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This group recommends a minimum age of 3 years for diagnosis of CP and considers age 5 years optimal&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Feeding problems are frequent in children with CP&#44; although nutritional and feeding problems are more frequent and severe in those with more severe neurologic impairment&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> The reported prevalence of malnutrition varies widely between case series&#44; ranging between 19&#37; and 50&#46;9&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Nutritional management aims at ensuring optimal growth&#44; preventing malnutrition and disorders related to nutritional deficiencies&#44; and at establishing healthy dietary habits to prevent the development of diseases associated with poor nutrition&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> An adequate nutritional status improves outcomes in motor skills&#44; cognitive stills&#44; communication and social interaction&#44; and therefore overall neurodevelopmental outcomes&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Nutritional and dietary measures must be safe and effective&#44; allowing to the extent possible the enjoyment of food&#46; All of the above requires continuous&#44; comprehensive&#44; coordinated and close monitoring based on a multidisciplinary approach&#44; with participation of paediatric neurologists&#44; gastroenterologists&#44; nutritionists&#47;dietitians&#44; nursing staff&#44; speech therapists and rehabilitation specialists&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of our study was to assess the nutritional status of patients with predominantly spastic CP and the degree of nutritional compromise based on the severity of CP&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">We conducted a cross-sectional&#44; observational&#44; descriptive and inferential study&#46; The study universe consisted of the patients aged 4&#8211;15 years with moderate to severe predominantly spastic CP managed in the paediatric neurology unit of a referral hospital&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We included patients at levels III&#44; IV or IV of the Gross Motor Function Classification System &#40;GMFCS&#41; developed by Palisano et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and modified according to the International Classification of Functioning&#44; Disability and Health &#40;ICF&#41; of the World Health Organization &#40;WHO&#41;&#44; which categorises patients based on the degree of motor impairment&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">We excluded patients who refused or whose parents refused to participate in the study&#44; those outside the age range under study&#44; and those that did not meet the diagnostic criteria for CP&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The study was approved by the Regional Ethics Committee &#40;CEICA&#59; PI16&#47;039&#41;&#46; All participating patients and&#47;or their guardians signed an informed consent form&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">After ascertaining that patients met the inclusion criteria&#44; we contacted the patient or the guardians to schedule an office visit during which we carried out a clinical interview to collect data on variables related to the patient&#8217;s clinical condition&#44; anthropometric values and dietary habits&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">For the anthropometric assessment&#44; we used the height calculated by means of the knee-height &#40;KH&#41; stature estimate equation developed by Stevenson<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#58; height<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>KH<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>2&#46;69<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>24&#46;2<span class="elsevierStyleHsp" style=""></span>cm&#46; The other anthropometric measurements taken were the weight&#44; arm circumference &#40;AC&#41;&#44; subcutaneous skinfolds &#40;biceps&#44; triceps &#91;TSF&#93;&#44; subscapular&#44; suprailiac&#41;&#46; These measurements were made with measuring tape &#40;perimeter and segmental height measures&#41;&#44; Holtain&#174; skinfold callipers &#40;subcutaneous folds&#41;&#44; scale &#40;weight&#41; and callipers &#40;knee height&#41;&#46; We used the Siri equation to estimate body composition&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">We calculated the <span class="elsevierStyleItalic">z</span>-scores for the obtained anthropometric values using the growth tables of Carrascosa et al&#46; &#40;2010&#41; as Ref&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> in adherence to the recommendation made in 2017 by the European Society for Paediatric Gastroenterology&#44; Hepatology and Nutrition &#40;ESPGHAN&#41; of using a standardised reference population&#46; We calculated the body mass index &#40;BMI&#41; and the weight-for-height &#40;WFH&#41; to categorise the nutritional status of the patient based on weight&#58; WFH<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>patient weight&#47;expected weight for height &#40;50th percentile&#41;<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">We evaluated the body composition of the patients using bioelectrical impedance analysis &#40;BIA&#41; with an Akern BIA-101 Anniversary bio-impedance analyser&#46; This method allowed us to obtain values for the total body water &#40;extracellular and intracellular e intracellular&#41;&#44; fat body mass&#44; body cell mass &#40;total mass of living&#44; functioning and metabolically active cells&#41; and lean body mass &#40;muscle mass and bone mass&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a> Measurements are obtained by adhering electrodes to the skin to generate a small alternating current in a single or multiple frequencies&#44; recording the resistance &#40;opposition to the passage of the electric current&#41; and the reactance &#40;the delay in conduction caused by cellular membranes&#44; tissue interfaces and non-ionic tissues&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Patients underwent BIA following a fast of at least 4<span class="elsevierStyleHsp" style=""></span>h&#44; after avoiding physical activity for at least the last 12<span class="elsevierStyleHsp" style=""></span>h and in a state of absolute rest&#46; The measurements were made with the patient lying in the supine position with the arms abducted at 20&#176;&#8211;30&#176; and the legs at 45&#176; from the trunk&#46; The 2 current-introducing electrodes were placed in the midlines of the wrist and the ankle of the unclothed patient lying on a cot made of non-conductive material&#44; and the voltage-sensing electrodes 4&#8211;5<span class="elsevierStyleHsp" style=""></span>cm away from the source along the metacarpal and the metatarsal phalangeal lines&#44; respectively&#59; always homolaterally &#40;hemibody&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In order to accurately assess lean body mass and eliminate the potential bias associated with low weight in these patients&#44; we calculated the expected percentage of lean mass for their height&#46; To do so&#44; after obtaining the expected weight for their height &#40;using the median in the growth charts of Carrascosa et al&#46;&#44; 2010&#41;&#44; we calculated the expected kilograms of lean mass &#40;using the references published by Fomon<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and Haschke<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#41; and&#44; lastly&#44; divided the lean body mass of the patient by the expected lean body mass &#40;both in kg&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">To classify lean body mass values&#44; we applied the cutoffs proposed by Lohman and Going<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#58; underfat &#40;&#60;10&#37; in boys and &#60;15&#37; in girls&#41;&#44; normal &#40;11&#8211;25&#37; in boys and 16&#8211;30&#37; in girls&#41; and excess fat &#40;&#62;25&#37; in boys and &#62;30&#37; in girls&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Our statistical analysis was performed with the software SPSS Statistics version 21&#46;0&#46; We did a descriptive analysis&#44; summarising the results as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation &#40;SD&#41; with the 95&#37; confidence interval &#40;quantitative variables&#41; or as frequencies &#40;qualitative variables&#41;&#46; We tested for normality with the Kolmogorov-Smirnov and Shapiro-Wilk tests&#46; Afterward&#44; we performed hypothesis testing with different methods&#58; chi square test and Fisher exact test &#40;qualitative variables&#41;&#44; Student <span class="elsevierStyleItalic">t</span> test &#40;parametric data&#44; quantitative and dichotomous variables&#41;&#44; Mann-Whitney <span class="elsevierStyleItalic">U</span> test &#40;nonparametric data&#44; quantitative and dichotomous variables&#41;&#44; analysis of variance &#40;ANOVA&#41; with the Bonferroni correction &#40;parametric data&#44; quantitative and dichotomous variables&#41; and Kruskal-Wallis test &#40;nonparametric data&#44; quantitative and non-dichotomous qualitative&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0095" class="elsevierStylePara elsevierViewall">A total of 82 patients met the inclusion criteria&#44; but we were unable to locate or obtain content for participation from 13&#44; so the final sample included 69 patients &#40;recruitment of 84&#46;2&#37;&#41;&#46; Of this total&#44; 50&#46;7&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>35&#41; were female&#46; The distribution of patients by level of functioning based on the GMFCS was as follows&#58; level III&#44; 36&#46;2&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>25&#41;&#59; level IV&#44; 29&#46;0&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>20&#41;&#59; level V&#44; 34&#46;8&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>24&#41;&#46; The mean age was 10&#46;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;4 years &#40;level III&#44; 10&#46;83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7 years&#59; level IV&#44; 10&#46;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8 years&#59; level V&#44; 9&#46;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7 years&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;380&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The distribution by form of CP based on the predominant clinical pattern was&#58; spastic&#44; 75&#46;4&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 52&#41;&#59; mixed&#44; 17&#46;4&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 12&#41;&#59; and dystonic&#44; 7&#46;2&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 5&#41;&#44; although all patients exhibited spasticity &#40;100&#37;&#41;&#46; The extension of paresis was&#58; tetraparesis &#40;59&#46;4&#37;&#59; &#40;<span class="elsevierStyleItalic">n &#61;</span> 41&#41;&#44; triparesis 21&#46;7&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 15&#41;&#44; diparesis 18&#46;9&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 13&#41;&#46; Of all patients&#44; 73&#46;9&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 51&#41; received regular doses of botulinum toxin&#44; with no differences in frequency between groups&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The distribution of patients by feeding modality was&#58; exclusively oral&#44; 87&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 60&#41;&#59; exclusively enteral&#44; 10&#46;1&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 7&#41;&#59; mixed&#44; 2&#46;9&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 2&#41;&#46; Thirteen percent of patients in the sample &#40;<span class="elsevierStyleItalic">n &#61;</span> 9&#41; had a gastrostomy&#44; all of them classified as level V&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents information on the use of supplements and nutritional support in the sample&#44; evincing that the use of polymeric formulas and thickening agents increased with the level of neurologic impairment&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> presents anthropometric data and body composition values calculated using anthropometric measures&#46; We found a higher frequency of anthropometric <span class="elsevierStyleItalic">z</span>-scores in the abnormal range in patients with more severe motor impairment&#44; which was particularly marked in the variables most relevant for assessment of nutritional status in patients with CP&#58; BMI&#44; AC&#44; TSF&#44; WFH&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">The tibial length and knee height could not be assessed in one patient that had undergone a bilateral bone surgery&#44; so this patient underwent segmental measurements&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">We did not find differences in weight&#44; height or BMI based on sex&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">When we classified the patients based on the WFH&#44; we found that most cases of moderate to severe undernutrition occurred in the level V group&#44; while most cases of overweight&#47;obesity occurred in groups III and IV III&#8211;IV &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> presents the body composition data obtained by BIA&#46; We found a significant decrease in the cellular mass in the Level V group compared to the rest of the sample&#46; We also found a decrease in the lean body mass&#44; muscle mass and fat mass in these patients&#44; but only in terms of absolute amounts as opposed to the percentages of the total body mass&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">In this sample&#44; 14&#46;5&#37; of patients &#40;<span class="elsevierStyleItalic">n &#61;</span> 10&#41; were underfat based on the findings of BIA&#44; while 50&#46;7&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 35&#41; had a normal fat mas and 34&#46;8&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 24&#41; excess fat&#46; The distribution by GMFCS level was as follows &#40;<span class="elsevierStyleItalic">P</span> &#61; &#46;104&#41;&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0145" class="elsevierStylePara elsevierViewall">III&#58; 0&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 0&#41; underfat&#44; 64&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 16&#41; normal fat and 36&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 9&#41; excess fat&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0150" class="elsevierStylePara elsevierViewall">IV&#58; 20&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 4&#41; underfat&#44; normal 40&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 8&#41; normal fat&#44; 40&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 8&#41; excess fat&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0155" class="elsevierStylePara elsevierViewall">V&#58; 25&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 6&#41; underfat&#44; 50&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 12&#41; normal fat&#44; 25&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 6&#41; excess fat&#46;</p></li></ul></p><p id="par0160" class="elsevierStylePara elsevierViewall">The distribution of male patients by body fat was&#58; 11&#46;8&#37; underfat &#40;&#60;10&#37;&#41;&#44; 41&#46;2&#37; normal fat &#40;11&#8211;25&#37;&#41;&#44; 47&#37; excess fat &#40;&#62;25&#37;&#41;&#46; The distribution of male patients by body fat was&#58; 17&#46;1&#37; underfat &#40;&#60;15&#37;&#41;&#44; 60&#37; normal fat &#40;16&#8211;30&#37;&#41;&#44; 22&#46;9&#37; excess fat &#40;&#62;30&#37;&#41;&#46; We did not find an association between sex and the prevalence of underfat&#47;normal fat&#47;excess fat established using BIA&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">In the overall sample&#44; the lean body mass was 88&#46;7&#37; of the lean body mass expected for height&#46; This percentage was higher in the level III group &#40;88&#46;93 &#177; 3&#46;5&#37;&#41; and the level IV group &#40;98&#46;31 &#177; 5&#46;7&#37;&#41;&#44; and lower in the level V group &#40;80&#46;66 &#177; 2&#46;8&#37;&#41; &#40;<span class="elsevierStyleItalic">P</span> &#61; &#46;012&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the distribution of the percentage of lean body mass relative to the expected lean body mass by group&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">In the level V group &#40;<span class="elsevierStyleItalic">n &#61;</span> 24&#41;&#44; 33&#46;3&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 8&#41; of patients had a gastrostomy&#46; The mean age of patients with a gastrostomy was 9&#46;73 &#177; 3&#46;3 years &#40;no difference between patients with and without a gastrostomy&#41;&#44; and 50&#37; were girls&#46; The mean time elapsed between the placement of the gastrostomy tube and the time of the study was 43&#46;89 &#177; 8&#46;5 months&#46; <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> compares the body composition and nutritional status markers in patients with and without a gastrostomy&#44; revealing that patients with gastrostomy had lower body muscle and body cell masses&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0175" class="elsevierStylePara elsevierViewall">Maintaining an adequate nutrition in patients with CP requires periodical and routine monitoring of nutritional status to detect actual malnutrition or its risk early on&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> However&#44; less than half of the patients in our study were in follow-up with regular evaluations by a nutrition specialist&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Due to their accessibility&#44; anthropometric methods are most commonly used to assess nutritional outcomes&#44; and the weight&#44; height&#44; TSF and AC are the most widely recommended values for monitoring of patients with CP&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5&#44;18&#44;19</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">When it came to stature&#44; we found that the degree of abnormality was directly proportional to the severity of CP&#46; This was to be expected&#44; as the growth and body composition patterns in patients with CP differ from those of the reference population for age and sex&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> As occurred in our study&#44; stunting tends to be more severe the more severe the neurologic impairment and the feeding difficulties&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Measuring the height of patients at levels III to V is usually challenging due to the presence of scoliosis&#44; spasticity and postural abnormalities&#46; For this reason&#44; it is recommended that height be assessed by taking segmental measurements and using an equation to estimate the stature&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;22</span></a> for which the knee height seems to be the measure least likely to be affected by least technical errors and associated with the lowest intrarater and interrater variability&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;23</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">It is advisable that weight assessments take into account height by using the BMI and&#47;or the WFH&#46; In our study&#44; categorization based on WFH resulted in a higher proportion of patients with undernutrition in the GMFCS level V group&#46; In contrast&#44; we found a high prevalence of overweight&#47;obesity with an excess of body fat in patients with GMFCS levels III to IV&#46; Such excess weight is relatively frequent in patients at levels III to IV that have no feeding problems depending on the level of impairment of motor skills or walking&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">In 2007&#44; Day et al&#46; published specific weight&#44; height and BMI tables for children with CP<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> based on the level of motor impairment&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> These tables are only descriptive and have not been standardised&#44; as there were many factors at play in the study&#44; such as a high prevalence of malnutrition&#44; that could affect anthropometric variables&#44; and therefore the tables do not reflect optimal growth patterns&#46; For this reason&#44; the ESPGHAN recommends against the routine use of these tables to assess for nutritional problems in children with CP&#44; and instead proposes using standardised reference population data&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">In addition to the weight&#44; the height and their relationships&#44; the ESPGHAN recommends routine measurement of subcutaneous skinfolds &#40;especially the TSF&#41; and of the AC to monitor nutritional status&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> In our sample&#44; patients with severe neurologic impairment had the lowest TSF and AC values&#46; The evidence on this aspect is contradictory&#44; as some studies have found similar trends while others have found no association between the level of neurologic impairment and the variability in skinfold and circumference measures&#44;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;24</span></a> and therefore further research is required to corroborate our findings&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">In addition to calculating the <span class="elsevierStyleItalic">z-</span>scores corresponding to the anthropometric measures&#44; it is also important to determine how the weight of the patient is distributed according to body composition&#46; This can be achieved with equations that use skinfold measures&#44; although these equations may not be very accurate in children with CP&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Other methods are available to assess body composition&#44; and BIA is an essential tool in clinical practice for this purpose&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> It is a safe&#44; reliable&#44; painless and quick method for assessment of body composition that is more accurate and with a lesser interrater and intrarater variability compared to other methods&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;25</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">In our study&#44; BIA found a lower muscle mass&#44; lean body mass and fat mass &#40;in kg&#41; in patients with greater impairment based on the GMFCS&#46; This was consistent with the previous literature&#44; in which greater neurologic impairment is associate with decreased body weight&#44; growth and lean body mass&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">When it came to the percentage of lean body mass&#44; we found that it was greater in patients at level V in absolute terms&#44; but when we adjusted the lean mass for height&#44; we found a greater decrease in this group&#46; This is why it is important to evaluate the obtained measures relative to the age&#44; height and sex of the patient&#46; We found it interesting that the lean mass was greater in patients at level IV compared to patients at level III&#46; A possible explanation is that 40&#37; of patients in the level IV group were in follow-up by the nutrition unit&#44; compared to 16&#37; of patients in the level III group&#46; Other authors have reported these positive changes in body composition once regular nutritional follow-up is initiated&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> so the ESPGHAN recommends performance of growth assessments in patients with CP every 1&#8211;3 months&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">Another parameter that can be measured by BIA is the cell mass&#44; which is considered a good marker of nutritional status&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> As occurred in our sample&#44; a study published in 2017 by Sung et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> in a series of 146 patients found a decrease in cell mass in patients with more severe neurologic impairment&#44; especially those with level V functioning&#46; When it comes to the fat compartment&#44; a study published by Kuperminc et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> in 2008 analysed the normal percentage of body fat in patients at levels III to V&#44; and found lower percentages of body fat compared to the percentages found in all groups&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Compared to BIA&#44; anthropometric methods underestimate the fat body mass and overestimates the lean body mass&#46; It has been estimated that anthropometric measures led to a systematic error of approximately 1&#46;3<span class="elsevierStyleHsp" style=""></span>kg in calculating the fat body mass&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> an error similar to the error found in our study&#46; One possible reason is that a decrease in peripheral cutaneous skinfold measures may not necessarily indicate a decrease in adiposity&#44; as fat tends to be stored in the abdominal region in children with CP&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;28</span></a></p><p id="par0230" class="elsevierStylePara elsevierViewall">Gastrostomy tube feeding can be used in case oral intake does not contribute adequate amounts of nutrients&#44; causes discomfort or is unsafe&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;19</span></a> The proportion of patients that required a gastrostomy in our sample was consistent with the 10&#8211;33&#37; range reported in other case series&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> When comparing nutritional status in patients with and without a gastrostomy&#44; previous studies have concluded that patients with gastrostomies have better nutritional outcomes&#44; especially in terms of weight&#44; BMI&#44; fat body mass and lean body mass&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;21</span></a> However&#44; in our sample patients with gastrostomies only exhibited an improvement in weight&#44; with an increase in fat body mass but no increase in the lean body mass&#46; This could be due to a greater degree of neurologic impairment in patients requiring enteral feeding&#44; or to the higher intake of fat associated with gastrostomy tube feeding&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">The main limitation of our study was the small sample size&#44; which was compounded by the division of the sample into groups&#44; although the sample was representative of the catchment population of a regional referral hospital&#44; of considerable size&#44; and the results were statistically significant&#46; Nevertheless&#44; it would be interesting to expand the scope of this investigation with additional studies allowing a comparison of nutritional status with its actual impact on quality of life&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">To conclude&#44; a higher proportion of patients with CP and more severe neurologic impairment are more likely to experience undernutrition&#44; whereas one third of patients with less severe forms of CP exhibited overweight or obesity&#46; Although anthropometry is a widely accessible and very useful tool for nutritional assessment&#44; BIA can be a helpful addition for the non-invasive monitoring of body composition&#44; as traditional anthropometric methods underestimate fat body mass and overestimate lean body mass&#46; When we adjusted the lean body mass for height&#44; we found greater deficits in patients at level V&#44; so it would be relevant to analyse obtained results in relation to age&#44; height and sex&#46; Due to all of the above&#44; performance of both routine and individualised evaluations in patients with CP are needed to ensure adequate nutritional management and to improve the health&#44; quality of life and developmental outcomes in these patients&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0245" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            1 => "Nutrition"
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            0 => "Par&#225;lisis cerebral"
            1 => "Nutrici&#243;n"
            2 => "Bioimpedanciometr&#237;a"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Cerebral palsy &#40;CP&#41; is the most frequent cause of motor disability in the paediatric age&#46; The aim of this article is the study of the nutritional status of patients with CP followed-up in a reference hospital&#44; as well as the relationship between neurological and nutritional state&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional&#44; observational&#44; descriptive and analytical study was conducted on a sample consisting of 4&#8211;15 year old patients with CP with Gross Motor Function Classification System &#40;GMFCS&#41; grades III&#8211;IV&#8211;V&#44; from a specialised paediatric hospital reference area&#46; An interview &#40;collection of general data&#44; medications and nutritional habits&#41;&#44; anthropometric study and bioimpedance &#40;BIA&#41; measurements were carried out&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">The study included 69 patients &#40;recruitment 84&#46;15&#37;&#41;&#44; with a mean age of 10&#46;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;43 years&#44; and 50&#46;7&#37; females&#46; The distribution according to GMFCS scale was&#58; grade III &#40;36&#46;2&#37;&#41;&#44; grade IV &#40;29&#37;&#41;&#44; and grade V &#40;34&#46;8&#37;&#41;&#46; According to weight for height&#58; moderate malnutrition 21&#46;8&#37; &#40;grade V&#58; 33&#46;3&#37;&#41;&#44; severe malnutrition 5&#46;8&#37; &#40;grade V&#58; 12&#46;6&#37;&#41;&#44; overweight&#47;obesity 23&#46;2&#37; &#40;grade III&#58; 24&#37;&#44; grade IV&#58; 35&#37;&#41;&#46; Adequate level of lean mass for height&#58; grade III &#40;36&#37;&#41;&#44; grade IV &#40;55&#37;&#41;&#44; and grade V &#40;16&#46;7&#37;&#41;&#46; Fat excess&#58; grade III &#40;36&#37;&#41;&#44; grade IV &#40;40&#37;&#41;&#44; and grade V &#40;29&#46;2&#37;&#41;&#46; Fat mass comparison&#58; BIA 6&#46;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;64<span class="elsevierStyleHsp" style=""></span>kg versus anthropometry 5&#46;56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;43<span class="elsevierStyleHsp" style=""></span>kg&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">In CP grade GMFCS V&#44; the weight deficit associated with a decrease in lean body mass is common&#46; Patients with CP grades GMFCS III&#8211;IV have a significant prevalence of overweight&#47;obesity&#46; Anthropometry is a useful tool for nutritional assessment in children with CP&#44; although fat levels could be underestimated&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La par&#225;lisis cerebral &#40;PC&#41; es la causa m&#225;s frecuente de discapacidad motora en edad pedi&#225;trica&#46; El objetivo es estudiar la situaci&#243;n nutricional de los pacientes con PC controlados en una unidad de referencia&#44; as&#237; como la relaci&#243;n entre la afectaci&#243;n neurol&#243;gica y nutricional&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal&#44; observacional&#44; descriptivo y anal&#237;tico en el que se han incluido pacientes con PC con grados III&#8211;IV&#8211;V &#40;GMFCS&#41; procedentes del &#225;rea de influencia de un hospital pedi&#225;trico de referencia&#44; con edades de 4&#8211;15 a&#241;os&#46; Se ha realizado&#58; encuesta &#40;con recogida de datos generales&#44; medicaciones y h&#225;bitos nutricionales&#41;&#44; estudio antropom&#233;trico y bioimpedanciometr&#237;a &#40;BIA&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>69 pacientes &#40;reclutamiento 84&#44;15&#37;&#41;&#46; Edad media 10&#44;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;43 a&#241;os&#44; el 50&#44;7&#37; mujeres&#46; Distribuci&#243;n seg&#250;n GMFCS&#58; grado III &#40;36&#44;2&#37;&#41;&#44; grado IV &#40;29&#37;&#41;&#44; grado V &#40;34&#44;8&#37;&#41;&#46; Seg&#250;n el peso para la talla&#58; desnutrici&#243;n moderada el 21&#44;8&#37; &#40;grado V&#58; 33&#44;3&#37;&#41;&#44; desnutrici&#243;n grave el 5&#44;8&#37; &#40;grado V&#58; 12&#46;6&#37;&#41;&#44; sobrepeso&#47;obesidad el 23&#44;2&#37; &#40;grado III&#58; 24&#37;&#59; grado IV&#58; 35&#37;&#41;&#46; Nivel adecuado de masa magra para su talla&#58; grado III &#40;36&#37;&#41;&#44; grado IV &#40;55&#37;&#41;&#44; grado V &#40;16&#44;7&#37;&#41;&#46; Exceso de grasa&#58; grado III &#40;36&#37;&#41;&#44; grado IV &#40;40&#37;&#41;&#44; grado V &#40;29&#44;2&#37;&#41;&#46; Comparaci&#243;n de masa grasa&#58; BIA 6&#44;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;64<span class="elsevierStyleHsp" style=""></span>kg Vs antropometr&#237;a 5&#44;56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;43<span class="elsevierStyleHsp" style=""></span>kg&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">En PC grado GMFCS V es frecuente el d&#233;ficit de peso asociado a disminuci&#243;n de masa magra para su talla&#46; Los pacientes con PC grados GMFCS III-IV presentan una prevalencia llamativa de sobrepeso&#47;obesidad&#46; La antropometr&#237;a es una herramienta &#250;til para la valoraci&#243;n nutricional en ni&#241;os con PC&#44; aunque los niveles de grasa tienden a infravalorarse&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Fern&#225;ndez JMMdZ&#44; Arnal IR&#44; Segura JLP&#44; Romero RG&#44; Mart&#237;nez GR&#46; Situaci&#243;n nutricional en una poblaci&#243;n con par&#225;lisis cerebral moderada-grave&#58; m&#225;s all&#225; del peso&#46; An Pediatr &#40;Barc&#41;&#46; 2020&#59;92&#58;192&#8211;199&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Percentage of lean mass relative to the ideal mass by GMFCS level&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Follow-up in nutrition clinic&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Require supplementation with polymeric formula&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Dosage &#40;kcal&#47;day&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#8722;1&#46;64 &#40;&#8722;2&#46;09&#59; &#8722;1&#46;21&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">SSSF &#40;<span class="elsevierStyleItalic">z</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#46;060&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">SISF &#40;<span class="elsevierStyleItalic">z</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#8722;0&#46;23 &#40;&#8722;072&#59;0&#46;26&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;85 &#40;&#8722;1&#46;32&#59; &#8722;0&#46;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;85 &#40;&#8722;1&#46;34&#59; &#8722;0&#46;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;096&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weight for height and body composition&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">WFH &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97&#46;0 &#177; 24&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101&#46;5 &#177; 4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">105&#46;1 &#177; 6&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#46;52 &#177; 3&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fat mass&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;2 &#177; 7&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">20&#46;5 &#177; 1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;2 &#177; 1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;0 &#177; 1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;123&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fat mass&#44; kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;6 &#177; 4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;4 &#177; 1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;9 &#177; 1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;5 &#177; 0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lean mass&#44; kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;4 &#177; 9&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;1 &#177; 2&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;6 &#177; 2&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;6 &#177; 0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">WFH&#44; weight-for-height&#46;</p>"
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            0 => array:2 [
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                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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CP level&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total sample &#40;<span class="elsevierStyleItalic">n<span class="elsevierStyleHsp" style=""></span>&#61;</span><span class="elsevierStyleHsp" style=""></span>69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Level III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Level IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Level V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Overweight&#47;obesity&#58; WFH<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>110&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;2&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;5&#37;&#40;<span class="elsevierStyleItalic">n &#61;</span> 3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&#58; WFH 90&#8211;110&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;3&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;8&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mild underweight&#58; WFH 80&#8211;90&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;9&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;8&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderate underweight&#58; WFH 70&#8211;79&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;8&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;3&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Severe underweight&#58; WFH<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#46;8&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&#46;6&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  <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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total sample&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Level III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Level IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Level V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total water&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;1 &#177; 1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#46;4 &#177; 1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;8 &#177; 2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#46;3 &#177; 2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;043&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Extracellular water&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;7 &#177; 1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;2 &#177; 1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;3 &#177; 1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#46;5 &#177; 2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;996&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intracellular water&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;4 &#177; 1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;9 &#177; 1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;7 &#177; 1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#46;5 &#177; 2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;994&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lean mass&#44; kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;0 &#177; 1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;5 &#177; 2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;3 &#177; 1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;2 &#177; 1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lean mass&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#46;9 &#177; 1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#46;5 &#177; 1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#46;0 &#177; 2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&#46;4 &#177; 2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;095&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Muscle mass&#44; kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;0 &#177; 0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;3 &#177; 1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;2 &#177; 1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;5 &#177; 0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Muscle mass&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;9 &#177; 1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;0 &#177; 1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;6 &#177; 1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#46;5 &#177; 2&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;161&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cell mass&#44; kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;6 &#177; 0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;5 &#177; 1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;7 &#177; 1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;5 &#177; 0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cell mass&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;6 &#177; 0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#46;12 &#177; 1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#46;1 &#177; 1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#46;0 &#177; 1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fat mass&#44; kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;9 &#177; 0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;0 &#177; 1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;2 &#177; 1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;5 &#177; 0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fat mass&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;7 &#177; 2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;5 &#177; 1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;8 &#177; 2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;6 &#177; 2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;111&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Body composition calculated by bioelectrical impedance analysis &#40;BIA&#41; by GMFCS level&#46;</p>"
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      5 => array:8 [
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          "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">BMI&#44; body mass index&#59; CI&#44; confidence interval&#59; SD&#44; standard deviation&#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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No gastrostomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gastrostomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anthropometric measures&#44; mean &#40;95&#37; CI&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Height &#40;<span class="elsevierStyleItalic">z</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;3&#46;24 &#40;&#8722;3&#46;88&#59;&#8722;2&#46;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;3&#46;43 &#40;&#8722;4&#46;72&#59; &#8722;2&#46;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;745&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weight &#40;<span class="elsevierStyleItalic">z</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;1 &#40;&#8722;2&#46;47&#59; &#8722;1&#46;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;24 &#40;&#8722;3&#46;17&#59; &#8722;1&#46;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;710&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BMI &#40;<span class="elsevierStyleItalic">z</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;31 &#40;&#8722;1&#46;76&#59; &#8722;0&#46;85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;13 &#40;&#8722;2&#46;33&#59;0&#46;07&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;706&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weight for height&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#46;0 &#177; 3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&#46;6 &#177; 8&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;341&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BIA&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total water&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;6 &#177; 2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#46;7 &#177; 5&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;088&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Extracellular water&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;8 &#177; 2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;9 &#177; 4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;689&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intracellular water&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;2 &#177; 2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#46;1 &#177; 4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;677&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lean mass&#44; kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;9 &#177; 0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;8 &#177; 2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;328&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lean mass&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;8 &#177; 2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#46;8 &#177; 5&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;171&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Muscle mass&#44; kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;0 &#177; 0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;7 &#177; 1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;227&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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Original Article
Nutritional status of a population with moderate-severe cerebral palsy: Beyond the weight
Situación nutricional en una población con parálisis cerebral moderada-grave: más allá del peso
José Miguel Martínez de Zabarte Fernándeza,
Corresponding author
chemi87@hormail.com

Corresponding author.
, Ignacio Ros Arnalb, José Luis Peña Segurac, Ruth García Romerob, Gerardo Rodríguez Martínezd
a Servicio de Pediatría, Hospital Obispo Polanco, Teruel, Spain
b Unidad de Gastroenterología y Nutrición Pediátrica, Hospital Universitario Miguel Servet, Zaragoza, Spain
c Unidad de Neuropediatría, Hospital Universitario Miguel Servet, Zaragoza, Spain
d Universidad de Zaragoza, Instituto de Investigación Sanitaria Aragón, Red de Salud Materno Infantil y del Desarrollo (SAMID), RETICS ISCIII, Zaragoza, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Cerebral palsy &#40;CP&#41; is the most frequent cause of motor impairment in the paediatric age group and the third leading cause of neurodevelopmental disorders following intellectual disability and autism spectrum disorders&#46; The term CP refers to motor sequelae that may be accompanied by other disorders and does not carry any aetiological implications or an association with a specific past medical history or adverse events&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The collaborative project known as Surveillance of Cerebral Palsy in Europe<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> has reported an incidence of CP of 2&#8211;3 cases per 1000 live births&#46; This group recommends a minimum age of 3 years for diagnosis of CP and considers age 5 years optimal&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Feeding problems are frequent in children with CP&#44; although nutritional and feeding problems are more frequent and severe in those with more severe neurologic impairment&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> The reported prevalence of malnutrition varies widely between case series&#44; ranging between 19&#37; and 50&#46;9&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Nutritional management aims at ensuring optimal growth&#44; preventing malnutrition and disorders related to nutritional deficiencies&#44; and at establishing healthy dietary habits to prevent the development of diseases associated with poor nutrition&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> An adequate nutritional status improves outcomes in motor skills&#44; cognitive stills&#44; communication and social interaction&#44; and therefore overall neurodevelopmental outcomes&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Nutritional and dietary measures must be safe and effective&#44; allowing to the extent possible the enjoyment of food&#46; All of the above requires continuous&#44; comprehensive&#44; coordinated and close monitoring based on a multidisciplinary approach&#44; with participation of paediatric neurologists&#44; gastroenterologists&#44; nutritionists&#47;dietitians&#44; nursing staff&#44; speech therapists and rehabilitation specialists&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of our study was to assess the nutritional status of patients with predominantly spastic CP and the degree of nutritional compromise based on the severity of CP&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">We conducted a cross-sectional&#44; observational&#44; descriptive and inferential study&#46; The study universe consisted of the patients aged 4&#8211;15 years with moderate to severe predominantly spastic CP managed in the paediatric neurology unit of a referral hospital&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We included patients at levels III&#44; IV or IV of the Gross Motor Function Classification System &#40;GMFCS&#41; developed by Palisano et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and modified according to the International Classification of Functioning&#44; Disability and Health &#40;ICF&#41; of the World Health Organization &#40;WHO&#41;&#44; which categorises patients based on the degree of motor impairment&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">We excluded patients who refused or whose parents refused to participate in the study&#44; those outside the age range under study&#44; and those that did not meet the diagnostic criteria for CP&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The study was approved by the Regional Ethics Committee &#40;CEICA&#59; PI16&#47;039&#41;&#46; All participating patients and&#47;or their guardians signed an informed consent form&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">After ascertaining that patients met the inclusion criteria&#44; we contacted the patient or the guardians to schedule an office visit during which we carried out a clinical interview to collect data on variables related to the patient&#8217;s clinical condition&#44; anthropometric values and dietary habits&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">For the anthropometric assessment&#44; we used the height calculated by means of the knee-height &#40;KH&#41; stature estimate equation developed by Stevenson<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#58; height<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>KH<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>2&#46;69<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>24&#46;2<span class="elsevierStyleHsp" style=""></span>cm&#46; The other anthropometric measurements taken were the weight&#44; arm circumference &#40;AC&#41;&#44; subcutaneous skinfolds &#40;biceps&#44; triceps &#91;TSF&#93;&#44; subscapular&#44; suprailiac&#41;&#46; These measurements were made with measuring tape &#40;perimeter and segmental height measures&#41;&#44; Holtain&#174; skinfold callipers &#40;subcutaneous folds&#41;&#44; scale &#40;weight&#41; and callipers &#40;knee height&#41;&#46; We used the Siri equation to estimate body composition&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">We calculated the <span class="elsevierStyleItalic">z</span>-scores for the obtained anthropometric values using the growth tables of Carrascosa et al&#46; &#40;2010&#41; as Ref&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> in adherence to the recommendation made in 2017 by the European Society for Paediatric Gastroenterology&#44; Hepatology and Nutrition &#40;ESPGHAN&#41; of using a standardised reference population&#46; We calculated the body mass index &#40;BMI&#41; and the weight-for-height &#40;WFH&#41; to categorise the nutritional status of the patient based on weight&#58; WFH<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>patient weight&#47;expected weight for height &#40;50th percentile&#41;<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">We evaluated the body composition of the patients using bioelectrical impedance analysis &#40;BIA&#41; with an Akern BIA-101 Anniversary bio-impedance analyser&#46; This method allowed us to obtain values for the total body water &#40;extracellular and intracellular e intracellular&#41;&#44; fat body mass&#44; body cell mass &#40;total mass of living&#44; functioning and metabolically active cells&#41; and lean body mass &#40;muscle mass and bone mass&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a> Measurements are obtained by adhering electrodes to the skin to generate a small alternating current in a single or multiple frequencies&#44; recording the resistance &#40;opposition to the passage of the electric current&#41; and the reactance &#40;the delay in conduction caused by cellular membranes&#44; tissue interfaces and non-ionic tissues&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Patients underwent BIA following a fast of at least 4<span class="elsevierStyleHsp" style=""></span>h&#44; after avoiding physical activity for at least the last 12<span class="elsevierStyleHsp" style=""></span>h and in a state of absolute rest&#46; The measurements were made with the patient lying in the supine position with the arms abducted at 20&#176;&#8211;30&#176; and the legs at 45&#176; from the trunk&#46; The 2 current-introducing electrodes were placed in the midlines of the wrist and the ankle of the unclothed patient lying on a cot made of non-conductive material&#44; and the voltage-sensing electrodes 4&#8211;5<span class="elsevierStyleHsp" style=""></span>cm away from the source along the metacarpal and the metatarsal phalangeal lines&#44; respectively&#59; always homolaterally &#40;hemibody&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In order to accurately assess lean body mass and eliminate the potential bias associated with low weight in these patients&#44; we calculated the expected percentage of lean mass for their height&#46; To do so&#44; after obtaining the expected weight for their height &#40;using the median in the growth charts of Carrascosa et al&#46;&#44; 2010&#41;&#44; we calculated the expected kilograms of lean mass &#40;using the references published by Fomon<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and Haschke<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#41; and&#44; lastly&#44; divided the lean body mass of the patient by the expected lean body mass &#40;both in kg&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">To classify lean body mass values&#44; we applied the cutoffs proposed by Lohman and Going<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#58; underfat &#40;&#60;10&#37; in boys and &#60;15&#37; in girls&#41;&#44; normal &#40;11&#8211;25&#37; in boys and 16&#8211;30&#37; in girls&#41; and excess fat &#40;&#62;25&#37; in boys and &#62;30&#37; in girls&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Our statistical analysis was performed with the software SPSS Statistics version 21&#46;0&#46; We did a descriptive analysis&#44; summarising the results as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation &#40;SD&#41; with the 95&#37; confidence interval &#40;quantitative variables&#41; or as frequencies &#40;qualitative variables&#41;&#46; We tested for normality with the Kolmogorov-Smirnov and Shapiro-Wilk tests&#46; Afterward&#44; we performed hypothesis testing with different methods&#58; chi square test and Fisher exact test &#40;qualitative variables&#41;&#44; Student <span class="elsevierStyleItalic">t</span> test &#40;parametric data&#44; quantitative and dichotomous variables&#41;&#44; Mann-Whitney <span class="elsevierStyleItalic">U</span> test &#40;nonparametric data&#44; quantitative and dichotomous variables&#41;&#44; analysis of variance &#40;ANOVA&#41; with the Bonferroni correction &#40;parametric data&#44; quantitative and dichotomous variables&#41; and Kruskal-Wallis test &#40;nonparametric data&#44; quantitative and non-dichotomous qualitative&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0095" class="elsevierStylePara elsevierViewall">A total of 82 patients met the inclusion criteria&#44; but we were unable to locate or obtain content for participation from 13&#44; so the final sample included 69 patients &#40;recruitment of 84&#46;2&#37;&#41;&#46; Of this total&#44; 50&#46;7&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>35&#41; were female&#46; The distribution of patients by level of functioning based on the GMFCS was as follows&#58; level III&#44; 36&#46;2&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>25&#41;&#59; level IV&#44; 29&#46;0&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>20&#41;&#59; level V&#44; 34&#46;8&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>24&#41;&#46; The mean age was 10&#46;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;4 years &#40;level III&#44; 10&#46;83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7 years&#59; level IV&#44; 10&#46;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8 years&#59; level V&#44; 9&#46;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7 years&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;380&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The distribution by form of CP based on the predominant clinical pattern was&#58; spastic&#44; 75&#46;4&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 52&#41;&#59; mixed&#44; 17&#46;4&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 12&#41;&#59; and dystonic&#44; 7&#46;2&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 5&#41;&#44; although all patients exhibited spasticity &#40;100&#37;&#41;&#46; The extension of paresis was&#58; tetraparesis &#40;59&#46;4&#37;&#59; &#40;<span class="elsevierStyleItalic">n &#61;</span> 41&#41;&#44; triparesis 21&#46;7&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 15&#41;&#44; diparesis 18&#46;9&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 13&#41;&#46; Of all patients&#44; 73&#46;9&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 51&#41; received regular doses of botulinum toxin&#44; with no differences in frequency between groups&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The distribution of patients by feeding modality was&#58; exclusively oral&#44; 87&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 60&#41;&#59; exclusively enteral&#44; 10&#46;1&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 7&#41;&#59; mixed&#44; 2&#46;9&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 2&#41;&#46; Thirteen percent of patients in the sample &#40;<span class="elsevierStyleItalic">n &#61;</span> 9&#41; had a gastrostomy&#44; all of them classified as level V&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents information on the use of supplements and nutritional support in the sample&#44; evincing that the use of polymeric formulas and thickening agents increased with the level of neurologic impairment&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> presents anthropometric data and body composition values calculated using anthropometric measures&#46; We found a higher frequency of anthropometric <span class="elsevierStyleItalic">z</span>-scores in the abnormal range in patients with more severe motor impairment&#44; which was particularly marked in the variables most relevant for assessment of nutritional status in patients with CP&#58; BMI&#44; AC&#44; TSF&#44; WFH&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">The tibial length and knee height could not be assessed in one patient that had undergone a bilateral bone surgery&#44; so this patient underwent segmental measurements&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">We did not find differences in weight&#44; height or BMI based on sex&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">When we classified the patients based on the WFH&#44; we found that most cases of moderate to severe undernutrition occurred in the level V group&#44; while most cases of overweight&#47;obesity occurred in groups III and IV III&#8211;IV &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> presents the body composition data obtained by BIA&#46; We found a significant decrease in the cellular mass in the Level V group compared to the rest of the sample&#46; We also found a decrease in the lean body mass&#44; muscle mass and fat mass in these patients&#44; but only in terms of absolute amounts as opposed to the percentages of the total body mass&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">In this sample&#44; 14&#46;5&#37; of patients &#40;<span class="elsevierStyleItalic">n &#61;</span> 10&#41; were underfat based on the findings of BIA&#44; while 50&#46;7&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 35&#41; had a normal fat mas and 34&#46;8&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 24&#41; excess fat&#46; The distribution by GMFCS level was as follows &#40;<span class="elsevierStyleItalic">P</span> &#61; &#46;104&#41;&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0145" class="elsevierStylePara elsevierViewall">III&#58; 0&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 0&#41; underfat&#44; 64&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 16&#41; normal fat and 36&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 9&#41; excess fat&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0150" class="elsevierStylePara elsevierViewall">IV&#58; 20&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 4&#41; underfat&#44; normal 40&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 8&#41; normal fat&#44; 40&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 8&#41; excess fat&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0155" class="elsevierStylePara elsevierViewall">V&#58; 25&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 6&#41; underfat&#44; 50&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 12&#41; normal fat&#44; 25&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 6&#41; excess fat&#46;</p></li></ul></p><p id="par0160" class="elsevierStylePara elsevierViewall">The distribution of male patients by body fat was&#58; 11&#46;8&#37; underfat &#40;&#60;10&#37;&#41;&#44; 41&#46;2&#37; normal fat &#40;11&#8211;25&#37;&#41;&#44; 47&#37; excess fat &#40;&#62;25&#37;&#41;&#46; The distribution of male patients by body fat was&#58; 17&#46;1&#37; underfat &#40;&#60;15&#37;&#41;&#44; 60&#37; normal fat &#40;16&#8211;30&#37;&#41;&#44; 22&#46;9&#37; excess fat &#40;&#62;30&#37;&#41;&#46; We did not find an association between sex and the prevalence of underfat&#47;normal fat&#47;excess fat established using BIA&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">In the overall sample&#44; the lean body mass was 88&#46;7&#37; of the lean body mass expected for height&#46; This percentage was higher in the level III group &#40;88&#46;93 &#177; 3&#46;5&#37;&#41; and the level IV group &#40;98&#46;31 &#177; 5&#46;7&#37;&#41;&#44; and lower in the level V group &#40;80&#46;66 &#177; 2&#46;8&#37;&#41; &#40;<span class="elsevierStyleItalic">P</span> &#61; &#46;012&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the distribution of the percentage of lean body mass relative to the expected lean body mass by group&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">In the level V group &#40;<span class="elsevierStyleItalic">n &#61;</span> 24&#41;&#44; 33&#46;3&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 8&#41; of patients had a gastrostomy&#46; The mean age of patients with a gastrostomy was 9&#46;73 &#177; 3&#46;3 years &#40;no difference between patients with and without a gastrostomy&#41;&#44; and 50&#37; were girls&#46; The mean time elapsed between the placement of the gastrostomy tube and the time of the study was 43&#46;89 &#177; 8&#46;5 months&#46; <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> compares the body composition and nutritional status markers in patients with and without a gastrostomy&#44; revealing that patients with gastrostomy had lower body muscle and body cell masses&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0175" class="elsevierStylePara elsevierViewall">Maintaining an adequate nutrition in patients with CP requires periodical and routine monitoring of nutritional status to detect actual malnutrition or its risk early on&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> However&#44; less than half of the patients in our study were in follow-up with regular evaluations by a nutrition specialist&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Due to their accessibility&#44; anthropometric methods are most commonly used to assess nutritional outcomes&#44; and the weight&#44; height&#44; TSF and AC are the most widely recommended values for monitoring of patients with CP&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5&#44;18&#44;19</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">When it came to stature&#44; we found that the degree of abnormality was directly proportional to the severity of CP&#46; This was to be expected&#44; as the growth and body composition patterns in patients with CP differ from those of the reference population for age and sex&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> As occurred in our study&#44; stunting tends to be more severe the more severe the neurologic impairment and the feeding difficulties&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Measuring the height of patients at levels III to V is usually challenging due to the presence of scoliosis&#44; spasticity and postural abnormalities&#46; For this reason&#44; it is recommended that height be assessed by taking segmental measurements and using an equation to estimate the stature&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;22</span></a> for which the knee height seems to be the measure least likely to be affected by least technical errors and associated with the lowest intrarater and interrater variability&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;23</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">It is advisable that weight assessments take into account height by using the BMI and&#47;or the WFH&#46; In our study&#44; categorization based on WFH resulted in a higher proportion of patients with undernutrition in the GMFCS level V group&#46; In contrast&#44; we found a high prevalence of overweight&#47;obesity with an excess of body fat in patients with GMFCS levels III to IV&#46; Such excess weight is relatively frequent in patients at levels III to IV that have no feeding problems depending on the level of impairment of motor skills or walking&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">In 2007&#44; Day et al&#46; published specific weight&#44; height and BMI tables for children with CP<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> based on the level of motor impairment&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> These tables are only descriptive and have not been standardised&#44; as there were many factors at play in the study&#44; such as a high prevalence of malnutrition&#44; that could affect anthropometric variables&#44; and therefore the tables do not reflect optimal growth patterns&#46; For this reason&#44; the ESPGHAN recommends against the routine use of these tables to assess for nutritional problems in children with CP&#44; and instead proposes using standardised reference population data&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">In addition to the weight&#44; the height and their relationships&#44; the ESPGHAN recommends routine measurement of subcutaneous skinfolds &#40;especially the TSF&#41; and of the AC to monitor nutritional status&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> In our sample&#44; patients with severe neurologic impairment had the lowest TSF and AC values&#46; The evidence on this aspect is contradictory&#44; as some studies have found similar trends while others have found no association between the level of neurologic impairment and the variability in skinfold and circumference measures&#44;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;24</span></a> and therefore further research is required to corroborate our findings&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">In addition to calculating the <span class="elsevierStyleItalic">z-</span>scores corresponding to the anthropometric measures&#44; it is also important to determine how the weight of the patient is distributed according to body composition&#46; This can be achieved with equations that use skinfold measures&#44; although these equations may not be very accurate in children with CP&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Other methods are available to assess body composition&#44; and BIA is an essential tool in clinical practice for this purpose&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> It is a safe&#44; reliable&#44; painless and quick method for assessment of body composition that is more accurate and with a lesser interrater and intrarater variability compared to other methods&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;25</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">In our study&#44; BIA found a lower muscle mass&#44; lean body mass and fat mass &#40;in kg&#41; in patients with greater impairment based on the GMFCS&#46; This was consistent with the previous literature&#44; in which greater neurologic impairment is associate with decreased body weight&#44; growth and lean body mass&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">When it came to the percentage of lean body mass&#44; we found that it was greater in patients at level V in absolute terms&#44; but when we adjusted the lean mass for height&#44; we found a greater decrease in this group&#46; This is why it is important to evaluate the obtained measures relative to the age&#44; height and sex of the patient&#46; We found it interesting that the lean mass was greater in patients at level IV compared to patients at level III&#46; A possible explanation is that 40&#37; of patients in the level IV group were in follow-up by the nutrition unit&#44; compared to 16&#37; of patients in the level III group&#46; Other authors have reported these positive changes in body composition once regular nutritional follow-up is initiated&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> so the ESPGHAN recommends performance of growth assessments in patients with CP every 1&#8211;3 months&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">Another parameter that can be measured by BIA is the cell mass&#44; which is considered a good marker of nutritional status&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> As occurred in our sample&#44; a study published in 2017 by Sung et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> in a series of 146 patients found a decrease in cell mass in patients with more severe neurologic impairment&#44; especially those with level V functioning&#46; When it comes to the fat compartment&#44; a study published by Kuperminc et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> in 2008 analysed the normal percentage of body fat in patients at levels III to V&#44; and found lower percentages of body fat compared to the percentages found in all groups&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Compared to BIA&#44; anthropometric methods underestimate the fat body mass and overestimates the lean body mass&#46; It has been estimated that anthropometric measures led to a systematic error of approximately 1&#46;3<span class="elsevierStyleHsp" style=""></span>kg in calculating the fat body mass&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> an error similar to the error found in our study&#46; One possible reason is that a decrease in peripheral cutaneous skinfold measures may not necessarily indicate a decrease in adiposity&#44; as fat tends to be stored in the abdominal region in children with CP&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;28</span></a></p><p id="par0230" class="elsevierStylePara elsevierViewall">Gastrostomy tube feeding can be used in case oral intake does not contribute adequate amounts of nutrients&#44; causes discomfort or is unsafe&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;19</span></a> The proportion of patients that required a gastrostomy in our sample was consistent with the 10&#8211;33&#37; range reported in other case series&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> When comparing nutritional status in patients with and without a gastrostomy&#44; previous studies have concluded that patients with gastrostomies have better nutritional outcomes&#44; especially in terms of weight&#44; BMI&#44; fat body mass and lean body mass&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;21</span></a> However&#44; in our sample patients with gastrostomies only exhibited an improvement in weight&#44; with an increase in fat body mass but no increase in the lean body mass&#46; This could be due to a greater degree of neurologic impairment in patients requiring enteral feeding&#44; or to the higher intake of fat associated with gastrostomy tube feeding&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">The main limitation of our study was the small sample size&#44; which was compounded by the division of the sample into groups&#44; although the sample was representative of the catchment population of a regional referral hospital&#44; of considerable size&#44; and the results were statistically significant&#46; Nevertheless&#44; it would be interesting to expand the scope of this investigation with additional studies allowing a comparison of nutritional status with its actual impact on quality of life&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">To conclude&#44; a higher proportion of patients with CP and more severe neurologic impairment are more likely to experience undernutrition&#44; whereas one third of patients with less severe forms of CP exhibited overweight or obesity&#46; Although anthropometry is a widely accessible and very useful tool for nutritional assessment&#44; BIA can be a helpful addition for the non-invasive monitoring of body composition&#44; as traditional anthropometric methods underestimate fat body mass and overestimate lean body mass&#46; When we adjusted the lean body mass for height&#44; we found greater deficits in patients at level V&#44; so it would be relevant to analyse obtained results in relation to age&#44; height and sex&#46; Due to all of the above&#44; performance of both routine and individualised evaluations in patients with CP are needed to ensure adequate nutritional management and to improve the health&#44; quality of life and developmental outcomes in these patients&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0245" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            1 => "Nutrition"
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          "palabras" => array:6 [
            0 => "Par&#225;lisis cerebral"
            1 => "Nutrici&#243;n"
            2 => "Bioimpedanciometr&#237;a"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Cerebral palsy &#40;CP&#41; is the most frequent cause of motor disability in the paediatric age&#46; The aim of this article is the study of the nutritional status of patients with CP followed-up in a reference hospital&#44; as well as the relationship between neurological and nutritional state&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional&#44; observational&#44; descriptive and analytical study was conducted on a sample consisting of 4&#8211;15 year old patients with CP with Gross Motor Function Classification System &#40;GMFCS&#41; grades III&#8211;IV&#8211;V&#44; from a specialised paediatric hospital reference area&#46; An interview &#40;collection of general data&#44; medications and nutritional habits&#41;&#44; anthropometric study and bioimpedance &#40;BIA&#41; measurements were carried out&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">The study included 69 patients &#40;recruitment 84&#46;15&#37;&#41;&#44; with a mean age of 10&#46;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;43 years&#44; and 50&#46;7&#37; females&#46; The distribution according to GMFCS scale was&#58; grade III &#40;36&#46;2&#37;&#41;&#44; grade IV &#40;29&#37;&#41;&#44; and grade V &#40;34&#46;8&#37;&#41;&#46; According to weight for height&#58; moderate malnutrition 21&#46;8&#37; &#40;grade V&#58; 33&#46;3&#37;&#41;&#44; severe malnutrition 5&#46;8&#37; &#40;grade V&#58; 12&#46;6&#37;&#41;&#44; overweight&#47;obesity 23&#46;2&#37; &#40;grade III&#58; 24&#37;&#44; grade IV&#58; 35&#37;&#41;&#46; Adequate level of lean mass for height&#58; grade III &#40;36&#37;&#41;&#44; grade IV &#40;55&#37;&#41;&#44; and grade V &#40;16&#46;7&#37;&#41;&#46; Fat excess&#58; grade III &#40;36&#37;&#41;&#44; grade IV &#40;40&#37;&#41;&#44; and grade V &#40;29&#46;2&#37;&#41;&#46; Fat mass comparison&#58; BIA 6&#46;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;64<span class="elsevierStyleHsp" style=""></span>kg versus anthropometry 5&#46;56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;43<span class="elsevierStyleHsp" style=""></span>kg&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">In CP grade GMFCS V&#44; the weight deficit associated with a decrease in lean body mass is common&#46; Patients with CP grades GMFCS III&#8211;IV have a significant prevalence of overweight&#47;obesity&#46; Anthropometry is a useful tool for nutritional assessment in children with CP&#44; although fat levels could be underestimated&#46;</p></span>"
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            "titulo" => "Material and methods"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La par&#225;lisis cerebral &#40;PC&#41; es la causa m&#225;s frecuente de discapacidad motora en edad pedi&#225;trica&#46; El objetivo es estudiar la situaci&#243;n nutricional de los pacientes con PC controlados en una unidad de referencia&#44; as&#237; como la relaci&#243;n entre la afectaci&#243;n neurol&#243;gica y nutricional&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal&#44; observacional&#44; descriptivo y anal&#237;tico en el que se han incluido pacientes con PC con grados III&#8211;IV&#8211;V &#40;GMFCS&#41; procedentes del &#225;rea de influencia de un hospital pedi&#225;trico de referencia&#44; con edades de 4&#8211;15 a&#241;os&#46; Se ha realizado&#58; encuesta &#40;con recogida de datos generales&#44; medicaciones y h&#225;bitos nutricionales&#41;&#44; estudio antropom&#233;trico y bioimpedanciometr&#237;a &#40;BIA&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>69 pacientes &#40;reclutamiento 84&#44;15&#37;&#41;&#46; Edad media 10&#44;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;43 a&#241;os&#44; el 50&#44;7&#37; mujeres&#46; Distribuci&#243;n seg&#250;n GMFCS&#58; grado III &#40;36&#44;2&#37;&#41;&#44; grado IV &#40;29&#37;&#41;&#44; grado V &#40;34&#44;8&#37;&#41;&#46; Seg&#250;n el peso para la talla&#58; desnutrici&#243;n moderada el 21&#44;8&#37; &#40;grado V&#58; 33&#44;3&#37;&#41;&#44; desnutrici&#243;n grave el 5&#44;8&#37; &#40;grado V&#58; 12&#46;6&#37;&#41;&#44; sobrepeso&#47;obesidad el 23&#44;2&#37; &#40;grado III&#58; 24&#37;&#59; grado IV&#58; 35&#37;&#41;&#46; Nivel adecuado de masa magra para su talla&#58; grado III &#40;36&#37;&#41;&#44; grado IV &#40;55&#37;&#41;&#44; grado V &#40;16&#44;7&#37;&#41;&#46; Exceso de grasa&#58; grado III &#40;36&#37;&#41;&#44; grado IV &#40;40&#37;&#41;&#44; grado V &#40;29&#44;2&#37;&#41;&#46; Comparaci&#243;n de masa grasa&#58; BIA 6&#44;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;64<span class="elsevierStyleHsp" style=""></span>kg Vs antropometr&#237;a 5&#44;56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;43<span class="elsevierStyleHsp" style=""></span>kg&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">En PC grado GMFCS V es frecuente el d&#233;ficit de peso asociado a disminuci&#243;n de masa magra para su talla&#46; Los pacientes con PC grados GMFCS III-IV presentan una prevalencia llamativa de sobrepeso&#47;obesidad&#46; La antropometr&#237;a es una herramienta &#250;til para la valoraci&#243;n nutricional en ni&#241;os con PC&#44; aunque los niveles de grasa tienden a infravalorarse&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Fern&#225;ndez JMMdZ&#44; Arnal IR&#44; Segura JLP&#44; Romero RG&#44; Mart&#237;nez GR&#46; Situaci&#243;n nutricional en una poblaci&#243;n con par&#225;lisis cerebral moderada-grave&#58; m&#225;s all&#225; del peso&#46; An Pediatr &#40;Barc&#41;&#46; 2020&#59;92&#58;192&#8211;199&#46;</p>"
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                  \t\t\t\t">Follow-up in nutrition clinic&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">42&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 29&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Require supplementation with polymeric formula&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">34&#46;8&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">8&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">62&#46;5&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Dosage &#40;kcal&#47;day&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">561 &#177; 64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">225 &#177; 75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">492 &#177; 85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">638 &#177; 87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Require thickening agents&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">18&#46;8&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;3&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#46;032&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Gastrostomy&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33&#46;3&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">SISF &#40;<span class="elsevierStyleItalic">z</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#8722;0&#46;85 &#40;&#8722;1&#46;34&#59; &#8722;0&#46;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#46;096&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Weight for height and body composition&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">WFH &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#46;52 &#177; 3&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#46;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Fat mass&#44; &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">18&#46;2 &#177; 1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">16&#46;0 &#177; 1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#46;123&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Fat mass&#44; kg&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#46;4 &#177; 1&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;9 &#177; 1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;5 &#177; 0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#46;029&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Lean mass&#44; kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;6 &#177; 2&#46;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  """
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CP level&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total sample &#40;<span class="elsevierStyleItalic">n<span class="elsevierStyleHsp" style=""></span>&#61;</span><span class="elsevierStyleHsp" style=""></span>69&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Level III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Level IV&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Level V&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Overweight&#47;obesity&#58; WFH<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>110&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;2&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 16&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12&#46;5&#37;&#40;<span class="elsevierStyleItalic">n &#61;</span> 3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&#58; WFH 90&#8211;110&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33&#46;3&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 23&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20&#46;8&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mild underweight&#58; WFH 80&#8211;90&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;9&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;8&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderate underweight&#58; WFH 70&#8211;79&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;8&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;3&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Severe underweight&#58; WFH<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;8&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;6&#37; &#40;<span class="elsevierStyleItalic">n &#61;</span> 3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total sample&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Level III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Level IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Level V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total water&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;1 &#177; 1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#46;4 &#177; 1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;8 &#177; 2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#46;3 &#177; 2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;043&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Extracellular water&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;7 &#177; 1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;2 &#177; 1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;3 &#177; 1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#46;5 &#177; 2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;996&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intracellular water&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;4 &#177; 1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;9 &#177; 1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;7 &#177; 1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#46;5 &#177; 2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;994&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lean mass&#44; kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;0 &#177; 1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;5 &#177; 2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;3 &#177; 1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;2 &#177; 1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lean mass&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#46;9 &#177; 1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#46;5 &#177; 1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#46;0 &#177; 2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&#46;4 &#177; 2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;095&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Muscle mass&#44; kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;0 &#177; 0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;3 &#177; 1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;2 &#177; 1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;5 &#177; 0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Muscle mass&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;9 &#177; 1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;0 &#177; 1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;6 &#177; 1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#46;5 &#177; 2&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;161&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cell mass&#44; kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;6 &#177; 0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;5 &#177; 1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;7 &#177; 1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;5 &#177; 0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cell mass&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;6 &#177; 0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#46;12 &#177; 1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#46;1 &#177; 1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#46;0 &#177; 1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fat mass&#44; kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;9 &#177; 0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;0 &#177; 1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;2 &#177; 1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;5 &#177; 0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fat mass&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;7 &#177; 2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;5 &#177; 1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;8 &#177; 2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;6 &#177; 2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;111&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Body composition calculated by bioelectrical impedance analysis &#40;BIA&#41; by GMFCS level&#46;</p>"
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          "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">BMI&#44; body mass index&#59; CI&#44; confidence interval&#59; SD&#44; standard deviation&#46;</p>"
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            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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No gastrostomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gastrostomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anthropometric measures&#44; mean &#40;95&#37; CI&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Height &#40;<span class="elsevierStyleItalic">z</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;3&#46;24 &#40;&#8722;3&#46;88&#59;&#8722;2&#46;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;3&#46;43 &#40;&#8722;4&#46;72&#59; &#8722;2&#46;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;745&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weight &#40;<span class="elsevierStyleItalic">z</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;1 &#40;&#8722;2&#46;47&#59; &#8722;1&#46;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;24 &#40;&#8722;3&#46;17&#59; &#8722;1&#46;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;710&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BMI &#40;<span class="elsevierStyleItalic">z</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;31 &#40;&#8722;1&#46;76&#59; &#8722;0&#46;85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;13 &#40;&#8722;2&#46;33&#59;0&#46;07&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;706&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weight for height&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#46;0 &#177; 3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&#46;6 &#177; 8&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;341&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BIA&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total water&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;6 &#177; 2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#46;7 &#177; 5&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;088&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Extracellular water&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;8 &#177; 2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;9 &#177; 4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;689&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intracellular water&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;2 &#177; 2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#46;1 &#177; 4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;677&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lean mass&#44; kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;9 &#177; 0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;8 &#177; 2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;328&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lean mass&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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Article information
ISSN: 23412879
Original language: English
DOI:10.1016/j.anpede.2019.06.008
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