients and methods"
        ]
        6 => array:3 [
          "identificador" => "sec0015"
          "titulo" => "Results"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Presence vs absence of parental obesity parental &#40;NO vs OB&#41;"
            ]
            1 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Number of obese parents"
            ]
            2 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Influence of the affected parent"
            ]
            3 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Response to treatment"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Conflicts of interest"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-03-02"
    "fechaAceptado" => "2018-06-15"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1097413"
          "palabras" => array:7 [
            0 => "Childhood obesity"
            1 => "Adolescent"
            2 => "Parental obesity"
            3 => "Maternal obesity"
            4 => "Metabolic comorbidities"
            5 => "Carbohydrate metabolism"
            6 => "Metabolic syndrome"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1097414"
          "palabras" => array:7 [
            0 => "Obesidad pedi&#225;trica"
            1 => "Adolescente"
            2 => "Obesidad parental"
            3 => "Obesidad materna"
            4 => "Comorbilidades metab&#243;licas"
            5 => "Metabolismo hidrocarbonado"
            6 => "S&#237;ndrome metab&#243;lico"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The influence of parental obesity on their obese offsprings is acknowledged but insufficiently characterised&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective study of 800 obese patients &#40;45&#46;2&#37; girls&#59; age&#58; 10&#46;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;40 years&#44; body mass index &#91;BMI&#93;&#58; &#43;4&#46;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;68 standard deviation score &#91;SDS&#93;&#41;&#46; Group comparison according to the presence of obesity in none &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>347&#41; or any of the parents &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>453&#41;&#44; and then whether the obese parent was the father &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>185&#41;&#44; the mother &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>151&#41;&#44; or both parents &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>117&#41; were performed&#46; The parameters analysed were&#58; Age at the onset of the obesity and at their first visit&#44; birth weight &#40;BW&#41;&#44; BMI-SDS&#44; blood glucose&#44; insulin level&#44; homeostatic model assessment &#40;HOMA&#41; index&#44; total cholesterol &#40;TC&#41;&#44; HDL&#44; LDL&#44; triglycerides&#44; 25-OH-vitamin-D&#44; area under the curve &#40;AUC&#41; for insulin in the oral glucose tolerance test &#40;OGTT&#41;&#44; whole body insulin sensitivity index &#40;WBISI&#41;&#44; LDL&#47;HDL and TC&#47;HDL ratios&#44; and weight loss after 12 month follow-up&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">No differences were observed between groups as regarding gender&#44; ethnic background&#44; or pubertal stage&#46; Patients with one obese parent showed higher BW-SDS and BMI-SDS &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#44; more severe impairment of carbohydrate metabolism &#40;blood insulin&#44; insulin-AUC&#44; HOMA&#44; HbA1c &#91;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#93; and lower WBISI &#91;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#93;&#41; than those with no obese parent&#46; Among those patients with a single obese parent&#44; higher BW-SDS&#44; insulin&#44; HOMA&#44; and lower 25-OH-vitamin D &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; was observed when obesity was present in the mother&#46; There was a higher prevalence of metabolic syndrome when both parents were obese &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>5&#46;96&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46; A total of 132 patients reduced their BMI by &#8805;1&#46;5 SDS&#44; or their weight by &#8805;10&#37;&#44; with no influence of the background of parental obesity&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Obesity in any parent determines a higher severity of their offspring obesity and metabolic comorbidities&#44; more importantly when obesity is present in the mother or in both parents&#44; but without interference in the options of therapeutic success&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Patients and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La influencia de la obesidad parental sobre la de los hijos y sus comorbilidades&#44; aunque asumida&#44; est&#225; insuficientemente caracterizada&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de 800 pacientes obesos &#40;45&#44;2&#37; ni&#241;as&#59; edad&#58; 10&#44;35<span class="elsevierStyleHsp" style=""></span>&#177;3&#44;40 a&#241;os&#44; &#237;ndice de masa corporal &#91;IMC&#93;&#58;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>4&#44;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;68 <span class="elsevierStyleItalic">standard deviation score</span><span class="elsevierStyleMonospace">&#91;</span>SDS&#93;&#41;&#46; Se realizaron comparaciones entre grupos seg&#250;n la presencia de obesidad en ning&#250;n &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>347&#41; o alg&#250;n progenitor &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>453&#41;&#44; diferenciando entre presencia de obesidad en el padre &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>185&#41;&#44; la madre &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>151&#41; o ambos progenitores &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>117&#41;&#46; Variables consideradas&#58; edad al inicio de la obesidad y en primera consulta&#44; peso neonatal &#40;PRN&#41;&#44; IMC-SDS&#44; glucemia&#44; insulinemia&#44; &#237;ndice <span class="elsevierStyleItalic">homeostatic model assessment</span> &#40;HOMA&#41;&#44; colesterol total &#40;CT&#41;&#44; HDL&#44; LDL&#44; triglic&#233;ridos&#44; 25-OH-vitamina<span class="elsevierStyleHsp" style=""></span>D&#44; &#225;rea bajo la curva &#40;AUC&#41; de insulinemia en el test de tolerancia oral a la glucosa &#40;TTOG&#41;&#44; <span class="elsevierStyleItalic">whole body insulin sensitivity index</span> &#40;WBISI&#41;&#44; cocientes LDL&#47;HDL y CT&#47;HDL y reducci&#243;n ponderal en los 12 primeros meses de seguimiento&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">No hubo diferencias en la distribuci&#243;n por sexo&#44; etnia y pubertad entre grupos&#46; Aquellos pacientes con alg&#250;n progenitor obeso presentaron mayor PRN-SDS e IMC-SDS &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; mayor afectaci&#243;n del metabolismo hidrocarbonado &#40;insulinemia&#44; AUC-insulina&#44; HOMA&#44; HbA1c &#91;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#93; y menor WBISI &#91;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#93;&#41; que aquellos sin ning&#250;n progenitor obeso&#46; Entre aquellos con un &#250;nico progenitor obeso&#44; se observ&#243; mayor PRN-SDS&#44; insulinemia y HOMA y menor 25-OH-vitamina<span class="elsevierStyleHsp" style=""></span>D &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; cuando el antecedente era materno&#46; Exist&#237;a mayor prevalencia de s&#237;ndrome metab&#243;lico cuando ambos progenitores eran obesos &#40;&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>5&#44;96&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; De todos ellos&#44; 132 disminuyeron el IMC<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1&#44;5<span class="elsevierStyleHsp" style=""></span>SDS y&#47;o el peso &#8805;<span class="elsevierStyleHsp" style=""></span>10&#37;&#44; sin influencia del antecedente de obesidad parental&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La obesidad en alg&#250;n progenitor determina mayor gravedad de la obesidad y de las alteraciones del metabolismo hidrocarbonado en sus hijos&#59; acentu&#225;ndose cuando la obesidad es materna o de ambos progenitores&#44; pero sin influir en la posibilidad de &#233;xito terap&#233;utico&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Pacientes y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Mart&#237;nez-Villanueva J&#44; Gonz&#225;lez-Leal R&#44; Argente J&#44; Martos-Moreno G&#193;&#46; La obesidad parental se asocia con la gravedad de la obesidad infantil y de sus comorbilidades&#46; An Pediatr &#40;Barc&#41;&#46; 2019&#59;90&#58;224&#8211;231&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010"><span class="elsevierStyleItalic">Previous presentation</span>&#58; This study was presented at the 37th Congress of the Sociedad Espa&#241;ola de Endocrinolog&#237;a Pedi&#225;trica &#40;SEEP&#41;&#44; Valencia&#44; Spain&#44; 2015&#46;</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" => 1721
            "Ancho" => 2269
            "Tamanyo" => 132039
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Comparison of the group without an obese parent &#40;NO&#41; and the group with obesity in at least 1 parent &#40;OB&#41;&#46; Data expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard error&#46;</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" => 787
            "Ancho" => 2331
            "Tamanyo" => 74264
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Comparison of the group with 1 obese parent &#40;1-OB&#41; and the group with 2 obese parents &#40;2-OB&#41;&#46; Data expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard error&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 2117
            "Ancho" => 1944
            "Tamanyo" => 99009
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Comparison of the group with paternal obesity &#40;F&#41; versus the group with maternal obesity &#40;M&#41;&#46; Data expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard error&#46;</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 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">AUC&#44; area under the curve&#59; BMI&#44; body mass index&#59; BW&#44; birth weight&#59; WBISI&#44; whole body insulin sensitivity index&#59; <span class="elsevierStyleItalic">z</span>&#44; <span class="elsevierStyleItalic">z</span>-score&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2 non-obese parents &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>347&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">At least 1 obese parent &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>453&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2 obese parents &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>117&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Obese father &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>185&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Obese mother &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>151&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;39<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;11&nbsp;\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">Age at onset of obesity &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;28<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;99<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;9&nbsp;\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">BW <span class="elsevierStyleItalic">z</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;39<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Height <span class="elsevierStyleItalic">z</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;94<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;04<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;97<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;09<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;03<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;23&nbsp;\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">Target height <span class="elsevierStyleItalic">z</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;34<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;23<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;23<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;00&nbsp;\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">BMI <span class="elsevierStyleItalic">z</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;82<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;87&nbsp;\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">Basal glucose &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&#46;60<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&#46;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&#46;02<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&#46;87<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93&#46;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;55&nbsp;\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">Basal insulin &#40;&#956;U&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;05<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;02<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;10&nbsp;\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">HOMA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;01<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;23<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;35&nbsp;\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">Insulin AUC &#40;&#956;U&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#46;50<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>49&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">101&#46;49<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>64&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">103&#46;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>61&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93&#46;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>56&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">109&#46;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>73&#46;23&nbsp;\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">WBISI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;18<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;64<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;78&nbsp;\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">Total cholesterol &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">158&#46;44<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">159&#46;04<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">158&#46;98<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>32&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">161&#46;29<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">156&#46;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>29&#46;54&nbsp;\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">LDL cholesterol &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&#46;34<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>24&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&#46;76<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>25&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&#46;09<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&#46;74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>24&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">94&#46;49<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>25&#46;71&nbsp;\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">Triglycerides &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#46;97<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>50&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82&#46;94<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>52&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82&#46;53<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>48&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&#46;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>56&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82&#46;72<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>49&#46;76&nbsp;\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">25-hydroxy vitamin D &#40;ng&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;05<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;15<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2002675.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Comparison of patients by parental obesity group&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:37 [
            0 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Globesity&#58; the root causes of the obesity epidemic in the USA and now worldwide"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "F&#46; Lifshitz"
                            1 => "J&#46;Z&#46; Lifshitz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Pediatr Endocrinol Rev"
                        "fecha" => "2014"
                        "volumen" => "12"
                        "paginaInicial" => "17"
                        "paginaFinal" => "34"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Childhood obesity and interpersonal dynamics during family meals"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Berge"
                            1 => "S&#46; Rowley"
                            2 => "A&#46; Trofholz"
                            3 => "C&#46; Hanson"
                            4 => "M&#46; Rueter"
                            5 => "R&#46;F&#46; MacLehose"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2014-1936"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2014"
                        "volumen" => "134"
                        "paginaInicial" => "923"
                        "paginaFinal" => "932"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25311603"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of grandparents in childhood obesity in China &#8211; evidence from a mixed methods study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46; Li"
                            1 => "P&#46; Adab"
                            2 => "K&#46;K&#46; Cheng"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Int J Behav Nutr Phys Act"
                        "fecha" => "2015"
                        "volumen" => "12"
                        "paginaInicial" => "91"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of parental misperception of child&#39;s body weight in childhood obesity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; McKee"
                            1 => "L&#46; Long"
                            2 => "L&#46;H&#46; Southward"
                            3 => "B&#46; Walker"
                            4 => "J&#46; McCown"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Pediatr Nurs"
                        "fecha" => "2016"
                        "volumen" => "31"
                        "paginaInicial" => "196"
                        "paginaFinal" => "203"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of parents in public views of strategies to address childhood obesity in the United States"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;A&#46; Wolfson"
                            1 => "S&#46;E&#46; Gollust"
                            2 => "J&#46; Niederdeppe"
                            3 => "C&#46;L&#46; Barry"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/1468-0009.12106"
                      "Revista" => array:6 [
                        "tituloSerie" => "Milbank Q"
                        "fecha" => "2015"
                        "volumen" => "93"
                        "paginaInicial" => "73"
                        "paginaFinal" => "111"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25752351"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The association between parent-reported provider communication quality and child obesity status&#58; Variation by parent obesity and child race&#47;ethnicity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;S&#46; Wong"
                            1 => "N&#46;N&#46; Showell"
                            2 => "S&#46;N&#46; Bleich"
                            3 => "K&#46;A&#46; Gudzune"
                            4 => "K&#46;S&#46; Chan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.pec.2017.03.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Patient Educ Couns"
                        "fecha" => "2017"
                        "volumen" => "100"
                        "paginaInicial" => "1588"
                        "paginaFinal" => "1597"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28318844"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of familial predisposition to obesity and cardiovascular disease on childhood obesity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;A&#46; Nielsen"
                            1 => "T&#46;R&#46; Nielsen"
                            2 => "J&#46;C&#46; Holm"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Obes Facts"
                        "fecha" => "2015"
                        "volumen" => "8"
                        "paginaInicial" => "319"
                        "paginaFinal" => "328"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Curvas y tablas de crecimiento&#46; Instituto de Investigaci&#243;n sobre Crecimiento y Desarrollo&#44; Fundaci&#243;n Faustino Orbegozo"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Hern&#225;ndez"
                            1 => "J&#46; Castellet"
                            2 => "J&#46;L&#46; Narvaiza"
                            3 => "J&#46;M&#46; Rinc&#243;n"
                            4 => "I&#46; Ruiz"
                            5 => "E&#46; S&#225;nchez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1988"
                        "editorial" => "Editorial Garsi"
                        "editorialLocalizacion" => "Madrid"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Establishing a standard definition for child overweight and obesity world-wide&#58; international survey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46;J&#46; Cole"
                            1 => "M&#46;C&#46; Bellizzi"
                            2 => "K&#46;M&#46; Flegal"
                            3 => "W&#46;H&#46; Dietz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2000"
                        "volumen" => "320"
                        "paginaInicial" => "1240"
                        "paginaFinal" => "1245"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Fourth Report on the diagnosis&#44; evaluation&#44; and treatment of high blood pressure in children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2004"
                        "volumen" => "114"
                        "paginaInicial" => "555"
                        "paginaFinal" => "576"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estudio transversal espa&#241;ol de crecimiento 2008&#44; Parte I&#58; valores de peso y longitud en reci&#233;n nacidos de 26-42 semanas de edad gestacional"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Carrascosa Lezcano"
                            1 => "A&#46; Fern&#225;ndez Long&#225;s"
                            2 => "D&#46; Yeste Fern&#225;ndez"
                            3 => "J&#46; Garc&#237;a-Dihinx Villanova"
                            4 => "A&#46; Romo Montejo"
                            5 => "A&#46; Copil Copil"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "An Pediatr"
                        "fecha" => "2008"
                        "volumen" => "68"
                        "paginaInicial" => "544"
                        "paginaFinal" => "551"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Serum visfatin and vaspin levels in prepubertal children&#58; effect of obesity and weight loss after behavior modifications on their secretion and relationship with glucose metabolism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#193; Martos-Moreno"
                            1 => "J&#46; Kratzsch"
                            2 => "A&#46; K&#246;rner"
                            3 => "V&#46; Barrios"
                            4 => "F&#46; Hawkins"
                            5 => "W&#46; Kiess"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Obes &#40;Lond&#41;"
                        "fecha" => "2011"
                        "volumen" => "35"
                        "paginaInicial" => "1355"
                        "paginaFinal" => "1362"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The IDF consensus definition of the metabolic syndrome in children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Alberti"
                            1 => "P&#46; Zimmet"
                            2 => "F&#46; Kaufman"
                            3 => "N&#46; Tajima"
                            4 => "M&#46; Silink"
                            5 => "S&#46; Arslanian"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2007"
                        "editorial" => "IDF Communications"
                        "editorialLocalizacion" => "Brussels&#44; Belgium"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Organizaci&#243;n Mundial de la Salud&#46; Obesidad y sobrepeso&#46; Nota descriptiva N&#46;<span class="elsevierStyleSup">o</span> 311&#46; Junio de 2016 &#91;consultado 18 Abr 2018&#93;&#46; Disponible en&#58; <a id="intr0010" class="elsevierStyleInterRef" href="http://www.who.int/mediacentre/factsheets/fs311/es/">http&#58;&#47;&#47;www&#46;who&#46;int&#47;mediacentre&#47;factsheets&#47;fs311&#47;es&#47;</a>"
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predicting obesity in young adulthood from childhood and parental obesity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46;C&#46; Whitaker"
                            1 => "J&#46;A&#46; Wright"
                            2 => "M&#46;S&#46; Pepe"
                            3 => "K&#46;D&#46; Seidel"
                            4 => "W&#46;H&#46; Dietz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199709253371301"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1997"
                        "volumen" => "337"
                        "paginaInicial" => "869"
                        "paginaFinal" => "873"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9302300"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of parental BMI on the manifestation of overweight 5&#8211;7 year old children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Danielzik"
                            1 => "K&#46; Langn&#228;se"
                            2 => "M&#46; Mast"
                            3 => "C&#46; Spethmann"
                            4 => "M&#46;J&#46; M&#252;ller"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00394-002-0367-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Nutr"
                        "fecha" => "2002"
                        "volumen" => "41"
                        "paginaInicial" => "132"
                        "paginaFinal" => "138"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12111051"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intergenerational influences on childhood body mass index&#58; the effect of parental body mass index trajectories"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46; Li"
                            1 => "C&#46; Law"
                            2 => "R&#46;L&#46; Conte"
                            3 => "C&#46; Power"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Clin Nutr"
                        "fecha" => "2009"
                        "volumen" => "89"
                        "paginaInicial" => "551"
                        "paginaFinal" => "557"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of maternal obesity on perinatal and childhood outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Santangeli"
                            1 => "N&#46; Sattar"
                            2 => "S&#46;S&#46; Huda"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bpobgyn.2014.10.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Best Pract Res Clin Obstet Gynaecol"
                        "fecha" => "2015"
                        "volumen" => "29"
                        "paginaInicial" => "438"
                        "paginaFinal" => "448"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25497183"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The early origins of obesity and insulin resistance&#58; timing&#44; programming and mechanisms"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46;M&#46; Nicholas"
                            1 => "J&#46;L&#46; Morrison"
                            2 => "L&#46; Rattanatray"
                            3 => "S&#46; Zhang"
                            4 => "S&#46;E&#46; Ozanne"
                            5 => "I&#46;C&#46; McMillen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Obes &#40;Lond&#41;"
                        "fecha" => "2016"
                        "volumen" => "40"
                        "paginaInicial" => "229"
                        "paginaFinal" => "238"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prenatal parental separation and body weight&#44; including development of overweight and obesity later in childhood"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46; Hohw&#252;"
                            1 => "J&#46;L&#46; Zhu"
                            2 => "L&#46; Graversen"
                            3 => "J&#46; Li"
                            4 => "T&#46;I&#46;A&#46; S&#248;rensen"
                            5 => "C&#46; Obel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "PLOS ONE"
                        "fecha" => "2015"
                        "volumen" => "10"
                        "paginaInicial" => "e0119138"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Modifiable early-life risk factors for childhood adiposity and overweight&#58; an analysis of their combined impact and potential for prevention"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;M&#46; Robinson"
                            1 => "S&#46;R&#46; Crozier"
                            2 => "N&#46;C&#46; Harvey"
                            3 => "B&#46;D&#46; Barton"
                            4 => "C&#46;M&#46; Law"
                            5 => "K&#46;M&#46; Godfrey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3945/ajcn.114.094268"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Clin Nutr"
                        "fecha" => "2015"
                        "volumen" => "101"
                        "paginaInicial" => "368"
                        "paginaFinal" => "375"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25646335"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity in adolescence is associated with perinatal risk factors&#44; parental BMI and sociodemographic characteristics"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Healthy Growth Study Group"
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Birbilis"
                            1 => "G&#46; Moschonis"
                            2 => "V&#46; Mougios"
                            3 => "Y&#46; Manios"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ejcn.2012.176"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Clin Nutr"
                        "fecha" => "2013"
                        "volumen" => "67"
                        "paginaInicial" => "115"
                        "paginaFinal" => "121"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23232586"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity and the metabolic syndrome in children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Weiss"
                            1 => "J&#46; Dziura"
                            2 => "T&#46;S&#46; Burgert"
                            3 => "W&#46;V&#46; Tamborlane"
                            4 => "S&#46;E&#46; Taksali"
                            5 => "C&#46;W&#46; Yeckel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa031049"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2004"
                        "volumen" => "350"
                        "paginaInicial" => "2362"
                        "paginaFinal" => "2374"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15175438"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Insulin resistance in prepubertal obese children correlates with sex-dependent early onset metabolomic alterations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Mastrangelo"
                            1 => "G&#46;&#193;&#46; Martos-Moreno"
                            2 => "A&#46; Garc&#237;a"
                            3 => "V&#46; Barrios"
                            4 => "F&#46;J&#46; Rup&#233;rez"
                            5 => "J&#46;A&#46; Chowen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Obes &#40;Lond&#41;"
                        "fecha" => "2016"
                        "volumen" => "40"
                        "paginaInicial" => "1494"
                        "paginaFinal" => "1502"
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673603152683"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metabolomics allows the discrimination of the pathophysiological relevance of hyperinsulinism in obese prepubertal children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;&#193;&#46; Martos-Moreno"
                            1 => "A&#46; Mastrangelo"
                            2 => "V&#46; Barrios"
                            3 => "A&#46; Garc&#237;a"
                            4 => "J&#46;A&#46; Chowen"
                            5 => "F&#46;J&#46; Rup&#233;rez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Obes &#40;Lond&#41;"
                        "fecha" => "2017"
                        "volumen" => "41"
                        "paginaInicial" => "1473"
                        "paginaFinal" => "1480"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Las alteraciones metab&#243;licas asociadas a la obesidad est&#225;n ya presentes en los primeros a&#241;os de vida&#58; estudio colaborativo espa&#241;ol"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Grupo de Trabajo de Obesidad de la Sociedad Espa&#241;ola de Endocrinolog&#237;a Pedi&#225;trica &#40;SEEP&#41;"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;&#193;&#46; Martos-Moreno"
                            1 => "M&#46; Gil-Campos"
                            2 => "G&#46; Bueno"
                            3 => "P&#46; Bahillo"
                            4 => "S&#46; Bernal"
                            5 => "A&#46; Feliu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Nutr Hosp"
                        "fecha" => "2014"
                        "volumen" => "30"
                        "paginaInicial" => "787"
                        "paginaFinal" => "793"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The association of cardiovascular risk factor clustering related to insulin resistance syndrome &#40;Syndrome X&#41; between young parents and their offspring&#58; the Bogalusa Heart Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "W&#46; Chen"
                            1 => "S&#46;R&#46; Srinivasan"
                            2 => "A&#46; Elkasabany"
                            3 => "G&#46;S&#46; Berenson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Atherosclerosis"
                        "fecha" => "1999"
                        "volumen" => "145"
                        "paginaInicial" => "197"
                        "paginaFinal" => "205"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10428311"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relation of cardiometabolic risk factors between parents and children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Halvorsen"
                            1 => "A&#46; Moran"
                            2 => "D&#46;R&#46; Jacobs Jr&#46;"
                            3 => "L&#46;M&#46; Steffen"
                            4 => "A&#46;R&#46; Sinaiko"
                            5 => "X&#46; Zhou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "2015"
                        "volumen" => "167"
                        "paginaInicial" => "1049"
                        "paginaFinal" => "1056&#46;e2"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metabolic syndrome is strictly associated with parental obesity beginning from childhood"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Monzani"
                            1 => "A&#46; Rapa"
                            2 => "N&#46; Fuiano"
                            3 => "G&#46; Diddi"
                            4 => "F&#46; Prodam"
                            5 => "S&#46; Bellone"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Endocrinol &#40;Oxf&#41;"
                        "fecha" => "2014"
                        "volumen" => "81"
                        "paginaInicial" => "45"
                        "paginaFinal" => "51"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metabolic syndrome in Spanish adolescents and its association with birth weight&#44; breastfeeding duration&#44; maternal smoking&#44; and maternal obesity&#58; a cross-sectional study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; Gonz&#225;lez-Jim&#233;nez"
                            1 => "M&#46;A&#46; Montero-Alonso"
                            2 => "J&#46; Schmidt-RioValle"
                            3 => "C&#46;J&#46; Garc&#237;a-Garc&#237;a"
                            4 => "C&#46; Padez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00394-014-0740-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Nutr"
                        "fecha" => "2015"
                        "volumen" => "54"
                        "paginaInicial" => "589"
                        "paginaFinal" => "597"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25052543"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metabolic syndrome in adolescence&#58; can it be predicted from natal and parental profile&#63; The Prediction of Metabolic Syndrome in Adolescence &#40;PREMA&#41; study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;P&#46; Efstathiou"
                            1 => "I&#46;I&#46; Skeva"
                            2 => "E&#46; Zorbala"
                            3 => "E&#46; Georgiou"
                            4 => "T&#46;D&#46; Mountokalakis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2012"
                        "volumen" => "125"
                        "paginaInicial" => "902"
                        "paginaFinal" => "910"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influence of maternal obesity on insulin sensitivity and secretion in offspring"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Mingrone"
                            1 => "M&#46; Manco"
                            2 => "M&#46;E&#46; Mora"
                            3 => "C&#46; Guidone"
                            4 => "A&#46; Iaconelli"
                            5 => "D&#46; Gniuli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2337/dc08-0432"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetes Care"
                        "fecha" => "2008"
                        "volumen" => "31"
                        "paginaInicial" => "1872"
                        "paginaFinal" => "1876"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18535193"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vitamin D status and childhood health"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Y&#46;H&#46; Shin"
                            1 => "H&#46;J&#46; Shin"
                            2 => "Y&#46;J&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Korean J Pediatr"
                        "fecha" => "2013"
                        "volumen" => "56"
                        "paginaInicial" => "417"
                        "paginaFinal" => "423"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maternal vitamin D in pregnancy may influence not only offspring bone mass but other aspects of musculoskeletal health and adiposity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;A&#46; Pasco"
                            1 => "J&#46;D&#46; Wark"
                            2 => "J&#46;B&#46; Carlin"
                            3 => "A&#46;L&#46; Ponsonby"
                            4 => "P&#46;J&#46; Vuillermin"
                            5 => "R&#46; Morley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.mehy.2008.01.033"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Hypotheses"
                        "fecha" => "2008"
                        "volumen" => "71"
                        "paginaInicial" => "266"
                        "paginaFinal" => "269"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18448261"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The empowerment of low-income parents engaged in a childhood obesity intervention"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;M&#46; Jurkowski"
                            1 => "H&#46;A&#46; Lawson"
                            2 => "L&#46;L&#46; Green Mills"
                            3 => "P&#46;G&#46; Wilner 3rd"
                            4 => "K&#46;K&#46; Davison"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/FCH.0000000000000024"
                      "Revista" => array:6 [
                        "tituloSerie" => "Fam Community Health"
                        "fecha" => "2014"
                        "volumen" => "37"
                        "paginaInicial" => "104"
                        "paginaFinal" => "118"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24569157"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Role modeling as an early childhood obesity prevention strategy&#58; effect of parents and teachers on preschool children&#39;s healthy lifestyle habits"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46;A&#46; Natale"
                            1 => "S&#46;E&#46; Messiah"
                            2 => "L&#46; Asfour"
                            3 => "S&#46;B&#46; Uhlhorn"
                            4 => "A&#46; Delamater"
                            5 => "K&#46;L&#46; Arheart"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Dev Behav Pediatr"
                        "fecha" => "2014"
                        "volumen" => "35"
                        "paginaInicial" => "378"
                        "paginaFinal" => "387"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of motivation in family-based guided self-help treatment for pediatric obesity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46;C&#46; Accurso"
                            1 => "G&#46;J&#46; Norman"
                            2 => "S&#46;J&#46; Crow"
                            3 => "C&#46;L&#46; Rock"
                            4 => "K&#46;N&#46; Boutelle"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Child Obes"
                        "fecha" => "2014"
                        "volumen" => "10"
                        "paginaInicial" => "392"
                        "paginaFinal" => "399"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/23412879/0000009000000004/v1_201904020615/S2341287919300365/v1_201904020615/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "26005"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/23412879/0000009000000004/v1_201904020615/S2341287919300365/v1_201904020615/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287919300365?idApp=UINPBA00005H"
]

Article information

ISSN: 23412879
Original language: English

DOI:10.1016/j.anpede.2018.06.010

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	7	10	17
2024 October	50	34	84
2024 September	47	27	74
2024 August	64	52	116
2024 July	100	33	133
2024 June	67	42	109
2024 May	62	40	102
2024 April	45	40	85
2024 March	66	32	98
2024 February	67	27	94
2024 January	62	29	91
2023 December	95	25	120
2023 November	77	48	125
2023 October	61	31	92
2023 September	39	33	72
2023 August	25	23	48
2023 July	35	33	68
2023 June	35	29	64
2023 May	69	26	95
2023 April	48	15	63
2023 March	75	34	109
2023 February	60	21	81
2023 January	49	39	88
2022 December	75	39	114
2022 November	108	41	149
2022 October	69	50	119
2022 September	45	29	74
2022 August	61	53	114
2022 July	38	39	77
2022 June	44	43	87
2022 May	55	51	106
2022 April	38	30	68
2022 March	81	73	154
2022 February	53	57	110
2022 January	84	49	133
2021 December	59	34	93
2021 November	67	54	121
2021 October	79	68	147
2021 September	54	37	91
2021 August	49	42	91
2021 July	54	38	92
2021 June	83	45	128
2021 May	64	33	97
2021 April	211	112	323
2021 March	126	50	176
2021 February	88	36	124
2021 January	86	32	118
2020 December	76	35	111
2020 November	83	28	111
2020 October	79	10	89
2020 September	119	37	156
2020 August	112	17	129
2020 July	122	24	146
2020 June	60	14	74
2020 May	69	19	88
2020 April	74	25	99
2020 March	79	18	97
2020 February	109	15	124
2020 January	71	21	92
2019 December	99	22	121
2019 November	50	19	69
2019 October	66	14	80
2019 September	43	16	59
2019 August	70	21	91
2019 July	40	16	56
2019 June	29	25	54
2019 May	49	32	81
2019 April	108	73	181
2019 March	37	15	52

Show all

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter