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we describe not only the comorbidities historically associated with obesity&#44; but also those for which evidence is currently emerging&#46; We also address the possible difficulties and complications in procedures that require invasive manoeuvres&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Frequent comorbidities</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Respiratory</span><p id="par0015" class="elsevierStylePara elsevierViewall">There is a bidirectional association between childhood obesity and decreases in sleep duration and&#47;or quality&#46; Sleep disturbances are a risk factor for the development and persistence of childhood obesity&#44; and there is a high prevalence of sleep-related breathing disorders in obese children&#44; including sleep apnoea&#8211;hypopnoea syndrome &#40;SAHS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The incidence of SAHS in school-aged children is estimated at 1&#37;&#8211;5&#37; and believed to be 4&#8211;5 times greater in adolescents with obesity compared to those with a normal weight&#46; Although the main cause of SAHS in children is upper airway obstruction due to enlargement of the tonsils or adenoid glands&#44; obesity is also a risk factor&#44; especially among older children&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Frequent apnoeic episodes cause oxygen desaturation and sleep fragmentation&#46; A persisting pattern of interrupted sleep is associated with cognitive and behavioural changes and emotional difficulties&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Children with severe obesity may also develop alveolar hypoventilation associated with oxygen desaturation&#46; There is also evidence that childhood obesity is associated with bronchial hyperresponsiveness and asthma&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The presence of sleep-related breathing disorders may go unnoticed by the parents&#46; It is important to emphasise the likelihood of these disorders so that they can be assessed correctly&#46; Snoring and daytime somnolence are potential red flags that facilitate their detection&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Musculoskeletal</span><p id="par0025" class="elsevierStylePara elsevierViewall">Obesity increases the risk of several musculoskeletal problems&#44; such as impaired mobility&#44; fractures&#44; joint pain in the lower extremities and malalignment of the extremities&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> It is also a risk factor for unilateral or bilateral slipped capital femoral epiphysis and tibia vara&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Many children with obesity exhibit the so-called paediatric inactivity triad&#44; a concept proposed to assess inactivity in its 3 components&#58; exercise deficit disorder &#40;poor cardiorespiratory and muscle fitness&#41;&#44; paediatric dynapenia &#40;low muscle strength and power not secondary to neuromuscular disease and the associated functional limitations&#41; and physical illiteracy &#40;lack of competence&#44; confidence&#44; motivation and knowledge to move well&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In addition&#44; an increase in body weight can limit functioning and increase the risk of injury during daily physical activities&#44; increasing the risk of falling due to decreased postural stability and control&#46; Furthermore&#44; recovery from injuries takes longer and the associated morbidity increases&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Renal</span><p id="par0040" class="elsevierStylePara elsevierViewall">Renal involvement secondary to obesity has been found to de independent from the potential association with diabetes and the development of high blood pressure&#46; A specific type of obesity-related glomerulopathy has been identified that manifests with progressive albuminuria with development of partial nephrotic syndrome over the years&#46; Data are currently emerging on the potential development of this form of glomerulopathy in obese children and adolescents&#44; although they are still very scarce&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Although further research is needed on the potential mechanisms that underlie this association with the aim of implementing preventive strategies to halt the development of chronic kidney disease&#44; as of now&#44; detection of albuminuria in obese children should be interpreted as a warning of future risk and be followed by implementation of measures to reduce excess weight and control potential comorbidities like hypertension or type 2 diabetes&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Cutaneous</span><p id="par0050" class="elsevierStylePara elsevierViewall">Cutaneous manifestations may be classified into 3 groups&#58; changes in skin physiology&#44; cutaneous changes related to obesity and cutaneous disease associated with obesity&#46; Cutaneous manifestations of obesity are directly related to the age of onset&#44; chronicity and severity of obesity&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Multiple skin physiology changes are found in children with obesity&#44; including excessive sweating and decreased tolerance to local and environmental increases in temperature&#44; facial redness as a compensatory mechanism&#44; xeroderma due to transepidermal water loss and chafing in friction areas&#46; Among the skin changes associated with obesity&#44; acanthosis nigricans &#40;AN&#41; is the most frequent cutaneous manifestation&#44; developing in 49&#37;&#8211;58&#37; of adolescents with excess weight&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In addition&#44; AN is the most frequent early cutaneous manifestation in children with obesity and&#47;or insulin resistance&#46; The development of stretch marks is directly associated with the degree of obesity&#44; with an incidence of up to 40&#37; in children with moderate to severe obesity&#46; Lastly&#44; there are cutaneous diseases that can be triggered and&#47;or exacerbated by obesity&#44; such as intertrigo&#44; psoriasis&#44; hidradenitis suppurativa and&#44; to a lesser extent&#44; atopic dermatitis&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Some of these manifestations&#44; being visible&#44; can exacerbate the psychosocial impact that paediatric patients with obesity inevitably experience&#46; The assessment of cutaneous manifestations is essential to allow early diagnosis and the prevention of sequelae&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Cardiometabolic risk</span><p id="par0065" class="elsevierStylePara elsevierViewall">The growing prevalence of obesity in children and adolescents worldwide has raised concerns regarding a future increase in the prevalence of cardiovascular diseases&#46; Obesity in children and adolescents can cause hypertension&#44; dyslipidaemia&#44; chronic inflammation and hyperinsulinaemia&#44; which increases the risk of morbidity and mortality as children grow into adulthood and is a significant public health concern&#46; Thus&#44; the identification of cardiometabolic risk factors in obese youth can be used to define a high-risk group within the paediatric population with obesity&#46; A cross-sectional study in adolescents aged 12&#8211;19 years in the NHANES 2017&#8211;2018 cohort showed that anthropometric measurements could predict cardiovascular risk in adolescents&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> A study conducted in the Unit against Obesity and Cardiometabolic Risk of the Department of Paediatrics of the Hospital General de Valencia<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> assessed for the presence of cardiometabolic risk factors in 611 children and adolescents with moderate obesity and&#44; in addition to obesity&#44; identified one risk factor in 39&#37;&#44; 2 risk factors in 16&#46;5&#37; and 3 risk factors in 2&#46;8&#37;&#46; Among the risk factors&#44; the most prevalent was hyperinsulinism &#40;30&#47;8&#37;&#41;&#44; followed by dyslipidaemia &#40;12&#46;9&#37;&#41; and hypertension &#40;10&#46;5&#37;&#41;&#46; High blood pressure &#40;BP&#41; is frequently associated with one or more cardiometabolic risk factors&#46; Although the clustering of cardiometabolic risk factors is interpreted as metabolic syndrome in adults&#44; reaching a consensus in the definition of metabolic syndrome in the paediatric population has proven challenging&#46; Understanding the relationships between excess weight&#44; insulin resistance and BP in early life is important in order to develop intervention or prevention strategies&#46; We found a significant correlation between insulin resistance and BP through the use of ambulatory BP monitoring over a 24-h period&#44; a method that allows more accurate assessment of BP values&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> This association was clearer at night&#44; when BP is less affected by external factors&#46; These findings support the role of insulin resistance in the elevation of BP&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Early elevation of nocturnal BP and heart rate associated with hyperinsulinaemia may be a forerunner of insulin resistance associated with hypertension and contribute to the increased cardiovascular risk associated with this condition&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">There is evidence that children and adolescents with obesity&#44; especially those with excess abdominal fat&#44; may exhibit an atherogenic lipid profile&#44; characterised by increased serum levels of total cholesterol &#40;CT&#41;&#44; triglycerides &#40;TG&#41; and low-density lipoprotein &#40;LDL&#41; and decreased serum levels of high-density lipoprotein &#40;HDL&#41;&#59; these abnormalities are found in up to 30&#37; of obese children and adolescents&#46; At present&#44; it is widely accepted that abnormalities in the serum lipid profile in paediatric patients with obesity may be early indicators of cardiovascular risk or manifestations of metabolic syndrome&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">A metabolic factor that has barely been investigated in children and that has only recently garnered attention is uric acid&#46; Several cross-sectional studies have analysed the association between serum uric acid levels and abdominal obesity&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#8211;20</span></a> In youth with overweight or obesity&#44; uric acid levels were the main determinant and exhibited the strongest association with the waist circumference&#46; There was a significant positive correlation between uric acid and the office BP&#44; increased cholesterol values&#44; TG levels and the HOMA index and an inverse correlation with HDL levels&#46; In addition&#44; the presence of low HDL values&#44; elevated TG values and hyperinsulinaemia was associated with an increase in uric acid levels&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> This is consistent with the findings of other studies and evinces the association between uric acid&#44; visceral fat and cardiometabolic risk factors&#46; Furthermore&#44; the association between uric acid and waist circumference has also been observed in individuals with normal weight obesity&#44; defined as excess body fat despite a healthy body weight&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Emerging comorbidities</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Psychosocial</span><p id="par0080" class="elsevierStylePara elsevierViewall">Children and adolescents with obesity have a lower quality of life compared to their normal-weight peers&#46; In addition to this impairment in their quality of life&#44; they also exhibit psychosocial comorbidities&#44; including low self-esteem<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> and an increased risk of depression&#44; anxieity&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> eating disorders and substance abuse&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Low self-esteem and greater body mass index values&#44; whether actual or perceived&#44; are associated with an increased probability of tobacco and alcohol use&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">In general&#44; low self-esteem does not seem to become a problem until adolescence&#44; as self-esteem is similar between preadolescents with obesity and their normal-weight peers&#46; However&#44; during adolescence&#44; self-esteem is most strongly associated with body image and deteriorates rapidly&#59; female adolescents with higher body mass index values and body dissatisfaction have lower self-esteem&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The stigma attached to being overweight or obese does not stem solely from the clinical repercussions of the excess weight&#44; but also from the socially-accepted rejection&#44; exclusion and discrimination inflicted on individuals living with this condition&#46; All of this has a deleterious impact on children and adolescents with obesity&#44; who are more likely to be teased and bullied&#44; socially isolated and have fewer friends than their non-obese peers&#44; giving rise to a vicious circle depression&#47;loss of self-esteem and social integration problem&#46; A psychological evaluation should be conducted if any of the above conditions are detected to prevent their progression&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Despite the substantial consideration devoted to the medical repercussions of obesity&#44; the deleterious impact on children and adults with obesity that results from stigmatization&#44; prejudice and discrimination is frequently ignored&#46; Obese individuals are frequently stigmatized due to their weight in many spheres of everyday life&#46; Research conducted over several decades has documented constant prejudice and stigmatization related to excess weight in work&#44; health care and school settings&#44; in the mass media and in interpersonal relationships&#46; In youth with overweight or obesity&#44; weight stigma leads to generalised intimidation&#44; mockery and victimization&#46; Exposure to weight stigma is associated with multiple adverse outcomes&#44; such as depression&#44; anxiety&#44; low self-esteem&#44; body dissatisfaction&#44; suicidal ideation&#44; poor academic performance&#44; decreased physical activity&#44; maladaptive eating behaviours and health care avoidance&#46; This review summarises the nature and magnitude of weight stigma against individuals with overweight and obesity and the impact of these experiences on the social&#44; psychological and physical health of the children and adults subjected to it&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Metabolic fatty liver disease</span><p id="par0100" class="elsevierStylePara elsevierViewall">Metabolic dysfunction-associated fatty liver disease &#40;MAFLD&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> is a metabolic disorder characterised by excessive accumulation of fat in the liver unrelated to infection&#44; medication or an autoimmune disorder&#46; It may range from simple fatty liver to steatohepatitis with manifest inflammation and cell damage&#46; At present&#44; it is the most frequent aetiology of chronic liver disease in the paediatric age group in developed countries and it is strongly associated with obesity&#44; with an estimated prevalence of 36&#46;1&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> Increasingly&#44; MAFLD is being considered an aspect associated with cardiometabolic risk factors&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">The most noteworthy characteristic of MAFLD is that&#44; while some affected individuals exhibit hepatocyte damage&#44; most remain asymptomatic&#44; and in obese children it manifests with transaminase elevation in routine blood panels&#46; Sonography is frequently used to assess MAFLD&#46; Magnetic resonance imaging is a less subjective technique for the measurement of hepatic steatosis&#44; but there are barriers to its routine&#44; including costs&#44; lack of widespread availability and the potential lack of cooperation of the child&#46; Liver elastography with FibroScan is the most widely used method for assessment&#44; despite its limitations&#46; Liver biopsy is the gold standard for diagnosis of MAFLD&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Early detection of MAFLD is necessary&#44; although the optimal timing&#44; frequency and method for screening remain to be determined&#46; Lifestyle changes and weight loss continue to be the cornerstone of treatment for MAFLD&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Interventions requiring anaesthesia</span><p id="par0115" class="elsevierStylePara elsevierViewall">Obesity is usually associated with comorbidities involving multiple organs that may be relevant in patients who require anaesthesia for diagnostic and&#47;or therapeutic procedures&#46; The most important issues arise from difficulty in securing the airway and the pharmacokinetics of anaesthetic agents&#46;</p><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Pharmacokinetics of anaesthetic agents</span><p id="par0120" class="elsevierStylePara elsevierViewall">The physiological changes associated with obesity alter the volume of distribution&#44; protein binding and elimination of pharmaceuticals&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31&#8211;33</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Most drugs are dosed in terms of a dose mass per unit of body weight based on the principle that clearance is proportional to body weight and that the volume of distribution per unit of weight remains constant&#46; In the case of obesity&#44; there are changes in body composition&#44; volume of distribution and renal and hepatic function&#46; The volume of the central compartment &#40;where a drug initially distributes upon administration&#41; tends to be greater due to the blood volume and the size of the major organs&#44; so that a higher initial dose is required to obtain the same pharmacological effect&#46; The volumes of distribution at equilibrium also increase for lipid-soluble drugs &#40;e&#46;g&#46;&#44; sodium thiopental&#44; lidocaine&#44; benzodiazepines&#41; and water-soluble drugs &#40;e&#46;g&#46;&#44; vecuronium&#44; rocuronium&#41; due to the increase in extracellular fluid in adipose and lean tissue&#46; To this&#44; we must add the increase in body fat&#44; changes in protein binding and the increase in blood volume and cardiac output&#46; All of it affects the distribution of water-soluble and lipid-soluble drugs&#44; so there is a risk of overdosing &#40;e&#46;g&#46;&#44; sufentanil&#41; or underdosing &#40;e&#46;g&#46;&#44; succinylcholine&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Plasma protein binding</span>&#46; It may decrease for some drugs&#44; increasing the proportion of free drug due to the higher concentration of free fatty acids&#44; TGs and cholesterol&#46; The increase in &#945;1-acid glycoprotein increases the binding of local anaesthetics and opioids&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Drug elimination</span>&#46; Renal clearance increases due to increases in renal flow&#44; glomerular filtration and tubular secretion&#46; The increase in glomerular filtration results in an increase in the clearance of drugs that do not undergo biotransformation prior to renal excretion and are filtrated by the glomeruli&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Despite the presence of steatosis&#44; hepatic drug metabolism changes little in obese children&#46; Oxidation&#44; reduction and hydrolysis reactions are normal or increase slightly&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">To prevent over- or underdosage&#44;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34&#8211;36</span></a> clinicians can apply dosing equations based on the total body weight &#40;TBW&#41;&#44; ideal body weight &#40;IBW&#41; and the lean body weight &#40;LBW&#41;&#44; defined as follows&#58; TBW as current total body weight of the patient&#44; IBW as the BMI at the 50th percentile for the patient&#8217;s age &#40;ideal BMI&#41; multiplied by the squared height in metres &#40;IBW&#8239;&#61;&#8239;ideal BMI&#8239;&#215;&#8239;height<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#41; and the LBW as the difference between the total body weight and the body fat mass&#46; The latter comprehends all lipids in the body &#40;primary depots and other depots&#41; and its calculation requires different equations for each sex&#46; One of the simplest equations includes the height&#44; waist circumference and head circumference&#46; These are the strategies used to adapt the dosage of the main drugs used in paediatrics anaesthesia&#44; as seen in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">In the case of propofol&#44; the dose should be titrated using a depth of anaesthesia monitor &#40;e&#46;g&#46;&#44; bispectral index &#91;BIS&#93;&#41;&#46; When it comes to volatile anaesthetics&#44; preferential use of desflurane and sevoflurane is recommended&#44; as they are the 2 least lipophilic agents in this group&#44; always adjusting the dose based on the minimum alveolar concentration &#40;MAC&#41;&#44; which is the minimum concentration in the alveoli of the inhaled agent that prevents 50&#37; of subjects from moving in response to a painful stimulus&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Issues concerning the airway</span><p id="par0155" class="elsevierStylePara elsevierViewall">The respiratory pathophysiology associated with obesity includes changes in ventilatory mechanics&#44; respiratory muscles&#44; ventilation regulation and the control of breathing during sleep&#46; The fatty tissue that infiltrates the chest wall reduces the static and dynamic lung volumes&#44; especially the residual volume &#40;RV&#41; and the functional residual capacity &#40;FRC&#41;&#46; There are ventilation&#47;perfusion mismatches&#44; with increases in oxygen consumption &#40;11&#37;&#41;&#44; cardiac output &#40;CO&#41; &#40;35&#37;&#41;&#44; cardiac index &#40;35&#37;&#41; and peripheral vascular resistance &#40;21&#37;&#41;&#46; Metabolic activity and work of breathing increase&#44; leading to greater oxygen consumption and CO<span class="elsevierStyleInf">2</span> production&#46; Obese individuals with SAHS &#40;5&#37;&#41; experience hypoxaemia with alveolar hypoventilation and hypercapnia possibly secondary to the submucosal fatty tissue infiltration in the upper airway&#46; This can lead to airway narrowing and collapse&#46;</p><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Asthma</span><p id="par0160" class="elsevierStylePara elsevierViewall">The underlying mechanisms are mechanical &#40;airway narrowing&#41;&#44; inflammatory and genetic&#46; During general anaesthesia&#44; obese patients have been found to be at increased risk of hypoxaemia and atelectasis&#44; with hypoventilation and decreased tolerance to apnoea&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34&#44;37</span></a></p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0165" class="elsevierStylePara elsevierViewall">This study was funded by the Pathophysiology of Obesity and Nutrition Biomedical Research Networking Centre &#40;<span class="elsevierStyleGrantSponsor" id="gs0005">CIBEROBN</span>&#41;&#44; <span class="elsevierStyleGrantSponsor" id="gs0010">Instituto de Salud Carlos III</span>&#44; Madrid&#44; Spain&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Childhood obesity is associated with comorbidities that affect almost all body systems&#44; including&#44; among others&#44; the endocrine&#44; gastrointestinal&#44; pulmonary&#44; cardiovascular and musculoskeletal systems&#44; as well as medical and surgical procedures that may be required due to different clinical situations&#46; The objective of this article is to describe the classic and emerging comorbidities associated with obesity and the complications of procedures that involve invasive manoeuvres&#46; Although some of the problems associated with obesity during childhood are widely known&#44; such as musculoskeletal and cutaneous disorders or apnoea&#8211;hypopnoea syndrome&#44; others&#44; such as changes in kidney function&#44; non-alcoholic fatty liver and cardiometabolic risk&#44; have received less attention due to their insidious development&#44; as they may not manifest until adulthood&#46; In contrast&#44; there is another group of comorbidities that may have a greater impact due to their frequency and consequences&#44; which are psychosocial problems&#46; Finally&#44; in the context of invasive medico-surgical interventions&#44; obesity can complicate airway management&#46; The recognition of these pathologies in association with childhood obesity is of vital importance not only in childhood but also due to their ramifications in adulthood&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La obesidad infantil est&#225; asociada con comorbilidades que afectan a casi todos los sistemas del organismo&#44; incluidos&#44; entre otros&#44; los sistemas endocrino&#44; gastrointestinal&#44; pulmonar&#44; cardiovascular y musculoesquel&#233;tico&#44; as&#237; como a los procedimientos m&#233;dicos y quir&#250;rgicos que puedan precisarse por situaciones cl&#237;nicas varias&#46; El objetivo del presente art&#237;culo es describir las enfermedades cl&#225;sicas y emergentes asociadas a la obesidad&#44; as&#237; como las complicaciones de procedimientos que requieren maniobras invasivas&#46; Aunque algunos de los problemas asociados a la obesidad durante la infancia son ampliamente conocidos como los musculoesquel&#233;ticos y cut&#225;neos&#44; as&#237; como el s&#237;ndrome de apneas hipopneas&#44; otros como las alteraciones de la funci&#243;n renal&#44; el h&#237;gado graso metab&#243;lico y el riesgo cardiometab&#243;lico han recibido menos atenci&#243;n debido a su desarrollo larvado que condiciona enfermedad en la edad adulta&#46; Por el contrario&#44; existe otro grupo quiz&#225; con mayor impacto por frecuencia y por sus consecuencias que son los problemas psicosociales&#46; Por &#250;ltimo&#44; en presencia de acciones m&#233;dico-quirurgicas invasivas la obesidad puede dificultar el acceso a la v&#237;a a&#233;rea&#46; El reconocimiento de estas enfermedades asociadas a la obesidad infantil es de vital importancia no solo para el periodo infantil&#44; sino tambi&#233;n pro su proyecci&#243;n a la vida adulta&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Induction dose&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">Maintenance dose&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">Propofol&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">LBW&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">TBW&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">Etomidate&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">LBW&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">&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">Ketamine&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">IBW&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">&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">Benzodiazepines&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">LBW&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">IBW&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">Desflurane and sevoflurane&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">MAC<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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">MAC<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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">Fentanyl&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">LBW&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">LBW&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">Remifentanil&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">LBW&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">LBW&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">Morphine&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">IBW&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">IBW&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">Succinylcholine&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">TBW&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">&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">Non-depolarizing neuromuscular blockers&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">IBW&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">IBW&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">Neostigmine&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">TBW&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">&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">Sugammadex&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">TBW&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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dose adjustment strategies in paediatric patients with obesity&#46;</p>"
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      "titulo" => "References"
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                    0 => array:2 [
                      "titulo" => "Polysomnographic comparison of sleep in children with obesity and normal weight without suspected sleep-related breathing disorder"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Y&#46;S&#46; Danielsen"
                            1 => "H&#46;F&#46; Skj&#229;k&#248;deg&#229;rd"
                            2 => "B&#46; Bjorvatn"
                            3 => "P&#46;B&#46; Juliusson"
                            4 => "S&#46; Pallesen"
                          ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/cob.12493"
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Obes"
                        "fecha" => "2022"
                        "volumen" => "12"
                        "paginaInicial" => "e12493"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34781415"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0010"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity in children with different risk factors for obstructive sleep apnea&#58; a community-based study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;-S&#46; Su"
                            1 => "H&#46;-L&#46; Zhang"
                            2 => "X&#46;-H&#46; Cai"
                            3 => "Y&#46; Lin"
                            4 => "P&#46;-N&#46; Liu"
                            5 => "Y&#46;-B&#46; Zhang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur J Pediatr"
                        "fecha" => "2016"
                        "volumen" => "175"
                        "paginaInicial" => "211"
                        "paginaFinal" => "220"
                      ]
                    ]
                  ]
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            2 => array:3 [
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              "etiqueta" => "3"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Overweight and obesity add to behavioral problems in children with sleep-disordered breathing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;N&#46; Biggs"
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                            2 => "L&#46;M&#46; Walter"
                            3 => "A&#46;J&#46; Weichard"
                            4 => "M&#46;J&#46; Davey"
                            5 => "G&#46;M&#46; Nixon"
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                      "doi" => "10.1016/j.sleep.2017.09.001"
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                        "tituloSerie" => "Sleep Med"
                        "fecha" => "2017"
                        "volumen" => "39"
                        "paginaInicial" => "62"
                        "paginaFinal" => "69"
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                          0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Review of childhood obesity&#58; from epidemiology&#44; etiology&#44; and comorbidities to clinical assessment and treatment"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Kumar"
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                    0 => array:2 [
                      "doi" => "10.1016/j.mayocp.2016.09.017"
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                        "tituloSerie" => "Mayo Clin Proc"
                        "fecha" => "2017"
                        "volumen" => "92"
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                          0 => array:2 [
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                  "contribucion" => array:1 [
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                      "titulo" => "Injury patterns in obese versus nonobese children presenting to a pediatric emergency department"
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                          "etal" => false
                          "autores" => array:3 [
                            0 => "W&#46;J&#46; Pomerantz"
                            1 => "N&#46;L&#46; Timm"
                            2 => "M&#46;A&#46; Gittelman"
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                        ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2009-2367"
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                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2010"
                        "volumen" => "125"
                        "paginaInicial" => "681"
                        "paginaFinal" => "685"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20194280"
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                      "titulo" => "Musculoskeletal effects of obesity"
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46; Chan"
                            1 => "C&#46;T&#46; Chen"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MOP.0b013e328320a914"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Pediatr"
                        "fecha" => "2009"
                        "volumen" => "21"
                        "paginaInicial" => "65"
                        "paginaFinal" => "70"
                        "link" => array:1 [
                          0 => array:2 [
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                  "contribucion" => array:1 [
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                      "titulo" => "Body mass index in patients with slipped capital femoral epiphysis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46;N&#46; Bhatia"
                            1 => "M&#46; Pirpiris"
                            2 => "N&#46;Y&#46; Otsuka"
                          ]
                        ]
                      ]
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                    0 => array:2 [
                      "doi" => "10.1097/01.bpo.0000218526.36362.3f"
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                        "tituloSerie" => "J Pediatr Orthop"
                        "fecha" => "2006"
                        "volumen" => "26"
                        "paginaInicial" => "197"
                        "paginaFinal" => "199"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16557134"
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                      "titulo" => "The unsolved problem of paediatric physical inactivity&#58; it&#8217;s time for a new perspective"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;D&#46; Faigenbaum"
                            1 => "T&#46; Rial Rebullido"
                            2 => "J&#46;P&#46; MacDonald"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/apa.14527"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Paediatr"
                        "fecha" => "2018"
                        "volumen" => "107"
                        "paginaInicial" => "1857"
                        "paginaFinal" => "1859"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Childhood obesity and impact on the kidney"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Correia-Costa"
                            1 => "A&#46; Azevedo"
                            2 => "A&#46; Caldas Afonso"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000492826"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nephron"
                        "fecha" => "2019"
                        "volumen" => "143"
                        "paginaInicial" => "8"
                        "paginaFinal" => "11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30359981"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acanthosis nigricans in obese adolescents&#58; prevalence&#44; impact&#44; and management challenges"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46;Y&#46; Ng"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Adolesc Health Med Ther"
                        "fecha" => "2016"
                        "volumen" => "8"
                        "paginaInicial" => "1"
                        "paginaFinal" => "10"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skin changes in the obese patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46;A&#46; Hirt"
                            1 => "D&#46;E&#46; Castillo"
                            2 => "G&#46; Yosipovitch"
                            3 => "J&#46;E&#46; Keri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2018.12.070"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2019"
                        "volumen" => "81"
                        "paginaInicial" => "1037"
                        "paginaFinal" => "1057"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31610857"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anthropometry for predicting cardiometabolic disease risk factors in adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Xie"
                            1 => "J&#46; Kim"
                            2 => "J&#46;P&#46; Almandoz"
                            3 => "J&#46; Clark"
                            4 => "M&#46;S&#46; Mathew"
                            5 => "B&#46;R&#46; Cartwright"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/oby.24090"
                      "Revista" => array:6 [
                        "tituloSerie" => "Obesity &#40;Silver Spring&#41;"
                        "fecha" => "2024"
                        "volumen" => "32"
                        "paginaInicial" => "1558"
                        "paginaFinal" => "1567"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/38994553"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Blood pressure in children and adolescents&#58; current insights"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46; Lurbe"
                            1 => "J&#46;R&#46; Ingelfinger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/HJH.0000000000000790"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hypertens"
                        "fecha" => "2016"
                        "volumen" => "34"
                        "paginaInicial" => "176"
                        "paginaFinal" => "183"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26599224"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Added impact of obesity and insulin resistance in nocturnal blood pressure elevation in children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Lurbe"
                            1 => "I&#46; Torro"
                            2 => "F&#46; Aguilar"
                            3 => "J&#46; Alvarez"
                            4 => "J&#46; Alcon"
                            5 => "J&#46;M&#46; Pascual"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/HYPERTENSIONAHA.107.099234"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hypertension"
                        "fecha" => "2008"
                        "volumen" => "51"
                        "paginaInicial" => "635"
                        "paginaFinal" => "641"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18195166"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity&#44; insulin resistance&#44; and nocturnal systolic blood pressure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Whaley-Connell"
                            1 => "J&#46;R&#46; Sowers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/HYPERTENSIONAHA.107.100255"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hypertension"
                        "fecha" => "2008"
                        "volumen" => "51"
                        "paginaInicial" => "620"
                        "paginaFinal" => "621"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18212271"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity and the metabolic sydrome in children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "W&#46; Ram"
                            1 => "J&#46; Dziura"
                            2 => "T&#46;S&#46; Burgert"
                            3 => "W&#46;V&#46; Tamborlane"
                            4 => "S&#46;E&#46; Taksali"
                            5 => "E&#46; Sara"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2004"
                        "volumen" => "350"
                        "paginaInicial" => "2363"
                        "paginaFinal" => "2374"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The metabolic syndrome&#58; look for it in children and adolescents&#44; too&#33;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Jessup"
                            1 => "J&#46;S&#46; Harrell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Diabetes"
                        "fecha" => "2005"
                        "volumen" => "23"
                        "paginaInicial" => "26"
                        "paginaFinal" => "32"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Uric acid is linked to cardiometabolic risk factors in overweight and obese youths"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Lurbe"
                            1 => "M&#46;I&#46; Torro"
                            2 => "J&#46; Alvarez-Pitti"
                            3 => "J&#46; Redon"
                            4 => "C&#46; Borghi"
                            5 => "P&#46; Redon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/HJH.0000000000001814"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hypertens"
                        "fecha" => "2018"
                        "volumen" => "36"
                        "paginaInicial" => "1840"
                        "paginaFinal" => "1846"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29916994"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of hyperuricemia and its association with metabolic syndrome and cardiometabolic risk factors in Korean children and adolescents&#58; analysis based on the 2016&#8211;2017 Korea National Health and Nutrition Examination Survey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;H&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3345/kjp.2019.00444"
                      "Revista" => array:6 [
                        "tituloSerie" => "Korean J Pediatr"
                        "fecha" => "2019"
                        "volumen" => "62"
                        "paginaInicial" => "317"
                        "paginaFinal" => "323"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31319650"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiometabolic risk in adolescents with normal weight obesity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46;C&#46; Cota"
                            1 => "S&#46;E&#46; Priore"
                            2 => "S&#46;A&#46;V&#46; Ribeiro"
                            3 => "L&#46;L&#46; Juvanhol"
                            4 => "E&#46;R&#46; de Faria"
                            5 => "F&#46;R&#46; de Faria"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/s41430-021-01037-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Clin Nutr"
                        "fecha" => "2022"
                        "volumen" => "76"
                        "paginaInicial" => "863"
                        "paginaFinal" => "870"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34711932"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "&#91;21&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Self-esteem and quality of life in obese children and adolescents&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;J&#46; Griffiths"
                            1 => "T&#46;J&#46; Parsons"
                            2 => "A&#46;J&#46; Hill"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/17477160903473697"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Pediatr Obes"
                        "fecha" => "2010"
                        "volumen" => "5"
                        "paginaInicial" => "282"
                        "paginaFinal" => "304"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20210677"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mental disorders in obese children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Vila"
                            1 => "E&#46; Zipper"
                            2 => "M&#46; Dabbas"
                            3 => "C&#46; Bertrand"
                            4 => "J&#46;J&#46; Robert"
                            5 => "C&#46; Ricour"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.psy.0000126201.12813.eb"
                      "Revista" => array:6 [
                        "tituloSerie" => "Psychosom Med"
                        "fecha" => "2004"
                        "volumen" => "66"
                        "paginaInicial" => "387"
                        "paginaFinal" => "394"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15184702"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pediatric obesity-assessment&#44; treatment&#44; and prevention&#58; an endocrine society clinical practice guideline"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;M&#46; Styne"
                            1 => "S&#46;A&#46; Arslanian"
                            2 => "E&#46;L&#46; Connor"
                            3 => "I&#46;S&#46; Farooqi"
                            4 => "M&#46;H&#46; Murad"
                            5 => "J&#46;H&#46; Silverstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1210/jc.2016-2573"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "2017"
                        "volumen" => "102"
                        "paginaInicial" => "709"
                        "paginaFinal" => "757"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28359099"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Can young adult smoking status be predicted from concern about body weight and self-reported BMI among adolescents&#63; Results from a ten-year cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;J&#46; Koval"
                            1 => "L&#46;L&#46; Pederson"
                            2 => "X&#46; Zhang"
                            3 => "P&#46; Mowery"
                            4 => "M&#46; McKenna"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Nicotine Tob Res"
                        "fecha" => "2008"
                        "volumen" => "10"
                        "paginaInicial" => "1449"
                        "paginaFinal" => "1455"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Body dissatisfaction and adolescent self-esteem&#58; prospective findings"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Tiggemann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bodyim.2005.03.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Body Image"
                        "fecha" => "2005"
                        "volumen" => "2"
                        "paginaInicial" => "129"
                        "paginaFinal" => "135"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18089181"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perfil psicopatol&#243;gico de ni&#241;os con sobrepeso u obesidad en tratamiento de p&#233;rdida de peso"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Cebolla"
                            1 => "R&#46;M&#46; Ba&#241;os"
                            2 => "C&#46; Botella"
                            3 => "E&#46; Lurbe"
                            4 => "M&#46;I&#46; Torr&#243;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Psicopatol Psicol Clin"
                        "fecha" => "2011"
                        "volumen" => "16"
                        "paginaInicial" => "125"
                        "paginaFinal" => "133"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "NAFLD nomenclature consensus group&#46; A multisociety Delphi consensus statement on new fatty liver disease nomenclature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;E&#46; Rinella"
                            1 => "J&#46;V&#46; Lazarus"
                            2 => "V&#46; Ratziu"
                            3 => "S&#46;M&#46; Francque"
                            4 => "A&#46;J&#46; Sanyal"
                            5 => "F&#46; Kanwal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/HEP.0000000000000520"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2023"
                        "volumen" => "78"
                        "paginaInicial" => "1966"
                        "paginaFinal" => "1986"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37363821"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
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                        "paginaFinal" => "153"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22575569"
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              "etiqueta" => "33"
              "referencia" => array:1 [
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                    0 => array:2 [
                      "titulo" => "A retrospective description of anesthetic medication dosing in overweight and obese children"
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                        "paginaFinal" => "862"
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                      "titulo" => "Perioperative considerations for airway management and drug dosing in obese children"
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                  "host" => array:1 [
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                        "tituloSerie" => "Curr Opin Anaesthesiol"
                        "fecha" => "2018"
                        "volumen" => "31"
                        "paginaInicial" => "320"
                        "paginaFinal" => "326"
                        "link" => array:1 [
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Special Article
A holistic perspective of the comorbidities in childhood obesity
Una visión holística de las comorbilidades en la obesidad infantil
Rosa Herreraa,b, Empar Lurbec,d,
Corresponding author
empar.lurbe@uv.es

Corresponding author.
a Servicio de Anestesia, Hospital Clínico Universitario de Valencia, Valencia, Spain
b Instituto de Investigación INCLIVA, Valencia, Spain
c Departamento de Pediatría, Obstetricia y Ginecología, Universitat de Valencia, Valencia, Spain
d CIBER Fsiopatología Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
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    "titulo" => "A holistic perspective of the comorbidities in childhood obesity"
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        "titulo" => "Una visi&#243;n hol&#237;stica de las comorbilidades en la obesidad infantil"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comorbidities associated with childhood obesity&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Childhood obesity is associated with comorbidities involving nearly every organ system&#44; including&#44; among others&#44; the endocrine&#44; gastrointestinal&#44; respiratory&#44; cardiovascular and musculoskeletal systems&#44; with affects the medical and surgical procedures that may be required due to a variety of clinical conditions &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In the past&#44; many of these complications were believed to occur in adults&#44; but evidence has since emerged that demonstrates that they may start developing as early as childhood or adolescence&#44; evincing the need to consider them in the comprehensive management of obesity in the paediatric population&#46; It is clear that their severity tends to increase with the degree of obesity and the number of associated comorbidities&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">In this review&#44; we describe not only the comorbidities historically associated with obesity&#44; but also those for which evidence is currently emerging&#46; We also address the possible difficulties and complications in procedures that require invasive manoeuvres&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Frequent comorbidities</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Respiratory</span><p id="par0015" class="elsevierStylePara elsevierViewall">There is a bidirectional association between childhood obesity and decreases in sleep duration and&#47;or quality&#46; Sleep disturbances are a risk factor for the development and persistence of childhood obesity&#44; and there is a high prevalence of sleep-related breathing disorders in obese children&#44; including sleep apnoea&#8211;hypopnoea syndrome &#40;SAHS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The incidence of SAHS in school-aged children is estimated at 1&#37;&#8211;5&#37; and believed to be 4&#8211;5 times greater in adolescents with obesity compared to those with a normal weight&#46; Although the main cause of SAHS in children is upper airway obstruction due to enlargement of the tonsils or adenoid glands&#44; obesity is also a risk factor&#44; especially among older children&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Frequent apnoeic episodes cause oxygen desaturation and sleep fragmentation&#46; A persisting pattern of interrupted sleep is associated with cognitive and behavioural changes and emotional difficulties&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Children with severe obesity may also develop alveolar hypoventilation associated with oxygen desaturation&#46; There is also evidence that childhood obesity is associated with bronchial hyperresponsiveness and asthma&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The presence of sleep-related breathing disorders may go unnoticed by the parents&#46; It is important to emphasise the likelihood of these disorders so that they can be assessed correctly&#46; Snoring and daytime somnolence are potential red flags that facilitate their detection&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Musculoskeletal</span><p id="par0025" class="elsevierStylePara elsevierViewall">Obesity increases the risk of several musculoskeletal problems&#44; such as impaired mobility&#44; fractures&#44; joint pain in the lower extremities and malalignment of the extremities&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> It is also a risk factor for unilateral or bilateral slipped capital femoral epiphysis and tibia vara&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Many children with obesity exhibit the so-called paediatric inactivity triad&#44; a concept proposed to assess inactivity in its 3 components&#58; exercise deficit disorder &#40;poor cardiorespiratory and muscle fitness&#41;&#44; paediatric dynapenia &#40;low muscle strength and power not secondary to neuromuscular disease and the associated functional limitations&#41; and physical illiteracy &#40;lack of competence&#44; confidence&#44; motivation and knowledge to move well&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In addition&#44; an increase in body weight can limit functioning and increase the risk of injury during daily physical activities&#44; increasing the risk of falling due to decreased postural stability and control&#46; Furthermore&#44; recovery from injuries takes longer and the associated morbidity increases&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Renal</span><p id="par0040" class="elsevierStylePara elsevierViewall">Renal involvement secondary to obesity has been found to de independent from the potential association with diabetes and the development of high blood pressure&#46; A specific type of obesity-related glomerulopathy has been identified that manifests with progressive albuminuria with development of partial nephrotic syndrome over the years&#46; Data are currently emerging on the potential development of this form of glomerulopathy in obese children and adolescents&#44; although they are still very scarce&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Although further research is needed on the potential mechanisms that underlie this association with the aim of implementing preventive strategies to halt the development of chronic kidney disease&#44; as of now&#44; detection of albuminuria in obese children should be interpreted as a warning of future risk and be followed by implementation of measures to reduce excess weight and control potential comorbidities like hypertension or type 2 diabetes&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Cutaneous</span><p id="par0050" class="elsevierStylePara elsevierViewall">Cutaneous manifestations may be classified into 3 groups&#58; changes in skin physiology&#44; cutaneous changes related to obesity and cutaneous disease associated with obesity&#46; Cutaneous manifestations of obesity are directly related to the age of onset&#44; chronicity and severity of obesity&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Multiple skin physiology changes are found in children with obesity&#44; including excessive sweating and decreased tolerance to local and environmental increases in temperature&#44; facial redness as a compensatory mechanism&#44; xeroderma due to transepidermal water loss and chafing in friction areas&#46; Among the skin changes associated with obesity&#44; acanthosis nigricans &#40;AN&#41; is the most frequent cutaneous manifestation&#44; developing in 49&#37;&#8211;58&#37; of adolescents with excess weight&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In addition&#44; AN is the most frequent early cutaneous manifestation in children with obesity and&#47;or insulin resistance&#46; The development of stretch marks is directly associated with the degree of obesity&#44; with an incidence of up to 40&#37; in children with moderate to severe obesity&#46; Lastly&#44; there are cutaneous diseases that can be triggered and&#47;or exacerbated by obesity&#44; such as intertrigo&#44; psoriasis&#44; hidradenitis suppurativa and&#44; to a lesser extent&#44; atopic dermatitis&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Some of these manifestations&#44; being visible&#44; can exacerbate the psychosocial impact that paediatric patients with obesity inevitably experience&#46; The assessment of cutaneous manifestations is essential to allow early diagnosis and the prevention of sequelae&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Cardiometabolic risk</span><p id="par0065" class="elsevierStylePara elsevierViewall">The growing prevalence of obesity in children and adolescents worldwide has raised concerns regarding a future increase in the prevalence of cardiovascular diseases&#46; Obesity in children and adolescents can cause hypertension&#44; dyslipidaemia&#44; chronic inflammation and hyperinsulinaemia&#44; which increases the risk of morbidity and mortality as children grow into adulthood and is a significant public health concern&#46; Thus&#44; the identification of cardiometabolic risk factors in obese youth can be used to define a high-risk group within the paediatric population with obesity&#46; A cross-sectional study in adolescents aged 12&#8211;19 years in the NHANES 2017&#8211;2018 cohort showed that anthropometric measurements could predict cardiovascular risk in adolescents&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> A study conducted in the Unit against Obesity and Cardiometabolic Risk of the Department of Paediatrics of the Hospital General de Valencia<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> assessed for the presence of cardiometabolic risk factors in 611 children and adolescents with moderate obesity and&#44; in addition to obesity&#44; identified one risk factor in 39&#37;&#44; 2 risk factors in 16&#46;5&#37; and 3 risk factors in 2&#46;8&#37;&#46; Among the risk factors&#44; the most prevalent was hyperinsulinism &#40;30&#47;8&#37;&#41;&#44; followed by dyslipidaemia &#40;12&#46;9&#37;&#41; and hypertension &#40;10&#46;5&#37;&#41;&#46; High blood pressure &#40;BP&#41; is frequently associated with one or more cardiometabolic risk factors&#46; Although the clustering of cardiometabolic risk factors is interpreted as metabolic syndrome in adults&#44; reaching a consensus in the definition of metabolic syndrome in the paediatric population has proven challenging&#46; Understanding the relationships between excess weight&#44; insulin resistance and BP in early life is important in order to develop intervention or prevention strategies&#46; We found a significant correlation between insulin resistance and BP through the use of ambulatory BP monitoring over a 24-h period&#44; a method that allows more accurate assessment of BP values&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> This association was clearer at night&#44; when BP is less affected by external factors&#46; These findings support the role of insulin resistance in the elevation of BP&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Early elevation of nocturnal BP and heart rate associated with hyperinsulinaemia may be a forerunner of insulin resistance associated with hypertension and contribute to the increased cardiovascular risk associated with this condition&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">There is evidence that children and adolescents with obesity&#44; especially those with excess abdominal fat&#44; may exhibit an atherogenic lipid profile&#44; characterised by increased serum levels of total cholesterol &#40;CT&#41;&#44; triglycerides &#40;TG&#41; and low-density lipoprotein &#40;LDL&#41; and decreased serum levels of high-density lipoprotein &#40;HDL&#41;&#59; these abnormalities are found in up to 30&#37; of obese children and adolescents&#46; At present&#44; it is widely accepted that abnormalities in the serum lipid profile in paediatric patients with obesity may be early indicators of cardiovascular risk or manifestations of metabolic syndrome&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">A metabolic factor that has barely been investigated in children and that has only recently garnered attention is uric acid&#46; Several cross-sectional studies have analysed the association between serum uric acid levels and abdominal obesity&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#8211;20</span></a> In youth with overweight or obesity&#44; uric acid levels were the main determinant and exhibited the strongest association with the waist circumference&#46; There was a significant positive correlation between uric acid and the office BP&#44; increased cholesterol values&#44; TG levels and the HOMA index and an inverse correlation with HDL levels&#46; In addition&#44; the presence of low HDL values&#44; elevated TG values and hyperinsulinaemia was associated with an increase in uric acid levels&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> This is consistent with the findings of other studies and evinces the association between uric acid&#44; visceral fat and cardiometabolic risk factors&#46; Furthermore&#44; the association between uric acid and waist circumference has also been observed in individuals with normal weight obesity&#44; defined as excess body fat despite a healthy body weight&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Emerging comorbidities</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Psychosocial</span><p id="par0080" class="elsevierStylePara elsevierViewall">Children and adolescents with obesity have a lower quality of life compared to their normal-weight peers&#46; In addition to this impairment in their quality of life&#44; they also exhibit psychosocial comorbidities&#44; including low self-esteem<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> and an increased risk of depression&#44; anxieity&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> eating disorders and substance abuse&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Low self-esteem and greater body mass index values&#44; whether actual or perceived&#44; are associated with an increased probability of tobacco and alcohol use&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">In general&#44; low self-esteem does not seem to become a problem until adolescence&#44; as self-esteem is similar between preadolescents with obesity and their normal-weight peers&#46; However&#44; during adolescence&#44; self-esteem is most strongly associated with body image and deteriorates rapidly&#59; female adolescents with higher body mass index values and body dissatisfaction have lower self-esteem&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The stigma attached to being overweight or obese does not stem solely from the clinical repercussions of the excess weight&#44; but also from the socially-accepted rejection&#44; exclusion and discrimination inflicted on individuals living with this condition&#46; All of this has a deleterious impact on children and adolescents with obesity&#44; who are more likely to be teased and bullied&#44; socially isolated and have fewer friends than their non-obese peers&#44; giving rise to a vicious circle depression&#47;loss of self-esteem and social integration problem&#46; A psychological evaluation should be conducted if any of the above conditions are detected to prevent their progression&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Despite the substantial consideration devoted to the medical repercussions of obesity&#44; the deleterious impact on children and adults with obesity that results from stigmatization&#44; prejudice and discrimination is frequently ignored&#46; Obese individuals are frequently stigmatized due to their weight in many spheres of everyday life&#46; Research conducted over several decades has documented constant prejudice and stigmatization related to excess weight in work&#44; health care and school settings&#44; in the mass media and in interpersonal relationships&#46; In youth with overweight or obesity&#44; weight stigma leads to generalised intimidation&#44; mockery and victimization&#46; Exposure to weight stigma is associated with multiple adverse outcomes&#44; such as depression&#44; anxiety&#44; low self-esteem&#44; body dissatisfaction&#44; suicidal ideation&#44; poor academic performance&#44; decreased physical activity&#44; maladaptive eating behaviours and health care avoidance&#46; This review summarises the nature and magnitude of weight stigma against individuals with overweight and obesity and the impact of these experiences on the social&#44; psychological and physical health of the children and adults subjected to it&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Metabolic fatty liver disease</span><p id="par0100" class="elsevierStylePara elsevierViewall">Metabolic dysfunction-associated fatty liver disease &#40;MAFLD&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> is a metabolic disorder characterised by excessive accumulation of fat in the liver unrelated to infection&#44; medication or an autoimmune disorder&#46; It may range from simple fatty liver to steatohepatitis with manifest inflammation and cell damage&#46; At present&#44; it is the most frequent aetiology of chronic liver disease in the paediatric age group in developed countries and it is strongly associated with obesity&#44; with an estimated prevalence of 36&#46;1&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> Increasingly&#44; MAFLD is being considered an aspect associated with cardiometabolic risk factors&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">The most noteworthy characteristic of MAFLD is that&#44; while some affected individuals exhibit hepatocyte damage&#44; most remain asymptomatic&#44; and in obese children it manifests with transaminase elevation in routine blood panels&#46; Sonography is frequently used to assess MAFLD&#46; Magnetic resonance imaging is a less subjective technique for the measurement of hepatic steatosis&#44; but there are barriers to its routine&#44; including costs&#44; lack of widespread availability and the potential lack of cooperation of the child&#46; Liver elastography with FibroScan is the most widely used method for assessment&#44; despite its limitations&#46; Liver biopsy is the gold standard for diagnosis of MAFLD&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Early detection of MAFLD is necessary&#44; although the optimal timing&#44; frequency and method for screening remain to be determined&#46; Lifestyle changes and weight loss continue to be the cornerstone of treatment for MAFLD&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Interventions requiring anaesthesia</span><p id="par0115" class="elsevierStylePara elsevierViewall">Obesity is usually associated with comorbidities involving multiple organs that may be relevant in patients who require anaesthesia for diagnostic and&#47;or therapeutic procedures&#46; The most important issues arise from difficulty in securing the airway and the pharmacokinetics of anaesthetic agents&#46;</p><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Pharmacokinetics of anaesthetic agents</span><p id="par0120" class="elsevierStylePara elsevierViewall">The physiological changes associated with obesity alter the volume of distribution&#44; protein binding and elimination of pharmaceuticals&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31&#8211;33</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Most drugs are dosed in terms of a dose mass per unit of body weight based on the principle that clearance is proportional to body weight and that the volume of distribution per unit of weight remains constant&#46; In the case of obesity&#44; there are changes in body composition&#44; volume of distribution and renal and hepatic function&#46; The volume of the central compartment &#40;where a drug initially distributes upon administration&#41; tends to be greater due to the blood volume and the size of the major organs&#44; so that a higher initial dose is required to obtain the same pharmacological effect&#46; The volumes of distribution at equilibrium also increase for lipid-soluble drugs &#40;e&#46;g&#46;&#44; sodium thiopental&#44; lidocaine&#44; benzodiazepines&#41; and water-soluble drugs &#40;e&#46;g&#46;&#44; vecuronium&#44; rocuronium&#41; due to the increase in extracellular fluid in adipose and lean tissue&#46; To this&#44; we must add the increase in body fat&#44; changes in protein binding and the increase in blood volume and cardiac output&#46; All of it affects the distribution of water-soluble and lipid-soluble drugs&#44; so there is a risk of overdosing &#40;e&#46;g&#46;&#44; sufentanil&#41; or underdosing &#40;e&#46;g&#46;&#44; succinylcholine&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Plasma protein binding</span>&#46; It may decrease for some drugs&#44; increasing the proportion of free drug due to the higher concentration of free fatty acids&#44; TGs and cholesterol&#46; The increase in &#945;1-acid glycoprotein increases the binding of local anaesthetics and opioids&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Drug elimination</span>&#46; Renal clearance increases due to increases in renal flow&#44; glomerular filtration and tubular secretion&#46; The increase in glomerular filtration results in an increase in the clearance of drugs that do not undergo biotransformation prior to renal excretion and are filtrated by the glomeruli&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Despite the presence of steatosis&#44; hepatic drug metabolism changes little in obese children&#46; Oxidation&#44; reduction and hydrolysis reactions are normal or increase slightly&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">To prevent over- or underdosage&#44;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34&#8211;36</span></a> clinicians can apply dosing equations based on the total body weight &#40;TBW&#41;&#44; ideal body weight &#40;IBW&#41; and the lean body weight &#40;LBW&#41;&#44; defined as follows&#58; TBW as current total body weight of the patient&#44; IBW as the BMI at the 50th percentile for the patient&#8217;s age &#40;ideal BMI&#41; multiplied by the squared height in metres &#40;IBW&#8239;&#61;&#8239;ideal BMI&#8239;&#215;&#8239;height<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#41; and the LBW as the difference between the total body weight and the body fat mass&#46; The latter comprehends all lipids in the body &#40;primary depots and other depots&#41; and its calculation requires different equations for each sex&#46; One of the simplest equations includes the height&#44; waist circumference and head circumference&#46; These are the strategies used to adapt the dosage of the main drugs used in paediatrics anaesthesia&#44; as seen in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">In the case of propofol&#44; the dose should be titrated using a depth of anaesthesia monitor &#40;e&#46;g&#46;&#44; bispectral index &#91;BIS&#93;&#41;&#46; When it comes to volatile anaesthetics&#44; preferential use of desflurane and sevoflurane is recommended&#44; as they are the 2 least lipophilic agents in this group&#44; always adjusting the dose based on the minimum alveolar concentration &#40;MAC&#41;&#44; which is the minimum concentration in the alveoli of the inhaled agent that prevents 50&#37; of subjects from moving in response to a painful stimulus&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Issues concerning the airway</span><p id="par0155" class="elsevierStylePara elsevierViewall">The respiratory pathophysiology associated with obesity includes changes in ventilatory mechanics&#44; respiratory muscles&#44; ventilation regulation and the control of breathing during sleep&#46; The fatty tissue that infiltrates the chest wall reduces the static and dynamic lung volumes&#44; especially the residual volume &#40;RV&#41; and the functional residual capacity &#40;FRC&#41;&#46; There are ventilation&#47;perfusion mismatches&#44; with increases in oxygen consumption &#40;11&#37;&#41;&#44; cardiac output &#40;CO&#41; &#40;35&#37;&#41;&#44; cardiac index &#40;35&#37;&#41; and peripheral vascular resistance &#40;21&#37;&#41;&#46; Metabolic activity and work of breathing increase&#44; leading to greater oxygen consumption and CO<span class="elsevierStyleInf">2</span> production&#46; Obese individuals with SAHS &#40;5&#37;&#41; experience hypoxaemia with alveolar hypoventilation and hypercapnia possibly secondary to the submucosal fatty tissue infiltration in the upper airway&#46; This can lead to airway narrowing and collapse&#46;</p><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Asthma</span><p id="par0160" class="elsevierStylePara elsevierViewall">The underlying mechanisms are mechanical &#40;airway narrowing&#41;&#44; inflammatory and genetic&#46; During general anaesthesia&#44; obese patients have been found to be at increased risk of hypoxaemia and atelectasis&#44; with hypoventilation and decreased tolerance to apnoea&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34&#44;37</span></a></p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0165" class="elsevierStylePara elsevierViewall">This study was funded by the Pathophysiology of Obesity and Nutrition Biomedical Research Networking Centre &#40;<span class="elsevierStyleGrantSponsor" id="gs0005">CIBEROBN</span>&#41;&#44; <span class="elsevierStyleGrantSponsor" id="gs0010">Instituto de Salud Carlos III</span>&#44; Madrid&#44; Spain&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            1 => array:2 [
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              "identificador" => "sec0030"
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            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Cardiometabolic risk"
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          "identificador" => "sec0040"
          "titulo" => "Emerging comorbidities"
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              "identificador" => "sec0045"
              "titulo" => "Psychosocial"
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            1 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Metabolic fatty liver disease"
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          "identificador" => "sec0055"
          "titulo" => "Interventions requiring anaesthesia"
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              "titulo" => "Pharmacokinetics of anaesthetic agents"
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          "identificador" => "sec0065"
          "titulo" => "Issues concerning the airway"
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              "titulo" => "Asthma"
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          "titulo" => "Funding"
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    "fechaRecibido" => "2024-07-04"
    "fechaAceptado" => "2024-07-29"
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            0 => "Obesity"
            1 => "Children"
            2 => "Adolescents"
            3 => "Anaesthesia"
            4 => "Comorbidities"
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            0 => "Obesidad"
            1 => "Ni&#241;os"
            2 => "Adolescentes"
            3 => "Anestesia"
            4 => "Comorbilidades"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Childhood obesity is associated with comorbidities that affect almost all body systems&#44; including&#44; among others&#44; the endocrine&#44; gastrointestinal&#44; pulmonary&#44; cardiovascular and musculoskeletal systems&#44; as well as medical and surgical procedures that may be required due to different clinical situations&#46; The objective of this article is to describe the classic and emerging comorbidities associated with obesity and the complications of procedures that involve invasive manoeuvres&#46; Although some of the problems associated with obesity during childhood are widely known&#44; such as musculoskeletal and cutaneous disorders or apnoea&#8211;hypopnoea syndrome&#44; others&#44; such as changes in kidney function&#44; non-alcoholic fatty liver and cardiometabolic risk&#44; have received less attention due to their insidious development&#44; as they may not manifest until adulthood&#46; In contrast&#44; there is another group of comorbidities that may have a greater impact due to their frequency and consequences&#44; which are psychosocial problems&#46; Finally&#44; in the context of invasive medico-surgical interventions&#44; obesity can complicate airway management&#46; The recognition of these pathologies in association with childhood obesity is of vital importance not only in childhood but also due to their ramifications in adulthood&#46;</p></span>"
      ]
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La obesidad infantil est&#225; asociada con comorbilidades que afectan a casi todos los sistemas del organismo&#44; incluidos&#44; entre otros&#44; los sistemas endocrino&#44; gastrointestinal&#44; pulmonar&#44; cardiovascular y musculoesquel&#233;tico&#44; as&#237; como a los procedimientos m&#233;dicos y quir&#250;rgicos que puedan precisarse por situaciones cl&#237;nicas varias&#46; El objetivo del presente art&#237;culo es describir las enfermedades cl&#225;sicas y emergentes asociadas a la obesidad&#44; as&#237; como las complicaciones de procedimientos que requieren maniobras invasivas&#46; Aunque algunos de los problemas asociados a la obesidad durante la infancia son ampliamente conocidos como los musculoesquel&#233;ticos y cut&#225;neos&#44; as&#237; como el s&#237;ndrome de apneas hipopneas&#44; otros como las alteraciones de la funci&#243;n renal&#44; el h&#237;gado graso metab&#243;lico y el riesgo cardiometab&#243;lico han recibido menos atenci&#243;n debido a su desarrollo larvado que condiciona enfermedad en la edad adulta&#46; Por el contrario&#44; existe otro grupo quiz&#225; con mayor impacto por frecuencia y por sus consecuencias que son los problemas psicosociales&#46; Por &#250;ltimo&#44; en presencia de acciones m&#233;dico-quirurgicas invasivas la obesidad puede dificultar el acceso a la v&#237;a a&#233;rea&#46; El reconocimiento de estas enfermedades asociadas a la obesidad infantil es de vital importancia no solo para el periodo infantil&#44; sino tambi&#233;n pro su proyecci&#243;n a la vida adulta&#46;</p></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comorbidities associated with childhood obesity&#46;</p>"
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          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">IBW&#44; ideal body weight&#59; LBW&#44; lean body weight&#59; MAC&#44; minimum alveolar concentration&#59; TBW total body weight&#46;</p>"
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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">Drug&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">Induction dose&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">Maintenance dose&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">Propofol&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">LBW&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">TBW&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">Etomidate&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">LBW&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">&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">Ketamine&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">IBW&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">&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">Benzodiazepines&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">LBW&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">IBW&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">Desflurane and sevoflurane&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">MAC<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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">MAC<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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">Fentanyl&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">LBW&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">LBW&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">Remifentanil&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">LBW&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">LBW&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">Morphine&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">IBW&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">IBW&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">Succinylcholine&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">TBW&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">&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">Non-depolarizing neuromuscular blockers&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">IBW&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">IBW&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Polysomnographic comparison of sleep in children with obesity and normal weight without suspected sleep-related breathing disorder"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            3 => "P&#46;B&#46; Juliusson"
                            4 => "S&#46; Pallesen"
                          ]
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                      "doi" => "10.1111/cob.12493"
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                        "tituloSerie" => "Clin Obes"
                        "fecha" => "2022"
                        "volumen" => "12"
                        "paginaInicial" => "e12493"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34781415"
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                          ]
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                    ]
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            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity in children with different risk factors for obstructive sleep apnea&#58; a community-based study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;-S&#46; Su"
                            1 => "H&#46;-L&#46; Zhang"
                            2 => "X&#46;-H&#46; Cai"
                            3 => "Y&#46; Lin"
                            4 => "P&#46;-N&#46; Liu"
                            5 => "Y&#46;-B&#46; Zhang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur J Pediatr"
                        "fecha" => "2016"
                        "volumen" => "175"
                        "paginaInicial" => "211"
                        "paginaFinal" => "220"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Overweight and obesity add to behavioral problems in children with sleep-disordered breathing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;N&#46; Biggs"
                            1 => "K&#46; Tamanyan"
                            2 => "L&#46;M&#46; Walter"
                            3 => "A&#46;J&#46; Weichard"
                            4 => "M&#46;J&#46; Davey"
                            5 => "G&#46;M&#46; Nixon"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.sleep.2017.09.001"
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                        "tituloSerie" => "Sleep Med"
                        "fecha" => "2017"
                        "volumen" => "39"
                        "paginaInicial" => "62"
                        "paginaFinal" => "69"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29157589"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Review of childhood obesity&#58; from epidemiology&#44; etiology&#44; and comorbidities to clinical assessment and treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Kumar"
                            1 => "A&#46;S&#46; Kelly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.mayocp.2016.09.017"
                      "Revista" => array:6 [
                        "tituloSerie" => "Mayo Clin Proc"
                        "fecha" => "2017"
                        "volumen" => "92"
                        "paginaInicial" => "251"
                        "paginaFinal" => "265"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28065514"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Injury patterns in obese versus nonobese children presenting to a pediatric emergency department"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "W&#46;J&#46; Pomerantz"
                            1 => "N&#46;L&#46; Timm"
                            2 => "M&#46;A&#46; Gittelman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2009-2367"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2010"
                        "volumen" => "125"
                        "paginaInicial" => "681"
                        "paginaFinal" => "685"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20194280"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Musculoskeletal effects of obesity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46; Chan"
                            1 => "C&#46;T&#46; Chen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MOP.0b013e328320a914"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Pediatr"
                        "fecha" => "2009"
                        "volumen" => "21"
                        "paginaInicial" => "65"
                        "paginaFinal" => "70"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19242242"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Body mass index in patients with slipped capital femoral epiphysis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46;N&#46; Bhatia"
                            1 => "M&#46; Pirpiris"
                            2 => "N&#46;Y&#46; Otsuka"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.bpo.0000218526.36362.3f"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Orthop"
                        "fecha" => "2006"
                        "volumen" => "26"
                        "paginaInicial" => "197"
                        "paginaFinal" => "199"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16557134"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The unsolved problem of paediatric physical inactivity&#58; it&#8217;s time for a new perspective"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;D&#46; Faigenbaum"
                            1 => "T&#46; Rial Rebullido"
                            2 => "J&#46;P&#46; MacDonald"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/apa.14527"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Paediatr"
                        "fecha" => "2018"
                        "volumen" => "107"
                        "paginaInicial" => "1857"
                        "paginaFinal" => "1859"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30069914"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Childhood obesity and impact on the kidney"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Correia-Costa"
                            1 => "A&#46; Azevedo"
                            2 => "A&#46; Caldas Afonso"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000492826"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nephron"
                        "fecha" => "2019"
                        "volumen" => "143"
                        "paginaInicial" => "8"
                        "paginaFinal" => "11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30359981"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acanthosis nigricans in obese adolescents&#58; prevalence&#44; impact&#44; and management challenges"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46;Y&#46; Ng"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Adolesc Health Med Ther"
                        "fecha" => "2016"
                        "volumen" => "8"
                        "paginaInicial" => "1"
                        "paginaFinal" => "10"
                      ]
                    ]
                  ]
                ]
              ]
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            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skin changes in the obese patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46;A&#46; Hirt"
                            1 => "D&#46;E&#46; Castillo"
                            2 => "G&#46; Yosipovitch"
                            3 => "J&#46;E&#46; Keri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2018.12.070"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2019"
                        "volumen" => "81"
                        "paginaInicial" => "1037"
                        "paginaFinal" => "1057"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31610857"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anthropometry for predicting cardiometabolic disease risk factors in adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Xie"
                            1 => "J&#46; Kim"
                            2 => "J&#46;P&#46; Almandoz"
                            3 => "J&#46; Clark"
                            4 => "M&#46;S&#46; Mathew"
                            5 => "B&#46;R&#46; Cartwright"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/oby.24090"
                      "Revista" => array:6 [
                        "tituloSerie" => "Obesity &#40;Silver Spring&#41;"
                        "fecha" => "2024"
                        "volumen" => "32"
                        "paginaInicial" => "1558"
                        "paginaFinal" => "1567"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/38994553"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Blood pressure in children and adolescents&#58; current insights"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46; Lurbe"
                            1 => "J&#46;R&#46; Ingelfinger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/HJH.0000000000000790"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hypertens"
                        "fecha" => "2016"
                        "volumen" => "34"
                        "paginaInicial" => "176"
                        "paginaFinal" => "183"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26599224"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Added impact of obesity and insulin resistance in nocturnal blood pressure elevation in children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Lurbe"
                            1 => "I&#46; Torro"
                            2 => "F&#46; Aguilar"
                            3 => "J&#46; Alvarez"
                            4 => "J&#46; Alcon"
                            5 => "J&#46;M&#46; Pascual"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/HYPERTENSIONAHA.107.099234"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hypertension"
                        "fecha" => "2008"
                        "volumen" => "51"
                        "paginaInicial" => "635"
                        "paginaFinal" => "641"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18195166"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity&#44; insulin resistance&#44; and nocturnal systolic blood pressure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Whaley-Connell"
                            1 => "J&#46;R&#46; Sowers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/HYPERTENSIONAHA.107.100255"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hypertension"
                        "fecha" => "2008"
                        "volumen" => "51"
                        "paginaInicial" => "620"
                        "paginaFinal" => "621"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18212271"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity and the metabolic sydrome in children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "W&#46; Ram"
                            1 => "J&#46; Dziura"
                            2 => "T&#46;S&#46; Burgert"
                            3 => "W&#46;V&#46; Tamborlane"
                            4 => "S&#46;E&#46; Taksali"
                            5 => "E&#46; Sara"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2004"
                        "volumen" => "350"
                        "paginaInicial" => "2363"
                        "paginaFinal" => "2374"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The metabolic syndrome&#58; look for it in children and adolescents&#44; too&#33;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Jessup"
                            1 => "J&#46;S&#46; Harrell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Diabetes"
                        "fecha" => "2005"
                        "volumen" => "23"
                        "paginaInicial" => "26"
                        "paginaFinal" => "32"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Uric acid is linked to cardiometabolic risk factors in overweight and obese youths"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Lurbe"
                            1 => "M&#46;I&#46; Torro"
                            2 => "J&#46; Alvarez-Pitti"
                            3 => "J&#46; Redon"
                            4 => "C&#46; Borghi"
                            5 => "P&#46; Redon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/HJH.0000000000001814"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hypertens"
                        "fecha" => "2018"
                        "volumen" => "36"
                        "paginaInicial" => "1840"
                        "paginaFinal" => "1846"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29916994"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of hyperuricemia and its association with metabolic syndrome and cardiometabolic risk factors in Korean children and adolescents&#58; analysis based on the 2016&#8211;2017 Korea National Health and Nutrition Examination Survey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;H&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3345/kjp.2019.00444"
                      "Revista" => array:6 [
                        "tituloSerie" => "Korean J Pediatr"
                        "fecha" => "2019"
                        "volumen" => "62"
                        "paginaInicial" => "317"
                        "paginaFinal" => "323"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31319650"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiometabolic risk in adolescents with normal weight obesity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46;C&#46; Cota"
                            1 => "S&#46;E&#46; Priore"
                            2 => "S&#46;A&#46;V&#46; Ribeiro"
                            3 => "L&#46;L&#46; Juvanhol"
                            4 => "E&#46;R&#46; de Faria"
                            5 => "F&#46;R&#46; de Faria"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/s41430-021-01037-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Clin Nutr"
                        "fecha" => "2022"
                        "volumen" => "76"
                        "paginaInicial" => "863"
                        "paginaFinal" => "870"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34711932"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "&#91;21&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Self-esteem and quality of life in obese children and adolescents&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;J&#46; Griffiths"
                            1 => "T&#46;J&#46; Parsons"
                            2 => "A&#46;J&#46; Hill"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/17477160903473697"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Pediatr Obes"
                        "fecha" => "2010"
                        "volumen" => "5"
                        "paginaInicial" => "282"
                        "paginaFinal" => "304"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20210677"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mental disorders in obese children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Vila"
                            1 => "E&#46; Zipper"
                            2 => "M&#46; Dabbas"
                            3 => "C&#46; Bertrand"
                            4 => "J&#46;J&#46; Robert"
                            5 => "C&#46; Ricour"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.psy.0000126201.12813.eb"
                      "Revista" => array:6 [
                        "tituloSerie" => "Psychosom Med"
                        "fecha" => "2004"
                        "volumen" => "66"
                        "paginaInicial" => "387"
                        "paginaFinal" => "394"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15184702"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pediatric obesity-assessment&#44; treatment&#44; and prevention&#58; an endocrine society clinical practice guideline"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;M&#46; Styne"
                            1 => "S&#46;A&#46; Arslanian"
                            2 => "E&#46;L&#46; Connor"
                            3 => "I&#46;S&#46; Farooqi"
                            4 => "M&#46;H&#46; Murad"
                            5 => "J&#46;H&#46; Silverstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1210/jc.2016-2573"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "2017"
                        "volumen" => "102"
                        "paginaInicial" => "709"
                        "paginaFinal" => "757"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28359099"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Can young adult smoking status be predicted from concern about body weight and self-reported BMI among adolescents&#63; Results from a ten-year cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;J&#46; Koval"
                            1 => "L&#46;L&#46; Pederson"
                            2 => "X&#46; Zhang"
                            3 => "P&#46; Mowery"
                            4 => "M&#46; McKenna"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Nicotine Tob Res"
                        "fecha" => "2008"
                        "volumen" => "10"
                        "paginaInicial" => "1449"
                        "paginaFinal" => "1455"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Body dissatisfaction and adolescent self-esteem&#58; prospective findings"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Tiggemann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bodyim.2005.03.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Body Image"
                        "fecha" => "2005"
                        "volumen" => "2"
                        "paginaInicial" => "129"
                        "paginaFinal" => "135"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18089181"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perfil psicopatol&#243;gico de ni&#241;os con sobrepeso u obesidad en tratamiento de p&#233;rdida de peso"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Cebolla"
                            1 => "R&#46;M&#46; Ba&#241;os"
                            2 => "C&#46; Botella"
                            3 => "E&#46; Lurbe"
                            4 => "M&#46;I&#46; Torr&#243;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Psicopatol Psicol Clin"
                        "fecha" => "2011"
                        "volumen" => "16"
                        "paginaInicial" => "125"
                        "paginaFinal" => "133"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "NAFLD nomenclature consensus group&#46; A multisociety Delphi consensus statement on new fatty liver disease nomenclature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;E&#46; Rinella"
                            1 => "J&#46;V&#46; Lazarus"
                            2 => "V&#46; Ratziu"
                            3 => "S&#46;M&#46; Francque"
                            4 => "A&#46;J&#46; Sanyal"
                            5 => "F&#46; Kanwal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/HEP.0000000000000520"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2023"
                        "volumen" => "78"
                        "paginaInicial" => "1966"
                        "paginaFinal" => "1986"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37363821"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non-alcoholic fatty liver disease and childhood obesity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Shaunak"
                            1 => "C&#46;D&#46; Byrne"
                            2 => "N&#46; Davis"
                            3 => "P&#46; Afolabi"
                            4 => "S&#46;N&#46; Faust"
                            5 => "J&#46;H&#46; Davies"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/archdischild-2019-318063"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dis Child"
                        "fecha" => "2021"
                        "volumen" => "106"
                        "paginaInicial" => "3"
                        "paginaFinal" => "8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32409495"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metabolic syndrome in children and adolescents&#58; diagnostic criteria&#44; therapeutic options and perspectives"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46; Weihe"
                            1 => "S&#46; Weihrauch-Bl&#252;her"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s13679-019-00357-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Obes Rep"
                        "fecha" => "2019"
                        "volumen" => "8"
                        "paginaInicial" => "472"
                        "paginaFinal" => "479"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31691175"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recent advances in understanding and managing pediatric nonalcoholic fatty liver disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Vittorio"
                            1 => "J&#46;E&#46; Lavine"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "F1000Res"
                        "fecha" => "2020"
                        "volumen" => "9"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of propofol anesthesia in morbidly obese children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Chidambaran"
                            1 => "S&#46; Sadhasivam"
                            2 => "J&#46; Diepstraten"
                            3 => "H&#46; Esslinger"
                            4 => "S&#46; Cox"
                            5 => "B&#46;M&#46; Schnell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "BMC Anesthesiol"
                        "fecha" => "2013"
                        "volumen" => "21&#59;13"
                        "paginaInicial" => "8"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effect of obesity on the ED&#40;95&#41; of propofol for loss of consciousness in children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "O&#46;A&#46; Olutoye"
                            1 => "X&#46; Yu"
                            2 => "K&#46; Govindan"
                            3 => "I&#46;M&#46; Tjia"
                            4 => "D&#46;L&#46; East"
                            5 => "R&#46; Spearman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1213/ANE.0b013e318256858f"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2012"
                        "volumen" => "115"
                        "paginaInicial" => "147"
                        "paginaFinal" => "153"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22575569"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A retrospective description of anesthetic medication dosing in overweight and obese children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;N&#46; Burke"
                            1 => "T&#46; Voepel-Lewis"
                            2 => "D&#46; Wagner"
                            3 => "I&#46; Lau"
                            4 => "A&#46; Baldock"
                            5 => "S&#46; Malviya"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/pan.12396"
                      "Revista" => array:6 [
                        "tituloSerie" => "Paediatr Anaesth"
                        "fecha" => "2014"
                        "volumen" => "24"
                        "paginaInicial" => "857"
                        "paginaFinal" => "862"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24708463"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perioperative considerations for airway management and drug dosing in obese children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Lerman"
                            1 => "K&#46; Becke"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ACO.0000000000000600"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Anaesthesiol"
                        "fecha" => "2018"
                        "volumen" => "31"
                        "paginaInicial" => "320"
                        "paginaFinal" => "326"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29697466"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anesthetic and pharmacologic considerations in perioperative care of obese children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "V&#46; Chidambaran"
                            1 => "A&#46; Tewari"
                            2 => "M&#46; Mahmoud"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jclinane.2017.12.016"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Anesth"
                        "fecha" => "2018"
                        "volumen" => "45"
                        "paginaInicial" => "39"
                        "paginaFinal" => "50"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29275265"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Best Pharmaceuticals for Children Act&#8211;Pediatric Trials Network Administrative Core Committee&#46; Drug dosing and pharmacokinetics in children with obesity&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;W&#46; Harskamp-van Ginkel"
                            1 => "K&#46;D&#46; Hill"
                            2 => "K&#46;C&#46; Becker"
                            3 => "D&#46; Testoni"
                            4 => "M&#46; Cohen-Wolkowiez"
                            5 => "D&#46; Gonzalez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamapediatrics.2015.132"
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                        "tituloSerie" => "JAMA Pediatr"
                        "fecha" => "2015"
                        "volumen" => "169"
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Article information
ISSN: 23412879
Original language: English
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