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ambientales y del contexto socioecon&#243;mico&#44; a su vez asociado al entorno familiar&#44; comunitario y escolar<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#44;5&#44;6</span></a>&#46; Para afrontar el problema se han puesto en marcha distintas iniciativas&#44; tanto en Espa&#241;a &#40;Estrategia para la Nutrici&#243;n&#44; Actividad F&#237;sica y Prevenci&#243;n de la Obesidad &#91;NAOS&#93;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a>&#59; Plan Estrat&#233;gico Nacional para la Reducci&#243;n de la Obesidad Infantil 2022-2030<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">8</span></a>&#41; como en Europa &#40;Plan de Acci&#243;n de la Uni&#243;n Europea contra la Obesidad Infantil 2014-2020&#41;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">9</span></a>&#46; Adem&#225;s&#44; la nutrici&#243;n y la salud se incluyen en los Objetivos de Desarrollo Sostenible &#40;ODS&#41;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a> de la Agenda 2030 de Naciones Unidas y en el Plan de Acci&#243;n Europeo sobre Alimentaci&#243;n y Nutrici&#243;n 2015-2020<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">11</span></a>&#44; siendo uno de los objetivos principales apoyar la vigilancia&#44; la monitorizaci&#243;n&#44; la evaluaci&#243;n y la investigaci&#243;n en dichos &#225;mbitos&#46; El estudio de la evoluci&#243;n de los indicadores de obesidad y de sobrepeso infantiles es imprescindible para evaluar el impacto de estas iniciativas y orientar el dise&#241;o y la implementaci&#243;n de futuras medidas<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Dos recientes metaan&#225;lisis&#44; que incluyen datos de Espa&#241;a&#44; basados en datos antropom&#233;tricos declarados por los progenitores&#44; discrepan respecto al aumento o la disminuci&#243;n de la obesidad infantil en Espa&#241;a<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">12&#44;13</span></a>&#46; Hasta ahora no hay estudios sobre la evoluci&#243;n del sobrepeso y la obesidad basados en mediciones antropom&#233;tricas objetivas en el tramo de 6 a 9<span class="elsevierStyleHsp" style=""></span>a&#241;os que permitan confirmar o refutar estas hip&#243;tesis&#46; El objetivo de este estudio es analizar la evoluci&#243;n del sobrepeso&#44; de la obesidad y de la obesidad central a partir de datos antropom&#233;tricos objetivos de los escolares de 6 a 9<span class="elsevierStyleHsp" style=""></span>a&#241;os en Espa&#241;a&#44; entre 2011 y 2019&#44; en funci&#243;n del sexo&#44; del nivel de ingresos familiar y del nivel de estudios de los progenitores&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Metodolog&#237;a</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Dise&#241;o y participantes</span><p id="par0020" class="elsevierStylePara elsevierViewall">El estudio ALADINO en Espa&#241;a&#44; dentro de la iniciativa COSI de la OMS&#44; ha desarrollado cuatro ediciones &#40;2011&#44; 2013&#44; 2015 y 2019&#41;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;14&#44;15</span></a>&#46; ALADINO es un estudio observacional&#44; descriptivo y transversal en escolares de 6 a 9<span class="elsevierStyleHsp" style=""></span>a&#241;os escolarizados en Espa&#241;a&#46; Su dise&#241;o detallado se ha publicado previamente<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">14&#44;15</span></a>&#46; Para el presente estudio se han analizado las bases de datos depuradas y homogeneizadas de las rondas de 2011&#44; 2015 y 2019 &#40;aprobaci&#243;n por el Comit&#233; &#201;tico de Ensayos Cl&#237;nicos del Hospital Cl&#237;nico San Carlos de Madrid&#41;&#44; con dise&#241;os y poblaciones comparables &#40;escolares de 6 a 9<span class="elsevierStyleHsp" style=""></span>a&#241;os&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">La poblaci&#243;n de estudio y el tama&#241;o muestral de cada edici&#243;n se establecieron siguiendo el protocolo y los procedimientos de COSI<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">16&#44;17</span></a>&#46; Se realiz&#243; un muestreo aleatorio por conglomerados &#40;centros de educaci&#243;n primaria &#91;CEP&#93;&#41;&#44; poliet&#225;pico y estratificado por comunidades aut&#243;nomas y tama&#241;o del municipio&#44; del registro de CEP del Ministerio de Educaci&#243;n&#46; Se seleccion&#243; una muestra representativa de escolares de 6 a 9<span class="elsevierStyleHsp" style=""></span>a&#241;os en Espa&#241;a&#58; primero se seleccionaron los CEP&#59; a continuaci&#243;n&#44; aleatoriamente&#44; un aula por curso &#40;de 1&#46;&#176; a 4&#46;&#176; de educaci&#243;n primaria&#41; en cada uno de los CEP&#44; y se incluyeron todos los escolares de las aulas seleccionadas con consentimiento informado firmado por los progenitores o tutores legales&#44; presentes el d&#237;a de la medici&#243;n y que accedieron a participar&#46; La participaci&#243;n alcanz&#243; en 2011 el 59&#44;4&#37; de 144 CEP&#44; en 2015 el 73&#44;1&#37; de 165 CEP y en 2019 el 63&#44;9&#37; de 276 CEP&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Variables</span><p id="par0030" class="elsevierStylePara elsevierViewall">En cada edici&#243;n&#44; un equipo de profesionales entrenados midi&#243; peso&#44; talla y circunferencia de cintura con equipos calibrados&#46; Se calcul&#243; el &#237;ndice de masa corporal &#40;IMC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>peso &#91;kg&#93;&#47;talla<span class="elsevierStyleSup">2</span> &#91;m<span class="elsevierStyleSup">2</span>&#41;&#93;&#41; y se clasific&#243; la situaci&#243;n ponderal seg&#250;n la referencia de crecimiento de la OMS<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a> y los criterios <span class="elsevierStyleItalic">International Obesity Task Force</span> &#40;IOTF&#41;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a>&#46; Para la obesidad central o abdominal se calcul&#243; el &#237;ndice cintura-talla &#40;ICT&#41;&#44; considerando obesidad central cuando ICT<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;5<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a>&#46; Se estudiaron factores de desigualdad mediante la desagregaci&#243;n de los resultados por sexo&#44; edad y variables socioecon&#243;micas familiares de nivel de renta del hogar y de estudios m&#225;s alto alcanzado por los progenitores&#44; recogidas a trav&#233;s de cuestionarios<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> autoadministrados dise&#241;ados seg&#250;n las indicaciones de COSI&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">An&#225;lisis estad&#237;stico</span><p id="par0035" class="elsevierStylePara elsevierViewall">Las variables cuantitativas se describieron con medias&#44; desviaciones est&#225;ndar&#44; medianas y rangos intercuart&#237;licos&#46; Las variables cualitativas se describieron con frecuencias&#44; porcentajes e intervalos de confianza al 95&#37;&#46; Se valor&#243; la asociaci&#243;n entre variables cualitativas con la prueba chi cuadrado de Pearson y para variables cuantitativas con la prueba t de Student&#46; El nivel de significaci&#243;n estad&#237;stica fue p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Se presentan los resultados como diferencias relativas y absolutas de las prevalencias entre los a&#241;os estudiados&#46; Para mejorar la precisi&#243;n de las estimaciones en el c&#225;lculo de intervalos de confianza se aplicaron t&#233;cnicas de <span class="elsevierStyleItalic">bootstrapping</span>&#46; Se emple&#243; el programa estad&#237;stico Stata v&#46;16&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><p id="par0040" class="elsevierStylePara elsevierViewall">En los estudios ALADINO 2011&#44; 2015 y 2019 participaron un total de 35&#46;223 escolares de 6 a 9<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; con similar distribuci&#243;n por sexo &#40;<a class="elsevierStyleCrossRef" href="#sec0060">tabla suplementaria A1</a>&#41;&#46; No se evidenciaron diferencias relevantes por sexo entre las medidas de peso&#44; talla&#44; cintura&#44; IMC ni ICT en ninguna de las ediciones &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">La prevalencia de sobrepeso &#40;OMS&#41; disminuy&#243; un 18&#37; &#40;4&#44;8 puntos porcentuales&#41; entre 2011 y 2019 en los ni&#241;os de 6 a 9<span class="elsevierStyleHsp" style=""></span>a&#241;os y no experiment&#243; cambios significativos en las ni&#241;as&#46; Las prevalencias de obesidad y de obesidad grave permanecieron estables en ambos sexos&#46; Con los criterios IOTF&#44; la prevalencia de sobrepeso en ni&#241;os disminuy&#243; un 14&#37; &#40;3&#44;3 puntos porcentuales&#41;&#44; sin cambios en las ni&#241;as ni en las prevalencias de obesidad y de obesidad grave en ning&#250;n sexo&#46; La prevalencia de obesidad central &#40;ICT<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;5&#41; tampoco experiment&#243; cambios entre 2011 y 2019 en ning&#250;n sexo &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">En todas las ediciones&#44; la obesidad y la obesidad grave &#40;OMS&#41; eran m&#225;s prevalentes en ni&#241;os&#44; mientras que el sobrepeso pas&#243; de ser m&#225;s prevalente en ni&#241;os en 2011 a ser m&#225;s frecuente entre las ni&#241;as a partir de 2015 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Por edad&#44; entre 2011 y 2019 se observ&#243; una disminuci&#243;n significativa de la prevalencia de sobrepeso de &#8722;5&#44;4&#44; &#8722;5&#44;7 y &#8722;5&#44;3 puntos porcentuales en ni&#241;os de 6&#44; 7 y 8<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; respectivamente&#44; seg&#250;n la referencia OMS &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#44; <a class="elsevierStyleCrossRef" href="#sec0060">tabla suplementaria A2</a>&#41;&#44; mientras que con los criterios IOTF solo se observ&#243; reducci&#243;n en ni&#241;os de 8<span class="elsevierStyleHsp" style=""></span>a&#241;os &#40;&#8722;5&#44;8 puntos porcentuales&#41; &#40;<a class="elsevierStyleCrossRef" href="#sec0060">tabla suplementaria A2</a>&#41;&#46; En las ni&#241;as&#44; la prevalencia de sobrepeso se mantuvo estable con ambos criterios&#46; Las prevalencias de obesidad y de obesidad grave con ambos criterios y la de obesidad central permanecieron sin cambios en ambos sexos y en todos los grupos de edad &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#44; <a class="elsevierStyleCrossRef" href="#sec0060">tabla suplementaria A2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Por renta&#44; entre 2011 y 2019 se observ&#243; una disminuci&#243;n significativa de la prevalencia de sobrepeso &#40;OMS&#41; tanto en ni&#241;os de familias con rentas bajas como altas &#40;&#8722;4&#44;8 y &#8722;5&#44;5 puntos porcentuales&#44; respectivamente&#41;&#44; mientras que con criterios IOTF el descenso solo fue significativo en los ni&#241;os de familias con mayor nivel de renta &#40;&#8722;4&#44;7 puntos porcentuales&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#44; <a class="elsevierStyleCrossRef" href="#sec0060">tabla suplementaria A3</a>&#41;&#46; En las ni&#241;as no hubo cambios relevantes en la prevalencia de sobrepeso en ning&#250;n grupo de renta &#40;OMS e IOTF&#41;&#46; La prevalencia de obesidad &#40;OMS e IOTF&#41; no sufri&#243; cambios relevantes en cada grupo de renta y sexo&#44; aunque se mantuvo durante todo el periodo un claro gradiente inverso de renta en ambos sexos&#44; ya que la prevalencia de obesidad entre los ni&#241;os y ni&#241;as de menor nivel de renta pr&#225;cticamente duplicaba&#44; en todas las ediciones&#44; la de los escolares de familias de mayor nivel de ingresos&#46; La obesidad central se mantuvo estable en todos los niveles de renta en ambos sexos &#40;<a class="elsevierStyleCrossRef" href="#sec0060">tabla suplementaria A3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Respecto al nivel de estudios de los progenitores&#44; la prevalencia de sobrepeso &#40;OMS&#41; en ni&#241;os descendi&#243; de forma significativa en aquellos ni&#241;os de progenitores con estudios secundarios y universitarios &#40;&#8722;5&#44;3 puntos porcentuales en ambos grupos&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#44; <a class="elsevierStyleCrossRef" href="#sec0060">tabla suplementaria A4</a>&#41;&#46; Con los criterios IOTF el sobrepeso solamente se redujo en ni&#241;os de progenitores con estudios universitarios &#40;&#8722;5&#44;2 puntos porcentuales&#41;&#46; En ni&#241;as el sobrepeso &#40;OMS e IOTF&#41; se mantuvo estable&#44; independientemente del nivel educativo de los progenitores&#46; La prevalencia de obesidad &#40;OMS&#41; solo disminuy&#243; en los ni&#241;os con progenitores con estudios universitarios &#40;&#8722;3&#44;3 puntos porcentuales&#41;&#44; pero no con los criterios IOTF&#46; En ni&#241;as no se observaron cambios en la prevalencia de obesidad &#40;OMS e IOTF&#41; en ning&#250;n nivel educativo&#46; Tampoco hubo cambios en la prevalencia de obesidad central&#44; en ning&#250;n sexo ni en ning&#250;n nivel educativo &#40;<a class="elsevierStyleCrossRef" href="#sec0060">tabla suplementaria A4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discusi&#243;n</span><p id="par0070" class="elsevierStylePara elsevierViewall">Este estudio analiza la evoluci&#243;n del sobrepeso&#44; de la obesidad y de la obesidad central en una amplia muestra representativa de los escolares de 6 a 9<span class="elsevierStyleHsp" style=""></span>a&#241;os entre 2011 y 2019 en Espa&#241;a a partir de medidas antropom&#233;tricas objetivas&#46; Esta evoluci&#243;n no ha sido homog&#233;nea&#44; observ&#225;ndose diferencias por g&#233;nero&#44; edad y variables socioecon&#243;micas&#46; Entre 2011 y 2019 solo ha disminuido la prevalencia de sobrepeso en ni&#241;os de 6&#44; 7 y 8<span class="elsevierStyleHsp" style=""></span>a&#241;os cuyos progenitores tienen nivel de estudios universitario&#46; No se han producido cambios en la prevalencia de obesidad ni de la obesidad central en ni&#241;os&#44; y en ninguna de las tres condiciones &#40;sobrepeso&#44; obesidad y obesidad central&#41; en ni&#241;as&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">La evoluci&#243;n dispar del sobrepeso y de la obesidad puede deberse&#44; por un lado&#44; a que la obesidad est&#225; m&#225;s relacionada con el nivel socioecon&#243;mico&#44; siendo este un determinante dif&#237;cil de modificar<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">5</span></a>&#46; Por otro lado&#44; el sobrepeso es una acumulaci&#243;n m&#225;s leve de grasa corporal y&#44; por tanto&#44; m&#225;s f&#225;cil de corregir&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Diferentes estudios han evidenciado una estabilizaci&#243;n de las prevalencias de obesidad y sobrepeso infantiles en Espa&#241;a y otros pa&#237;ses europeos<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">12&#44;21</span></a>&#44; aunque un reciente metaan&#225;lisis ha se&#241;alado un incremento en Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">13</span></a>&#46; Sin embargo&#44; un estudio de la iniciativa COSI muestra una reducci&#243;n del sobrepeso en ambos sexos en pa&#237;ses del sur de Europa&#44; incluida Espa&#241;a&#44; en l&#237;nea con nuestros resultados&#44; as&#237; como de la obesidad&#44; mientras que en el norte de Europa la prevalencia parece estabilizada<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Un hallazgo relevante es la diferencia de g&#233;nero en la evoluci&#243;n de la prevalencia de sobrepeso&#44; pasando de ser m&#225;s frecuente en ni&#241;os en 2011 a serlo en ni&#241;as a partir de 2015&#44; a pesar de no haber aumentado&#44; mientras que la obesidad se mantuvo m&#225;s prevalente en ni&#241;os todo el periodo&#46; Este cambio se debe al descenso del sobrepeso en ni&#241;os entre 2011 y 2019&#44; que no ocurri&#243; en las ni&#241;as&#46; Esta evoluci&#243;n es similar a la registrada en pa&#237;ses como Italia<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">23</span></a>&#44; mientras en Portugal la disminuci&#243;n significativa del exceso de peso se limit&#243; a las ni&#241;as<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">24</span></a>&#46; Por otro lado&#44; en un estudio en Catalu&#241;a entre 2006 y 2016 el descenso del exceso de peso se produjo en ambos sexos&#44; aunque el m&#233;todo de muestreo y las mediciones difieren de los de nuestro estudio<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a>&#46; Es conocido que el grado de actividad f&#237;sica de ni&#241;os y ni&#241;as en Espa&#241;a suele ser diferente&#44; como ha mostrado un estudio europeo&#44; que incluye datos de Espa&#241;a&#44; en el que las ni&#241;as son m&#225;s sedentarias y realizan menos actividad f&#237;sica que los ni&#241;os<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a>&#46; Una explicaci&#243;n de estas diferencias es que podr&#237;a haber mayor oferta y acceso a actividades deportivas para los ni&#241;os<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a>&#46; Sin embargo&#44; no existe evidencia hasta el momento sobre cambios en la actividad f&#237;sica en este periodo que pudiera justificar la diferencia de g&#233;nero en la evoluci&#243;n del sobrepeso en nuestro estudio&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En nuestro estudio las prevalencias de sobrepeso y de obesidad var&#237;an en funci&#243;n del criterio utilizado &#40;OMS&#44; IOTF&#41;&#44; especialmente en la obesidad &#40;superior con OMS&#41;&#44; como muestran otros estudios<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a>&#46; Estas discrepancias se deben a que cada est&#225;ndar utiliza una poblaci&#243;n de referencia y unos puntos de corte diferentes para identificar grupos de riesgo<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a>&#46; A pesar de estas diferencias&#44; la evoluci&#243;n de la obesidad y del sobrepeso es congruente&#44; coincidiendo en la disminuci&#243;n del sobrepeso y la estabilizaci&#243;n de la obesidad en ni&#241;os y de ambas condiciones en ni&#241;as&#46; Tambi&#233;n se ha analizado la evoluci&#243;n de la obesidad abdominal o central&#44; mostrando prevalencias superiores a las calculadas con la referencia OMS&#44; aunque estables en el periodo&#44; coincidiendo con la evoluci&#243;n de la prevalencia de obesidad seg&#250;n las referencias OMS e IOTF&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">La evoluci&#243;n por edad muestra que la reducci&#243;n del sobrepeso en los ni&#241;os se produce fundamentalmente en aquellos m&#225;s j&#243;venes &#40;6-8<span class="elsevierStyleHsp" style=""></span>a&#241;os&#41; pero no en los de 9<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; Un estudio en Andaluc&#237;a en escolares de 8 a 15<span class="elsevierStyleHsp" style=""></span>a&#241;os tambi&#233;n registr&#243; un descenso del exceso de peso en los m&#225;s j&#243;venes &#40;8 a 13<span class="elsevierStyleHsp" style=""></span>a&#241;os&#41; entre 2011 y 2015&#44; que se produjo a expensas fundamentalmente del sobrepeso<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">30</span></a>&#46; Adem&#225;s&#44; en las &#250;ltimas ediciones de ALADINO los ni&#241;os de 6<span class="elsevierStyleHsp" style=""></span>a&#241;os tienen mejor situaci&#243;n ponderal que en ediciones previas&#44; quiz&#225; como resultado de las medidas poblacionales de mejora de h&#225;bitos de vida&#44; como la Estrategia NAOS en Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a>&#44; que incluyen distintas iniciativas para la promoci&#243;n de una alimentaci&#243;n saludable y la pr&#225;ctica de ejercicio f&#237;sico&#44; unido a una mayor concienciaci&#243;n familiar<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">31</span></a>&#46; Esta tendencia&#44; de consolidarse en pr&#243;ximas ediciones&#44; puede indicar un cambio sustancial respecto al patr&#243;n observado entre 1985 y 2019 en un amplio estudio en 200 pa&#237;ses sobre las trayectorias del IMC por edad&#44; que indicaba que en Espa&#241;a en los ni&#241;os y ni&#241;as m&#225;s peque&#241;os se observaba mayor exceso de IMC respecto al est&#225;ndar de la OMS<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">32</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Respecto a la evoluci&#243;n en funci&#243;n del nivel socioecon&#243;mico&#44; nuestro estudio mostr&#243; una disminuci&#243;n del sobrepeso y de la obesidad limitada fundamentalmente a los ni&#241;os de familias con mayor nivel de estudios de los progenitores&#46; Es bien conocida la relaci&#243;n inversa entre el nivel socioecon&#243;mico familiar y la prevalencia de obesidad y de obesidad central infantil<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">30&#44;33&#44;34</span></a>&#46; Sin embargo&#44; en otro estudio<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">35</span></a>&#44; basado en datos declarados por los progenitores de la Encuesta Nacional de Salud entre 1997 y 2017&#44; se objetiv&#243; un descenso de la obesidad en ni&#241;os de padres de nivel socioecon&#243;mico bajo y un ascenso en ni&#241;as&#46; Por el contrario&#44; en el estudio de la evoluci&#243;n entre 2006 y 2016 en Catalu&#241;a se registr&#243; un descenso de la prevalencia global de obesidad&#44; aunque en las zonas desfavorecidas&#44; de acuerdo con el &#237;ndice de privaci&#243;n MEDEA&#44; esta prevalencia se increment&#243;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a>&#46; En nuestro estudio&#44; las diferencias en la evoluci&#243;n seg&#250;n el nivel socioecon&#243;mico son m&#225;s evidentes utilizando el nivel de estudios que el nivel de renta&#44; un indicador cuyo significado y correlaci&#243;n con el nivel de vida de la familia puede variar en el per&#237;odo de estudio que abarca 9<span class="elsevierStyleHsp" style=""></span>a&#241;os de crisis y postcrisis econ&#243;mica en Espa&#241;a&#46; Aunque ambos indicadores son esenciales en el estudio de las desigualdades&#44; en base a nuestros resultados&#44; el nivel educativo de los progenitores podr&#237;a ser m&#225;s espec&#237;fico para estudiar las diferencias en el plano socioecon&#243;mico<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">36</span></a>&#44; ya que puede tener mayor relaci&#243;n con los h&#225;bitos y los estilos de vida<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">37</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Aunque la disminuci&#243;n del sobrepeso y la mejora de la situaci&#243;n ponderal de los escolares m&#225;s j&#243;venes a lo largo de las ediciones del estudio ALADINO permitir&#237;a realizar una proyecci&#243;n optimista para el futuro pr&#243;ximo&#44; cabe se&#241;alar que la tendencia observada refleja la situaci&#243;n previa a la pandemia por COVID-19&#44; y que es necesario evaluar en pr&#243;ximas ediciones el impacto que esta ha podido tener&#44; ya que algunos estudios<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">38</span></a> y datos de pa&#237;ses como el Reino Unido<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">39</span></a> se&#241;alan un empeoramiento de la situaci&#243;n ponderal de los escolares tras la pandemia&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Entre las fortalezas de este trabajo destaca la homogeneidad de metodolog&#237;a y de dise&#241;o de las tres ediciones incluidas&#44; as&#237; como el amplio tama&#241;o muestral &#40;m&#225;s de 35&#46;000 escolares&#41;&#44; que garantiza la representatividad de los resultados a nivel nacional&#46; Por otro lado&#44; la medici&#243;n antropom&#233;trica objetiva&#44; en lugar de emplear datos declarados por los progenitores&#44; confiere mayor fiabilidad a los resultados&#46; Adem&#225;s&#44; el hecho de que la evaluaci&#243;n con distintos est&#225;ndares de crecimiento empleados habitualmente &#40;OMS&#44; IOTF&#41; sea congruente entre s&#237; avala la consistencia de los resultados&#46; Adicionalmente&#44; el an&#225;lisis evolutivo de la obesidad central&#44; poco habitual en estudios previos&#44; proporciona la base para avanzar en el conocimiento y la interpretaci&#243;n del per&#237;metro abdominal y el &#237;ndice cintura-talla como par&#225;metros adicionales para valorar la situaci&#243;n ponderal de los escolares&#46; Por &#250;ltimo&#44; el an&#225;lisis comparativo por factores socioecon&#243;micos permite caracterizar desigualdades de g&#233;nero y socioecon&#243;micas en la evoluci&#243;n de la obesidad infantil&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Entre las limitaciones hay que se&#241;alar que se basa en estudios transversales&#44; lo que limita la posibilidad de establecer inferencias causales&#46; Adem&#225;s&#44; dado que el rango de edad estudiado est&#225; restringido a los 6 a 9<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; los resultados pueden no ser representativos de otros grupos de edad&#46; Otra limitaci&#243;n es que no se han tenido en cuenta factores clave como los h&#225;bitos alimentarios&#44; la actividad f&#237;sica o la concienciaci&#243;n familiar&#44; que podr&#237;an ser algunos de los factores explicativos de la ausencia de diferencias seg&#250;n la renta en la evoluci&#243;n del sobrepeso&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusiones</span><p id="par0120" class="elsevierStylePara elsevierViewall">Entre 2011 y 2019 ha disminuido la prevalencia de sobrepeso en ni&#241;os de 6 a 8<span class="elsevierStyleHsp" style=""></span>a&#241;os y aquellos cuyos progenitores tienen estudios universitarios&#46; La prevalencia de sobrepeso en ni&#241;os sigue siendo superior en hogares con estudios universitarios&#44; al contrario de lo que ocurre con el sobrepeso en ni&#241;as&#44; y la obesidad es m&#225;s prevalente en hogares con estudios primarios&#46; En las ni&#241;as y en los ni&#241;os&#44; de otros estratos socioecon&#243;micos o de 9<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; no se han producido cambios en las prevalencias de sobrepeso y de obesidad&#44; y en todo caso siguen siendo inaceptablemente altas&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Estos resultados subrayan la importancia de implantar pol&#237;ticas dirigidas a monitorizar y combatir la obesidad infantil que tengan en cuenta las desigualdades de g&#233;nero y socioecon&#243;micas subyacentes&#44; que condicionan una peor evoluci&#243;n del sobrepeso y la obesidad en las ni&#241;as y en la poblaci&#243;n m&#225;s desfavorecida&#44; desarrollando enfoques inclusivos que permitan reducir estas desigualdades en salud&#46; La vigilancia en pr&#243;ximos estudios ALADINO permitir&#225; conocer la evoluci&#243;n de estos indicadores tras la pandemia por COVID-19&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Financiaci&#243;n</span><p id="par0130" class="elsevierStylePara elsevierViewall">Los estudios ALADINO han sido financiados por la Agencia Espa&#241;ola de Seguridad Alimentaria y Nutrici&#243;n&#44; que desarrolla peri&#243;dicamente el estudio ALADINO en el marco de la <span class="elsevierStyleItalic">Child Obesity Surveillance Initiative</span> de la Oficina Regional para Europa de la OMS&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicto de intereses</span><p id="par0135" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de inter&#233;s&#46;</p></span></span>"
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            1 => "Overweight"
            2 => "Child"
            3 => "Child poverty"
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            6 => "Gender equity"
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    "resumen" => array:2 [
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introducci&#243;n</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El exceso de peso infantil es un problema de salud p&#250;blica creciente&#46; El objetivo del trabajo es estudiar la evoluci&#243;n de la prevalencia de sobrepeso&#44; de obesidad y de obesidad central en escolares de 6 a 9<span class="elsevierStyleHsp" style=""></span>a&#241;os en Espa&#241;a entre 2011 y 2019 seg&#250;n caracter&#237;sticas demogr&#225;ficas y socioecon&#243;micas&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Metodolog&#237;a</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron las rondas 2011&#44; 2015 y 2019 del estudio observacional&#44; descriptivo y transversal ALADINO en escolares de ambos sexos de 6 a 9<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; Se realiz&#243; un an&#225;lisis descriptivo de la evoluci&#243;n de la prevalencia de sobrepeso y de obesidad seg&#250;n los criterios de la Organizaci&#243;n Mundial de la Salud &#40;OMS&#41; y la <span class="elsevierStyleItalic">International Obesity Task Force</span> &#40;IOTF&#41;&#44; as&#237; como obesidad central&#44; y las variables demogr&#225;ficas y socioecon&#243;micas asociadas&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Entre 2011 y 2019 se redujo la prevalencia de sobrepeso &#40;criterios OMS&#41; en ni&#241;os de 6&#44; 7 y 8<span class="elsevierStyleHsp" style=""></span>a&#241;os &#40;&#8722;5&#44;4&#44; &#8722;5&#44;7 y &#8722;5&#44;3 puntos porcentuales&#44; respectivamente&#41; y ni&#241;os cuyos progenitores ten&#237;an estudios superiores &#40;&#8722;5&#44;3 puntos porcentuales&#41;&#46; Por renta&#44; el sobrepeso en ni&#241;os se redujo en todos los niveles de ingresos&#46; Sin embargo&#44; entre 2011 y 2019 se mantuvieron estables tanto la prevalencia de sobrepeso en ni&#241;as como la prevalencia de obesidad seg&#250;n las referencias OMS e IOTF y la de obesidad central en ambos sexos&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Las prevalencias de sobrepeso y de obesidad en escolares de 6 a 9<span class="elsevierStyleHsp" style=""></span>a&#241;os en Espa&#241;a siguen siendo altas&#46; Entre 2011 y 2019 disminuy&#243; la prevalencia de sobrepeso en ni&#241;os de 6 a 8<span class="elsevierStyleHsp" style=""></span>a&#241;os y aquellos cuyos progenitores tienen estudios universitarios&#44; mientras que la obesidad en ni&#241;os&#44; el sobrepeso y la obesidad en ni&#241;as&#44; y la obesidad central en ambos sexos han permanecido estables&#46;</p></span>"
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            "titulo" => "Metodolog&#237;a"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Childhood excess weight is a growing public health problem&#46; The aim of this study was to assess temporal trends in the prevalence of overweight&#44; obesity and central obesity in schoolchildren aged 6 to 9<span class="elsevierStyleHsp" style=""></span>years in Spain between 2011 and 2019 based on demographic and socioeconomic characteristics&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Methodology</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The analysis included data from the 2011&#44; 2015 and 2019 rounds of the cross-sectional observational and descriptive ALADINO study in schoolchildren of both sexes aged 6 to 9<span class="elsevierStyleHsp" style=""></span>years&#46; We conducted a descriptive analysis of the trends in the prevalence of overweight and obesity &#40;defined according to the criteria of the World Health Organization &#91;WHO&#93; and the International Obesity Task Force &#91;IOTF&#93;&#41; and of central obesity&#44; in addition to associated demographic and socioeconomic variables&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Between 2011 and 2019&#44; the prevalence of overweight &#40;WHO criteria&#41; decreased in boys aged 6&#44; 7 and 8<span class="elsevierStyleHsp" style=""></span>years &#40;by &#8722;5&#46;4&#37;&#44; &#8722;5&#46;7&#37; and &#8722;5&#46;3&#37;&#44; respectively&#41; and boys whose parents had a higher educational attainment &#40;by &#8722;5&#46;3&#37;&#41;&#46; In relation to the socioeconomic level&#44; overweight in boys declined at all income levels&#46; However&#44; between 2011 and 2019&#44; both the prevalence of overweight in girls and the prevalence of obesity &#40;applying the WHO and IOTF criteria&#41; and the prevalence of central obesity in both sexes remained stable&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The prevalence of overweight and the prevalence of obesity in schoolchildren aged 6 to 9<span class="elsevierStyleHsp" style=""></span>years in Spain remain high&#46; Between 2011 and 2019&#44; the prevalence of overweight in children aged 6 to 8<span class="elsevierStyleHsp" style=""></span>years and in children whose parents had university degrees decreased&#44; whereas obesity in boys&#44; overweight and obesity in girls and central obesity in both sexes remained stable&#46;</p></span>"
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          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Media&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">DE&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">p50&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">RIC&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">Media&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">DE&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p50&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">RIC&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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="center" valign="middle"><span class="elsevierStyleBold">Ni&#241;os 2011</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="center" valign="middle"><span class="elsevierStyleBold">Ni&#241;as 2011</span></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">Peso &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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">Talla &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">129&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">129&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">129&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">128&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;4&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">IMC &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;7&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">Cintura &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;6&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">&#205;ndice cintura&#47;talla&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="center" valign="middle"><span class="elsevierStyleBold">Ni&#241;os 2015</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="center" valign="middle"><span class="elsevierStyleBold">Ni&#241;as 2015</span></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">Peso &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;7&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">Talla &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">129&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">IMC &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Cintura &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">10&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#205;ndice cintura&#47;talla&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="4" align="center" valign="middle"><span class="elsevierStyleBold">Ni&#241;os 2019</span></td><td class="td" title="\n
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                  \t\t\t\t  " colspan="4" align="center" valign="middle"><span class="elsevierStyleBold">Ni&#241;as 2019</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">IMC &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Cintura &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">59&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#205;ndice cintura&#47;talla&nbsp;\t\t\t\t\t\t\n
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