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Por tanto&#44; resulta de gran inter&#233;s determinar la prevalencia de exceso de peso con datos recientes para poder analizar la situaci&#243;n&#44; identificar factores condicionantes y establecer medidas preventivas a nivel local&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El &#237;ndice de masa corporal &#40;IMC&#41; es un buen indicador indirecto del exceso de peso&#44; tanto para su valoraci&#243;n individual como comunitaria&#44; y permite la comparaci&#243;n de su prevalencia entre estudios nacionales e internacionales para dimensionar el alcance del problema<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;13</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En Espa&#241;a se han publicado diversas tablas y gr&#225;ficos del IMC por edad y sexo&#44; proponi&#233;ndose puntos de corte del IMC a partir de los cuales los ni&#241;os se clasifican en sobrepeso y obesidad&#46; Sin embargo&#44; existen bastantes discrepancias y controversias a la hora de decidir qu&#233; criterios de referencia utilizar para ello&#44; pues cada uno presenta ventajas e inconvenientes debido a su distinta metodolog&#237;a&#46; El European Childhood Obesity Group &#40;ECOG&#41;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> recomienda que&#44; en ausencia de un consenso ampliamente compartido&#44; en estudios de prevalencia deber&#237;an considerarse varias referencias&#44; concretamente las del International Obesity Task Force &#40;IOTF&#41; y la Organizaci&#243;n Mundial de la Salud &#40;OMS&#41;&#44; y otras nacionales&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El objetivo de este trabajo consiste en estimar la prevalencia de sobrepeso y obesidad en poblaci&#243;n infantil de la Regi&#243;n de Murcia mediante la determinaci&#243;n del IMC aplicando los criterios de referencia del IOTF<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a>&#44; y valorar estos resultados con los obtenidos mediante las referencias de la OMS<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a> y las de estudios nacionales como los de la Fundaci&#243;n Orbegozo &#40;FO&#41;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#8211;21</span></a> y los Estudios Transversales Espa&#241;oles de Crecimiento &#40;ETEC&#41; 2010<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;23</span></a>&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se trata de un estudio que estima las prevalencias de sobrepeso&#44; obesidad y sobrecarga ponderal en ni&#241;os de 2 a 14 a&#241;os de edad&#44; con datos procedentes de los controles de salud establecidos en el Programa de Atenci&#243;n al Ni&#241;o y al Adolescente &#40;PANA&#41;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> durante el per&#237;odo 2005-2011&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">La obesidad se define como un incremento de peso corporal a expensas&#44; preferentemente&#44; del aumento del tejido adiposo&#46; La clasificaci&#243;n de individuos como sobrepeso u obesidad se establece usando diferentes par&#225;metros del IMC como percentiles y puntuaciones est&#225;ndar<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#46; 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los ni&#241;os fueron clasificados como sobrepeso entre 1 y 2 desviaciones est&#225;ndar &#40;DE&#41; por encima de la media y como obesidad con m&#225;s de 2<span class="elsevierStyleHsp" style=""></span>DE por encima de la media&#46; En 2007&#44; la OMS elabor&#243; las gr&#225;ficas de crecimiento de ni&#241;os de 5 a 19 a&#241;os usando datos del National Center for Health Statistics&#44; enlaz&#225;ndolas con sus est&#225;ndares de 0 a 5 a&#241;os mediante procedimientos estad&#237;sticos<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">La FO ha patrocinado distintos trabajos sobre crecimiento y desarrollo&#44; utilizando diversos tipos de dise&#241;os&#46; Las 3 referencias valoradas son&#58; el Estudio semilongitudinal Orbegozo 1988 &#40;FO-1988&#41;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#44; que fue iniciado en 1978 con una muestra aleatoria de 600 ni&#241;os de 0&#44; 5 y 9 a&#241;os que fueron seguidos durante 9 a&#241;os&#59; la Gu&#237;a de Pr&#225;ctica Cl&#237;nica del Ministerio de Sanidad<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#44; publicada en 2009&#44; recomienda usar&#44; para este estudio&#44; el percentil 90 para sobrepeso y el 97 para obesidad como puntos de corte del IMC&#59; el Estudio longitudinal Orbegozo 2004 &#40;FO-2004&#41;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> iniciado en los mismos a&#241;os que el anterior&#44; con ni&#241;os seguidos durante 18 a&#241;os hasta 1998&#44; que propone el percentil 85 para sobrepeso y el 95 para obesidad como puntos de corte&#59; y m&#225;s recientemente&#44; se ha editado el Estudio transversal Orbegozo-2011 &#40;FO-2011&#41;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> realizado con datos recogidos en 2000-2001 de un estudio transversal publicado junto con el longitudinal en 2004&#44; a los que se aplic&#243; la misma metodolog&#237;a que IOTF para obtener los puntos de corte espec&#237;ficos por edad y sexo&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El an&#225;lisis conjunto de distintos estudios transversales y longitudinales de crecimiento realizados en Espa&#241;a entre 2000 y 2010&#44; con datos de 32&#46;064 sujetos de 0 a 24 a&#241;os de varias zonas geogr&#225;ficas&#44; ha dado lugar al ETEC<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;23</span></a>&#44; que propone&#44; como puntos de corte&#44; los percentiles 80 y 97 para el sobrepeso y obesidad en varones&#44; y 85 y 97 en mujeres&#44; respectivamente&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Recogida de datos y depuraci&#243;n</span><p id="par0075" class="elsevierStylePara elsevierViewall">Los datos originales del estudio se han extra&#237;do de la base de datos de historias cl&#237;nicas informatizadas de atenci&#243;n primaria &#40;mediante OMI-AP&#41; donde est&#225;n registrados los controles de salud&#46; Se utilizaron todos los registros de los ni&#241;os que ten&#237;an entre 2 y 14 a&#241;os en el per&#237;odo 2005-2011&#46; Un mismo ni&#241;o pod&#237;a tener varios registros en ese per&#237;odo&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Los datos fueron anonimizados previamente asignando a cada ni&#241;o&#44; de manera aleatoria&#44; un n&#250;mero de historia cl&#237;nica &#40;NHC&#41; falso distinto al real&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">De cada registro de control de salud se recogieron&#58; NHC&#44; fechas de nacimiento y control de salud&#44; sexo&#44; peso &#40;kg&#41; y talla &#40;cm&#41;&#46; A partir de estos&#44; se calcularon las variables&#58; edad en a&#241;os&#44; meses y d&#237;as&#44; edad en a&#241;os completos&#44; edad en intervalos de medio a&#241;o&#44; a&#241;o del control de salud e IMC&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Se excluyeron los registros que estaban duplicados o en los que faltaba alguna de las variables indicadas o que por incoherencia entre los datos de peso y talla daban valores de IMC demasiado extremos&#46; Aquellos que ten&#237;an intercambiados el peso y la talla o que expresaban la talla en metros fueron corregidos adecuadamente&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">M&#233;todo estad&#237;stico</span><p id="par0095" class="elsevierStylePara elsevierViewall">Para la clasificaci&#243;n del IMC de cada registro en sobrepeso u obesidad se us&#243; la edad en intervalos de medio a&#241;o&#44; pues as&#237; lo requer&#237;an los criterios de referencia utilizados&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Como un ni&#241;o pod&#237;a tener varios registros en el per&#237;odo global o en alg&#250;n per&#237;odo anual de su edad o en alg&#250;n a&#241;o de control de salud&#44; y con el fin de contabilizarlo solamente una vez en ese per&#237;odo&#44; se emple&#243; solo un registro de cada ni&#241;o en cada per&#237;odo considerado&#44; eligi&#233;ndose&#44; para el c&#225;lculo de la prevalencia en el mismo&#44; el registro con mayor IMC en dicho per&#237;odo&#44; ya que interesaba detectar si ese ni&#241;o hab&#237;a estado en sobrepeso u obesidad en alg&#250;n momento del mismo&#44; produciendo que el c&#225;lculo de prevalencias se realizara sobre distinto n&#250;mero de registros seg&#250;n el tipo de per&#237;odo considerado en cada momento&#44; aprovech&#225;ndose as&#237; la m&#225;xima informaci&#243;n posible&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Se calcularon las prevalencias de sobrepeso&#44; obesidad y sobrecarga ponderal globalmente&#44; por sexo&#44; por a&#241;os de edad y por a&#241;o del control de salud para todas las referencias&#46; Se presentan las prevalencias calculadas con IOTF por a&#241;o de edad y sexo con sus intervalos de confianza al 95&#37;&#46; La comparaci&#243;n de las mismas entre sexos se realiz&#243; con el test ji-cuadrado&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Para evaluar los distintos criterios de referencia se utilizaron tablas&#44; gr&#225;ficos y el coeficiente kappa entre cada 2 de ellos&#44; que informa de su grado de concordancia&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0115" class="elsevierStylePara elsevierViewall">Se han valorado 303&#46;247 registros de controles de salud correspondientes a 178&#46;894 ni&#241;os de 2 a 14 a&#241;os de edad en el per&#237;odo 2005-2011&#44; de los que 91&#46;517 eran ni&#241;os y 87&#46;377 ni&#241;as&#44; que suponen un 60&#44;5&#37; de la poblaci&#243;n de esa edad con asistencia sanitaria p&#250;blica&#44; seg&#250;n informaci&#243;n de la base de datos del Servicio Murciano de Salud&#46; El c&#225;lculo de prevalencias global y por sexo se realiz&#243; con 178&#46;894 registros&#44; uno por ni&#241;o&#44; por a&#241;os de edad con 293&#46;980 registros&#44; y por a&#241;o de control de salud con 295&#46;168 registros&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se muestran las prevalencias globales de sobrepeso&#44; obesidad y sobrecarga ponderal&#44; seg&#250;n las referencias del IOTF&#44; por sexo y por edad con sus intervalos de confianza&#46; Estos tienen reducida amplitud debido al gran tama&#241;o de muestra utilizado&#44; reflejando una gran precisi&#243;n en las estimaciones&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Se obtiene una prevalencia global del 20&#44;6&#37; de sobrepeso&#44; del 11&#44;4&#37; de obesidad y del 32&#37; de sobrecarga ponderal&#46; Esas prevalencias son significativamente mayores en ni&#241;as que en ni&#241;os hasta los 10 a&#241;os&#44; pero despu&#233;s la tendencia se invierte&#44; superando los ni&#241;os a las ni&#241;as&#46; El sobrepeso aumenta progresivamente&#44; alcanzando tasas de hasta el 29 y 28&#37; a los 10 y 11 a&#241;os&#44; respectivamente&#46; La obesidad tambi&#233;n aumenta con la edad&#44; alcanzando los porcentajes m&#225;s elevados&#44; 21 y 21&#44;6&#37;&#44; a los 8 y 9 a&#241;os&#44; respectivamente&#44; para despu&#233;s ir disminuyendo&#46; La sobrecarga ponderal presenta una prevalencia muy alta&#44; sobre todo a los 8&#44; 9 y 10 a&#241;os&#44; en alg&#250;n caso superior al 45&#37;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">La evoluci&#243;n de las prevalencias durante el per&#237;odo estudiado &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41; muestra un crecimiento claro hasta 2007&#44; a partir del cual&#44; y hasta 2011&#44; la de obesidad sigue aumentando m&#225;s suavemente&#44; la de sobrepeso disminuye y la de sobrecarga ponderal se mantiene m&#225;s o menos estable&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se exponen las prevalencias con las distintas referencias estudiadas&#46; La referencia OMS muestra el porcentaje m&#225;s alto de sobrepeso &#40;25&#37;&#41;&#44; siendo los ofrecidos por ETEC&#44; FO-2011 e IOTF bastantes similares&#44; mientras que con FO-1988 &#40;8&#44;31&#37;&#41; y FO-2004 &#40;10&#44;6&#37;&#41; son mucho m&#225;s bajos&#46; En cuanto a la obesidad&#44; el IOTF &#40;11&#44;4&#37;&#41; y&#44; sobre todo&#44; ETEC &#40;7&#44;2&#37;&#41; y FO-2011 &#40;8&#37;&#41; presentan cifras m&#225;s bajas que el resto de referencias&#44; que casi duplican estos porcentajes&#46; La sobrecarga ponderal oscila entre porcentajes tan dispares como el 43&#44;7&#37; de la OMS y el 26&#44;4&#37; de FO-2004&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">La prevalencia de sobrepeso aumenta con todas las referencias&#44; sobre todo a los 10-11 a&#241;os &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; Esta evoluci&#243;n es bastante menos acentuada con FO-2004 y FO-1988&#44; que presentan cifras m&#225;s bajas que el resto&#46; IOTF y FO-2011 muestran la evoluci&#243;n m&#225;s similar&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">Tambi&#233;n aumenta con la edad la prevalencia de obesidad &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#44; correspondiendo las cifras m&#225;s altas a FO-1988 y OMS&#44; quedando en una situaci&#243;n intermedia IOTF y FO-2004&#46; En todas se produce un brusco incremento entre los 7-9 a&#241;os&#44; que es menos perceptible con ETEC y FO-2011&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">La referencia OMS presenta&#44; en todas las edades&#44; un porcentaje de sobrecarga ponderal mucho mayor que el resto &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">Las concordancias m&#225;s altas entre referencias se presentan entre IOTF con FO-2011 &#40;kappa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;795&#41;&#44; ETEC con FO-2011 &#40;kappa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;794&#41; y FO-1988 con FO-2004 &#40;kappa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;794&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0160" class="elsevierStylePara elsevierViewall">Los resultados de este estudio confirman una elevada prevalencia de sobrepeso y obesidad en los ni&#241;os de la Regi&#243;n de Murcia &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#44; siendo mayor en ni&#241;as antes de los 10 a&#241;os y en ni&#241;os despu&#233;s de esta edad&#44; probablemente debido al distinto patr&#243;n de crecimiento y desarrollo entre ambos sexos&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Siguiendo las recomendaciones del ECOG<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#44; la prevalencia de exceso de peso se ha valorado con la referencia del IOTF<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46; Su idoneidad se basa en que est&#225; construida con datos de varios pa&#237;ses&#44; sus puntos de corte son menos arbitrarios porque se han calculado a partir de los que se consideran ligados a tasas y riesgos de mortalidad en adultos &#40;IMC 25 y 30&#41;&#44; y son menos dependientes temporal y geogr&#225;ficamente que otras referencias&#44; lo que permite el estudio de tendencias de la prevalencia en el tiempo&#46; Adem&#225;s&#44; puede utilizarse con prop&#243;sitos comparativos debido al amplio uso que se le ha dado en Europa y otros continentes&#46; Seg&#250;n algunos autores&#44; aunque las referencias IOTF pueden usarse para cribado de sobrepeso y obesidad&#44; en la pr&#225;ctica cl&#237;nica deben emplearse tambi&#233;n otros par&#225;metros<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Se han excluido los registros de menores de 2 a&#241;os&#44; ya que no existen definiciones de sobrepeso y obesidad para esa edad y no est&#225; consensuada la idoneidad de la utilizaci&#243;n del IMC en ese per&#237;odo<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;33</span></a>&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Los resultados obtenidos en la Regi&#243;n de Murcia son m&#225;s elevados que los ofrecidos&#44; con la referencia IOTF&#44; por el estudio enKid<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a> y la ENS-2006<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> para el conjunto de Espa&#241;a&#46; Esta &#250;ltima&#44; en su muestra de la Regi&#243;n de Murcia&#44; ofrece datos superiores &#40;23&#44;1&#37; para sobrepeso y 12&#44;4&#37; para obesidad&#41; a los nuestros&#44; aunque con una muestra mucho menor que la de este estudio&#46; En el trabajo de Rodr&#237;guez Artalejo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a>&#44; realizado con datos de 1998-1999 en poblaci&#243;n de 6-7 a&#241;os&#44; la prevalencia en la ciudad de Murcia fue del 19&#37; de sobrepeso y del 13&#44;9&#37; de obesidad&#44; inferior a la nuestra para esa edad&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">La comparaci&#243;n con estos estudios ha de hacerse con precauci&#243;n porque no son totalmente comparables al nuestro&#44; ya que son encuestas transversales que estiman la prevalencia de exceso de peso en un momento concreto con ni&#241;os que tienen solo un registro en dicho momento&#44; mientras que en este trabajo se estima esa prevalencia en un per&#237;odo anual o plurianual&#44; no en un momento determinado&#44; y cada ni&#241;o puede tener varios registros en ese per&#237;odo&#46; Al seleccionar&#44; para cada ni&#241;o&#44; su registro de mayor IMC en dicho per&#237;odo&#44; la probabilidad de identificar a un ni&#241;o que ha estado en sobrepeso u obesidad en ese tiempo es mayor que en las encuestas transversales&#44; por lo que estas podr&#237;an infravalorar dicha prevalencia&#44; proporcionando nuestro m&#233;todo&#44; en nuestra opini&#243;n&#44; estimaciones ligeramente superiores&#44; pero m&#225;s fiables&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">No obstante&#44; para valorar si este procedimiento de selecci&#243;n del registro produce diferencias importantes respecto a otros m&#233;todos&#44; hemos estimado la prevalencia seleccionando el &#250;ltimo registro de cada ni&#241;o en ese per&#237;odo&#46; Los resultados reflejan&#44; como es l&#243;gico&#44; una leve disminuci&#243;n en la prevalencia global del 1&#44;3&#37; para sobrepeso y del 1&#37; para obesidad&#46; Sin embargo&#44; cuando se consideran per&#237;odos anuales de edad&#44; dicha disminuci&#243;n es insignificante&#44; entre el 0 y 0&#44;3&#37;&#44; manteni&#233;ndose alta la prevalencia de exceso de peso&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">La evoluci&#243;n de la prevalencia de obesidad en nuestro estudio coincide con lo que publican algunos autores<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a>&#44; se&#241;alando una tendencia creciente&#46; Sin embargo&#44; el descenso de la prevalencia de sobrepeso despu&#233;s de 2007 da lugar a cierta estabilizaci&#243;n de la de sobrecarga ponderal desde ese a&#241;o&#44; coincidiendo con trabajos m&#225;s recientes<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">35&#44;36</span></a>&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Hemos considerado el criterio de la OMS<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a> por su impacto a nivel internacional y su calidad metodol&#243;gica&#46; Adem&#225;s&#44; en menores de 5 a&#241;os&#44; su utilizaci&#243;n tiene inter&#233;s porque permite comparar con ni&#241;os criados en condiciones &#243;ptimas&#46; Sin embargo&#44; los resultados de sobrepeso y obesidad con la referencia OMS son claramente m&#225;s elevados que con las otras referencias &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">figs&#46; 2&#8211;4</a>&#41;&#44; coincidiendo as&#237; con todos los estudios nacionales e internacionales<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;30&#44;37</span></a>&#44; por lo que podr&#237;a sobrevalorar la obesidad en nuestro entorno&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Se han contemplado las referencias basadas en los estudios espa&#241;oles m&#225;s recientes y m&#225;s implantados<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;23</span></a>&#44; aunque tambi&#233;n se ha incluido la referencia FO-1988<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> porque la Gu&#237;a de Pr&#225;ctica Cl&#237;nica del Ministerio de Sanidad<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> aconseja su uso para el cribado de exceso de peso&#44; justific&#225;ndolo en que sus datos se recogieron antes de la epidemia de obesidad y&#44; por tanto&#44; no normalizar&#237;an su valoraci&#243;n&#44; al contrario de lo que podr&#237;a ocurrir con otras referencias m&#225;s recientes&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">El incremento de obesidad entre los 7-9 a&#241;os&#44; mostrado en todas las referencias&#44; puede ser debido al propio proceso de crecimiento&#44; pero no se muestra tan claramente con FO-2011 y ETEC&#46; Esto podr&#237;a explicarse porque&#44; al ser estudios m&#225;s recientes&#44; estar&#237;an influidos por la aceleraci&#243;n secular del desarrollo infantil mostrado en las &#250;ltimas d&#233;cadas que&#44; entre otros cambios madurativos&#44; refleja un adelanto en la edad del ascenso del IMC de los ni&#241;os de dichos estudios&#44; provocando una elevaci&#243;n de sus percentiles en dicho per&#237;odo que&#44; al utilizarlos como puntos de corte&#44; producir&#237;an estimaciones de la prevalencia de obesidad m&#225;s bajas&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Se confirma que&#44; seg&#250;n sea la referencia utilizada&#44; la prevalencia difiere considerablemente &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#44; por lo que&#44; coincidiendo con otros autores<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;37&#44;38</span></a>&#44; al ofrecer datos de obesidad deben especificarse las referencias usadas&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Las referencias FO-1988 y FO-2004 infravaloran el sobrepeso&#44; sus curvas est&#225;n muy por debajo de las dem&#225;s y resulta llamativo que muestren mayor prevalencia de obesidad que de sobrepeso &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">figs&#46; 2 y 3</a>&#41;&#44; aspecto que no parece plausible desde los puntos de vista biol&#243;gico y estad&#237;stico&#44; pues lo esperado es lo contrario&#44; como muestran el resto de referencias&#46; Ello sugerir&#237;a revisar los puntos de corte propuestos en ambos criterios&#44; sobre todo en FO-1988&#44; en donde los percentiles 90 y 97 parecen puntos de corte demasiado elevados y podr&#237;an explicar estos an&#243;malos resultados&#46; Dichas observaciones cuestionar&#237;an la idoneidad de utilizar estos criterios para valorar el exceso de peso&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Al estudiar la concordancia mediante el &#237;ndice kappa&#44; la referencia FO-2011 es la que m&#225;s se aproxima al IOTF&#44; seguida del ETEC&#44; pudi&#233;ndose pensar en utilizar cualquiera de ellas como referencias nacionales&#46; La buena concordancia entre IOTF y FO-2011 es l&#243;gica pues utilizan la misma metodolog&#237;a para la obtenci&#243;n de los puntos de corte&#44; y la de FO-2011 y ETEC tambi&#233;n&#44; pues los ni&#241;os del primero son contempor&#225;neos a los de la muestra del ETEC y est&#225;n incluidos en ella&#44; y los puntos de corte propuestos en ETEC se obtienen de manera parecida a los de FO-2011&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Este trabajo tiene como limitaci&#243;n la existencia de sesgos no sistem&#225;ticos debidos al observador y al instrumental&#44; que se equilibran y minimizan debido al gran n&#250;mero de registros utilizados y al riguroso proceso de depuraci&#243;n realizado&#46; Como ventajas&#44; debe destacarse que es el &#250;nico trabajo realizado en la Regi&#243;n de Murcia de estas caracter&#237;sticas y que la utilizaci&#243;n de informaci&#243;n procedente de la base de datos de historias cl&#237;nicas permite una gran agilidad en su recogida y la obtenci&#243;n de una ampl&#237;sima muestra que proporciona gran precisi&#243;n en las estimaciones&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; la elevada prevalencia de exceso de peso en ni&#241;os de la Regi&#243;n de Murcia hace necesario&#44; para su prevenci&#243;n y&#44; en su caso&#44; tratamiento&#44; incrementar la detecci&#243;n precoz<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;32&#44;39</span></a> mediante el desarrollo del PANA<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#44; sin olvidar que un aspecto fundamental es establecer pol&#237;ticas de prevenci&#243;n interinstitucionales y multidisciplinares implicando a toda la sociedad&#44; as&#237; como desarrollar estudios de investigaci&#243;n para determinar factores condicionantes que permitan promover intervenciones preventivas eficientes&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0250" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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    "fechaRecibido" => "2012-07-02"
    "fechaAceptado" => "2012-09-06"
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            3 => "&#205;ndice de masa corporal"
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          "clase" => "keyword"
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          "identificador" => "xpalclavsec180600"
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            1 => "Prevalence"
            2 => "Childhood"
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    "resumen" => array:2 [
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La obesidad infantil es un problema de elevada magnitud y con graves repercusiones en el estado de salud&#44; lo que justifica conocer su prevalencia a nivel local para identificar factores condicionantes y emprender acciones preventivas&#46; El objetivo de este trabajo consiste en estimar la prevalencia de sobrepeso y obesidad en poblaci&#243;n infantil de la Regi&#243;n de Murcia a partir del &#237;ndice de masa corporal &#40;IMC&#41; aplicando los criterios de referencia del International Obesity Task Force &#40;IOTF&#41;&#44; y comparar estos resultados con los obtenidos con otras referencias de uso frecuente en Espa&#241;a&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se determin&#243; el IMC correspondiente a 178&#46;894 ni&#241;os de 2 a 14 a&#241;os de edad&#46; La prevalencia de sobrepeso y obesidad se valor&#243; seg&#250;n los criterios del IOTF&#44; de los estudios de la Organizaci&#243;n Mundial de la Salud&#44; de la Fundaci&#243;n Orbegozo &#40;FO&#41;&#44; y del Estudio Transversal Espa&#241;ol de Crecimiento &#40;ETEC&#41;&#46; La concordancia entre los diferentes resultados fue evaluada mediante el &#237;ndice kappa&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La prevalencia&#44; mediante los puntos de corte del IOTF&#44; fue para sobrepeso del 20&#44;6&#37; &#40;IC 95&#37;&#58; 20&#44;4-20&#44;8&#41;&#44; para obesidad del 11&#44;4&#37; &#40;IC 95&#37;&#58; 11&#44;2-11&#44;5&#41; y para sobrecarga ponderal del 32&#37; &#40;IC 95&#37;&#58; 31&#44;8-32&#44;2&#41;&#44; siendo esta &#250;ltima mayor en ni&#241;as &#40;33&#44;2&#37;&#41; que en ni&#241;os &#40;30&#44;9&#37;&#41;&#46; La mayor concordancia se da entre el IOTF y FO-2011 &#40;kappa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;795&#41;&#44; y entre este y el ETEC &#40;kappa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;794&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se encontraron altas prevalencias de sobrepeso y obesidad en ni&#241;os de la Regi&#243;n de Murcia&#46; El ETEC y el estudio FO-2011 mostraron las concordancias m&#225;s altas con los resultados obtenidos seg&#250;n los criterios del IOTF&#46;</p>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Childhood obesity is a problem of high magnitude with serious repercussions on health&#44; which justifies estimating its prevalence at local level to identify conditioning factors and to take preventive actions&#46; The main objective of the present work is to estimate the prevalence of overweight and obesity in the children in the general population of the Murcia Region&#44; using the body mass index &#40;BMI&#41; and applying the International Obesity Task Force &#40;IOTF&#41; criteria&#44; and to compare these results with the ones obtained from other frequently used references in Spain&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The BMI of 178&#44;894 children aged from 2 to 14 years was determined&#46; The prevalence of overweight and obesity was compared to the IOTF&#44; to the studies of the World Health Organization&#44; as well as those of the Orbergozo Foundation &#40;FO&#41;&#44; and the Cross-sectional Spanish Growth Study &#40;ETEC&#41; references&#46; The agreement between the different results was evaluated using the kappa index&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The evaluation using the IOTF cut-off points gave an overweight prevalence of 20&#46;6&#37; &#40;95&#37; CI&#58; 20&#46;4-20&#46;8&#41;&#44; an obesity prevalence of 11&#46;4&#37; &#40;95&#37; CI&#58; 11&#46;2-11&#46;5&#41; and an overweight plus obesity prevalence of 32&#37; &#40;95&#37; CI&#58; 31&#46;8-32&#46;2&#41;&#44; with this last one being higher in girls &#40;33&#46;2&#37;&#41; than in boys &#40;30&#46;9&#37;&#41;&#46; The highest agreement is between IOTF and FO-2011 &#40;kappa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;795&#41; and between FO-2011 and ETEC &#40;kappa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;794&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A high prevalence of overweight and obesity in children in the Region of Murcia was found&#46; The ETEC and the FO-2011 study showed the highest agreement with the results obtained using the IOTF criteria&#46;</p>"
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                  """
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">ETEC&#58; Estudio Transversal Espa&#241;ol de Crecimiento&#59; FO-1988&#58; Estudio semilongitudinal Fundaci&#243;n Orbegozo 1988&#59; FO-2004&#58; Estudio longitudinal Fundaci&#243;n Orbegozo 2004&#59; FO-2011&#58; Estudio transversal Fundaci&#243;n Orbegozo 2011&#59; IOTF&#58; International Obesity Task Force&#59; OMS&#58; Organizaci&#243;n Mundial de la Salud&#46;</p>"
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Prevalencias de sobrepeso&#44; obesidad y sobrecarga ponderal por sexo&#44; seg&#250;n las referencias valoradas&#46; Per&#237;odo 2005-2011&#46; Regi&#243;n de Murcia</p>"
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