Original Article
Positive association between waist-to-height ratio and hypertension in adolescents
Associação positiva entre razão cintura-estatura e presença de hipertensão em adolescentes
Juliana Gomes Madruga
, Flávia Moraes Silva, Fernanda Scherer Adami
Corresponding author
Centro Universitário Univates, Centro de Ciências Biológicas e da Saúde, Curso de Nutrição, Lajeado, Brasil
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=> true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "479" "paginaFinal" => "484" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Juliana Gomes Madruga, Flávia Moraes Silva, Fernanda Scherer Adami" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Juliana Gomes" "apellidos" => "Madruga" "email" => array:1 [ 0 => "jgmadruga@univates.br" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Flávia" "apellidos" => "Moraes Silva" ] 2 => array:2 [ "nombre" => "Fernanda" "apellidos" => "Scherer Adami" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Centro Universitário Univates, Centro de Ciências Biológicas e da Saúde, Curso de Nutrição, Lajeado, Brasil" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Associação positiva entre razão cintura-estatura e presença de hipertensão em adolescentes" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiovascular disease (CVD) is the leading global cause of morbidity and mortality.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> The obesity and overweight epidemic, together with increasing cardiovascular disease, represent a major public health problem worldwide.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2,3</span></a> Although the clinical manifestations of CVD are generally not seen until adulthood, studies have shown that comorbidities such as dyslipidemia, hypertension and insulin resistance may be present in childhood or adolescence, and that the greater the number of risk factors, the greater the likelihood of developing CVD at a young age.<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Obesity is a metabolic disorder characterized by excessive body fat and a chronic inflammatory state.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> There are two types of obesity, central and peripheral. Abdominal obesity is now considered the main risk factor for hypertension in children and adolescents, as confirmed in a cross-sectional study of 1716 adolescents in the city of Cuiabá, Mato Grosso, Brazil.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7,8</span></a> When adjusted for age, gender and skin color, hypertension was associated with obesity (odds ratio [OR] 2.27; 95% confidence interval [CI] 1.64-3.14) but not with waist circumference (WC) after adjustment for body mass index (BMI).<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Of the indicators used to assess body fat, the waist-to-height ratio (WHR) is a simple and practical tool that uses WC as a measure of abdominal adiposity adjusted to the size of the individual by dividing WC by height.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> WC and WHR are considered important measures to identify overweight adolescents at high cardiometabolic risk.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> Studies have demonstrated that anthropometric indicators can predict hypertension in adolescents.<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">12–15</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The objective of this study was to assess the association between WHR and the incidence of hypertension in adolescents.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">We performed a cross-sectional observational study involving 1030 adolescents aged 10-17 years of both sexes attending municipal schools in inland Rio Grande do Sul, Brazil. The data were extracted from a secondary database established in 2012 and derived from a study which included all students enrolled in municipal schools in September and October 2012 of both sexes and aged between 10 and 17 years. The study was approved by the research ethics committee of Univates, protocol no. 72871 and 151/10, and written informed consent was obtained from parents and guardians. Children not present on the day of data collection, and those who refused or failed to participate in any stage of the study, were excluded.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Blood pressure (BP) was measured using an automatic sphygmomanometer (Omron HEM-742INT) in accordance with the guidelines of the Brazilian Society of Cardiology.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> Subjects were seated in a calm and quiet environment for at least 5 min before assessment, with legs uncrossed and feet flat on the floor, in a chair with their back supported and relaxed, clothing removed from the arm on which the cuff was placed, with the arm supported, hand at the level of the heart and palm upward. They were told not to speak during BP measurement. Those who had physical exercise classes on the day of data collection had their BP measured before or 60-90 min after the exercise session. BP was classified in accordance with the 6th Brazilian Guidelines on Hypertension for each age-group and gender, systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) between the 90th and 95th percentiles being classified as pre-hypertension, between the 95th and 99th percentiles as stage 1 hypertension, and above the 99th percentile as stage 2 hypertension.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Body weight was assessed using a calibrated digital scale (Urano<span class="elsevierStyleSup">®</span>), with a maximum capacity of 150 kg and a precision of 100 g. Subjects stood on the center of the scale, without shoes and wearing light clothing. A Sanny<span class="elsevierStyleSup">®</span> stadiometer was used to measure height, the subjects standing without shoes, heels together, backs straight and arms beside the body.</p><p id="par0040" class="elsevierStylePara elsevierViewall">WC was measured with the subject standing straight, using a flexible non-stretch tape measure with a precision of 1 mm. The bottom of the lowest rib was first located and marked with a pen, then the tape was positioned at the mid-line between the bottom of the lowest rib and the iliac crest and kept horizontal around the abdomen over the navel.</p><p id="par0045" class="elsevierStylePara elsevierViewall">WHR was calculated by dividing WC in cm by height in cm. The cutoff used was 0.50 for both sexes, those with WHR ≥0.50 being classified as at cardiovascular risk and those with WHR <0.50 as not at risk.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0050" class="elsevierStylePara elsevierViewall">Descriptive statistics were used to analyze the data (means and standard deviation for quantitative variables and absolute and relative frequencies for qualitative variables). The subjects were compared according to the presence of hypertension using the Student's t test for quantitative variables and the chi-square test for qualitative variables. The correlation between WHR and SBP and DBP was assessed by means of Pearson's correlation coefficient. The strength of the association between WHR and the presence of hypertension was assessed by logistic regression analysis, using the presence of hypertension as the dependent variable and age and gender as covariables. SPSS version 18 was used for the statistical analysis and values of p<0.05 were considered significant.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">Of the 1030 adolescents aged 10-17, mean age 12.43±1.81 years, most (54.7%) were female and most (52%) lived in rural areas.</p><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents the anthropometric and BP data of the study population, while <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows categories of WHR and the presence of hypertension. Most subjects were classified as normal weight (63.8%) and normotensive (52%) based on combined SBP and DBP values. More than 80% of the sample had WHR values indicating no cardiovascular risk and 76% had normal WC values.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">A weak positive correlation was seen between SBP (r=0.210; p<0.001) and DBP (r=0.136; p<0.001) levels and WHR.</p><p id="par0070" class="elsevierStylePara elsevierViewall">When the study population was grouped according to the presence of hypertension and anthropometric variables were compared, weight, height, BMI, WC and WHR were significantly greater in hypertensive subjects, as shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">The prevalence of childhood obesity has increased in recent decades, and has been called a global epidemic.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> In the present study, 29.6% of adolescents were overweight or obese, a lower figure than in Carneiro et al.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a> in a study of 148 adolescents in São Paulo, in which 35.8% were overweight, but higher than in Lima et al.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> in 305 adolescents in Petrolina, Pernambuco (16%) and in Klimek-Piotrowska et al.,<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> in 970 Polish adolescents (14.4%). These findings are worrying, since obesity is the main risk factor for hypertension in childhood and adolescence,<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> as well as being an independent risk factor for CVD, diabetes, and other disorders.<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">20,21</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">With regard to abdominal adiposity, 24% of adolescents in the present study had high WC, which puts them at cardiovascular risk. Similar prevalences were found in studies by Bozza et al.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> of 1732 adolescents in Curitiba, Paraná (central obesity in 12.2%) and by Christofaro et al.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> in Londrina, Paraná of 1021 adolescents (15.2% of boys and 8.5% of girls) <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>.</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">In the present study, 18.3% of adolescents presented high WHR and thus increased cardiovascular risk, a higher figure than in a study by Mirhosseini et al.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> of 477 adolescent girls in Mashhad, Iran, in which more than 10% had WHR >0.50.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The prevalence of hypertension in the present study was 30.4%, with 17.9% classified as having stage 1 and 12.5% stage 2 hypertension. These figures are higher than those reported by Corrêa Neto et al.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> in a study of 854 adolescents in Rio de Janeiro, of whom 19.4% had hypertension, and by Moura et al.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> in 211 adolescents from north-east Brazil, of whom 13.7% presented hypertension. The prevalence observed in both these studies is high, as the expected prevalence of hypertension in adolescents is around 5%.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> By contrast, Lima et al.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> identified hypertension in only 1% of 305 adolescents in Petrolina, Pernambuco, while Beck et al.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> studied 660 adolescents in Três de Maio, Rio Grande do Sul, and found only 3.3% with hypertension.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Early detection of hypertension is important for control and prevention of hypertension in adulthood, but BP is not routinely measured in most adolescents, which makes the condition difficult to monitor.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">SBP and DBP correlated positively and significantly with WHR in the present study. In a study by Carvalho et al.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> in 968 university students in Maranhão, SBP and DBP were also significantly associated with anthropometric indicators of obesity (BMI, WC, waist-to-hip ratio and WHR). According to Beck et al.,<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> WC, BMI and WHR were the best predictors of hypertension in both sexes in 660 adolescents in inland areas of Rio Grande do Sul.</p><p id="par0105" class="elsevierStylePara elsevierViewall">In the present study WHR was significantly associated with BP levels, with more subjects with elevated SBP and DBP and a diagnosis of hypertension among those with WHR ≥0.50 than among those with WHR <0.50. We also showed that participants with WHR ≥0.50 were 2.4 times more likely to have hypertension than those with WHR <0.50 after adjustment for age and gender. In the study by Klimek-Piotrowska et al.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> of 970 Polish adolescents, WHR was the best indicator of obesity in both sexes, while a study by Bacopoulou et al.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> of 1610 adolescents in Greece concluded that WHR was a better predictor of abdominal obesity in both sexes than waist-to-hip ratio.</p><p id="par0110" class="elsevierStylePara elsevierViewall">WHR is a simple, effective and practical screening tool for detecting obesity and metabolic syndrome in children.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> A study by Pelegrini et al.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> of 1197 adolescents in the Brazilian state of Santa Catarina state demonstrated that as well as BMI, WC and WHR can be used to predict high body fat in adolescents, since both are indicators of central obesity.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The present study has the advantage of a large sample size but the potential limitation that only two rather than three BP readings were taken.</p><p id="par0120" class="elsevierStylePara elsevierViewall">In the light of this study's findings and those of similar studies referred to above, it is suggested that adolescents be encouraged to keep their WC to less than half their height.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0125" class="elsevierStylePara elsevierViewall">A high prevalence of overweight was observed in this sample of adolescents attending municipal schools in inland Rio Grande do Sul, Brazil. Increased cardiovascular risk, as identified by WHR ≥0.50, was positively associated with BP levels, a greater proportion of participants with high WHR having high SBP and DBP and being diagnosed with hypertension. High WHR was associated with a 2.4 times higher likelihood of hypertension than those with normal WHR. We suggest that WHR should be used as an additional tool in the assessment of cardiovascular risk in adolescents, and that they should be encouraged to keep their WC to less than half their height.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Ethical disclosures</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Protection of human and animal subjects</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Confidentiality of data</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Right to privacy and informed consent</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres823852" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec820452" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres823853" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec820451" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 10 => array:3 [ "identificador" => "sec0035" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Right to privacy and informed consent" ] ] ] 11 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-12-15" "fechaAceptado" => "2016-03-22" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec820452" "palabras" => array:4 [ 0 => "Waist-to-height ratio" 1 => "Hypertension" 2 => "Obesity" 3 => "Cardiovascular disease" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec820451" "palabras" => array:4 [ 0 => "Razão cintura-estatura" 1 => "Hipertensão" 2 => "Obesidade" 3 => "Doenças cardiovasculares" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The obesity and overweight epidemic, together with increasing cardiovascular disease, represent a major public health problem worldwide, and their occurrence in childhood and adolescence has increased in recent decades. The objective of this study was to assess the association between waist-to-height ratio (WHR) and the incidence of hypertension in adolescents.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We performed a cross-sectional study of adolescents aged 10-17 years of both sexes attending municipal schools in inland Rio Grande do Sul, Brazil. Using a secondary database, weight and height measurements, blood pressure, and waist circumference (WC) were analyzed and body mass index (BMI) and WHR were calculated. Blood pressure was classified according to the Brazilian hypertension guidelines, BMI according to the curves of the World Health Organization, and WC according to Taylor et al. The cutoff used for WHR was 0.50 for both sexes.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Of the 1030 adolescents studied, 29.6% (305) presented overweight/obesity and 30.4% (313) had hypertension; 24% (247) had high WC and 18.3% (189) presented high WHR. Participants with WHR ≥0.50 were 2.4 times more likely to have hypertension than those with WHR <0.50 (OR 2.39; 95% CI 1.73-3.32; p<0.001).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A positive association was found between WHR and the presence of hypertension in adolescents.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdução</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A epidemia de sobrepeso e obesidade, assim como as doenças cardiovasculares, representam um importante problema de saúde pública em todo mundo e a sua prevalência na infância e adolescência vem aumentando nas últimas décadas. O objetivo deste estudo foi avaliar a possível associação entre a razão cintura/estatura (RCE) e a presença de hipertensão (HAS) em adolescentes.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo transversal envolvendo adolescentes com idade entre 10-17 anos, de ambos os gêneros, pertencentes a escolas municipais do interior do Rio Grande do Sul, Brasil. A partir de banco de dados secundário, foram analisadas as medidas de peso, estatura, pressão arterial e circunferência da cintura (CC), calculou-se o índice de massa corporal (IMC) e a RCE. A classificação da pressão arterial foi feita de acordo com as V Diretrizes Brasileiras de Hipertensão Arterial; o IMC foi classificado de acordo com as curvas da Organização Mundial da Saúde; a CC foi classificada conforme a recomendação de Taylor et al.; e o ponto de corte utilizado para a RCE foi de 0,50 para ambos os gêneros.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Foram estudados 1030 adolescentes, dentre os quais 29,6% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>305) apresentavam sobrepeso/obesidade e 30,4% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>313) hipertensão; 24% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>247) dos adolescentes apresentaram CC elevada e 18,3% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>189) apresentaram RCE elevada. Participantes com RCE<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0,50 apresentaram uma chance 2,4 vezes maior de HAS, em comparação àqueles com RCE<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,50 (OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2,39; IC95% 1,73 - 3,32; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusão</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Associação positiva entre RCE e presença de HAS em adolescentes foi observada.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as: Gomes Madruga J, Moraes Silva F, Scherer Adami F. Associação positiva entre razão cintura-estatura e presença de hipertensão em adolescentes. Rev Port Cardiol. 2016;35:479–484.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">DBP: diastolic blood pressure; SD: standard deviation; SBP: systolic blood pressure; WC: waist circumference; WHR: waist-to-height ratio.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Minimum \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Maximum \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.81 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Height (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">124.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">186.10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">156.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">104.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.75 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">WHR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.06 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">WC (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">119.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70.51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SBP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">185.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">119.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.62 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DBP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">130.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67.83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.61 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1385155.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Anthropometric and blood pressure data of the study population.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">CV: cardiovascular; DBP: diastolic blood pressure; HTN: hypertension; SBP: systolic blood pressure; WHR: waist-to-height ratio.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Category \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">WHR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No CV risk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">841 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SBP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">561 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pre-hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">140 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Stage 1 HTN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">173 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Stage 2 HTN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">156 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DBP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">847 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pre-hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">113 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Stage 1 HTN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Stage 2 HTN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SBP and DBP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">536 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pre-hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">181 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Stage 1 HTN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">184 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Stage 2 HTN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">129 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1385153.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Categories of waist-to-height ratio and hypertension in the study population.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">BMI: body mass index; HTN: hypertension; WC: waist circumference; WHR: waist-to-height ratio.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No HTN/pre-HTN \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HTN \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.85±12.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.30±14.96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Height (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">155.09±11.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">158.27±10.70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI (kg/m<span class="elsevierStyleSup">2</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.64±3.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.84±4.62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">WC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.86±9.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74.30±11.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">WHR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.44±0.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.47±0.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1385154.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Student's t test for independent samples. Data presented as means ± standard deviation.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Anthropometric variables according to the presence of hypertension.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">DBP: diastolic blood pressure; SBP: systolic blood pressure; WHR: waist-to-height ratio.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Category \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">WHR category</th><th class="td" title="table-head " align="left" valign="top" scope="col">p \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">OR \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><0.50</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">≥0.50</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">SBP</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">496 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.743 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">High \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">345 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">124 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">DBP</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">707 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">140 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.847 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">High \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">134 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">SBP and DBP</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">474 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.646 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">High \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">367 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">127 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1385152.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">p≤0.01.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Association between hypertension and high waist-to-height ratio in the study population.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0155" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A promoção da saúde e a prevenção integrada dos fatores de risco para doenças cardiovasculares" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.G. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 5 | 9 |
| 2024 October | 40 | 28 | 68 |
| 2024 September | 36 | 23 | 59 |
| 2024 August | 50 | 25 | 75 |
| 2024 July | 33 | 33 | 66 |
| 2024 June | 31 | 16 | 47 |
| 2024 May | 38 | 30 | 68 |
| 2024 April | 24 | 18 | 42 |
| 2024 March | 29 | 27 | 56 |
| 2024 February | 26 | 43 | 69 |
| 2024 January | 21 | 40 | 61 |
| 2023 December | 18 | 34 | 52 |
| 2023 November | 24 | 27 | 51 |
| 2023 October | 14 | 16 | 30 |
| 2023 September | 19 | 18 | 37 |
| 2023 August | 21 | 18 | 39 |
| 2023 July | 13 | 7 | 20 |
| 2023 June | 21 | 7 | 28 |
| 2023 May | 36 | 18 | 54 |
| 2023 April | 22 | 5 | 27 |
| 2023 March | 59 | 21 | 80 |
| 2023 February | 41 | 19 | 60 |
| 2023 January | 18 | 11 | 29 |
| 2022 December | 55 | 25 | 80 |
| 2022 November | 44 | 21 | 65 |
| 2022 October | 23 | 9 | 32 |
| 2022 September | 20 | 29 | 49 |
| 2022 August | 24 | 42 | 66 |
| 2022 July | 34 | 29 | 63 |
| 2022 June | 21 | 22 | 43 |
| 2022 May | 25 | 25 | 50 |
| 2022 April | 23 | 28 | 51 |
| 2022 March | 17 | 30 | 47 |
| 2022 February | 21 | 16 | 37 |
| 2022 January | 19 | 23 | 42 |
| 2021 December | 22 | 27 | 49 |
| 2021 November | 35 | 38 | 73 |
| 2021 October | 53 | 34 | 87 |
| 2021 September | 21 | 27 | 48 |
| 2021 August | 32 | 31 | 63 |
| 2021 July | 18 | 26 | 44 |
| 2021 June | 34 | 23 | 57 |
| 2021 May | 26 | 40 | 66 |
| 2021 April | 49 | 65 | 114 |
| 2021 March | 53 | 15 | 68 |
| 2021 February | 65 | 15 | 80 |
| 2021 January | 34 | 16 | 50 |
| 2020 December | 41 | 10 | 51 |
| 2020 November | 53 | 15 | 68 |
| 2020 October | 34 | 14 | 48 |
| 2020 September | 49 | 13 | 62 |
| 2020 August | 17 | 13 | 30 |
| 2020 July | 64 | 13 | 77 |
| 2020 June | 44 | 11 | 55 |
| 2020 May | 41 | 10 | 51 |
| 2020 April | 50 | 8 | 58 |
| 2020 March | 64 | 12 | 76 |
| 2020 February | 86 | 25 | 111 |
| 2020 January | 51 | 9 | 60 |
| 2019 December | 36 | 10 | 46 |
| 2019 November | 41 | 4 | 45 |
| 2019 October | 56 | 5 | 61 |
| 2019 September | 35 | 18 | 53 |
| 2019 August | 34 | 9 | 43 |
| 2019 July | 37 | 7 | 44 |
| 2019 June | 43 | 20 | 63 |
| 2019 May | 47 | 14 | 61 |
| 2019 April | 27 | 14 | 41 |
| 2019 March | 93 | 11 | 104 |
| 2019 February | 98 | 8 | 106 |
| 2019 January | 86 | 7 | 93 |
| 2018 December | 89 | 13 | 102 |
| 2018 November | 119 | 16 | 135 |
| 2018 October | 268 | 16 | 284 |
| 2018 September | 51 | 13 | 64 |
| 2018 August | 79 | 9 | 88 |
| 2018 July | 21 | 6 | 27 |
| 2018 June | 32 | 7 | 39 |
| 2018 May | 65 | 13 | 78 |
| 2018 April | 64 | 1 | 65 |
| 2018 March | 114 | 13 | 127 |
| 2018 February | 45 | 11 | 56 |
| 2018 January | 107 | 13 | 120 |
| 2017 December | 211 | 3 | 214 |
| 2017 November | 64 | 6 | 70 |
| 2017 October | 55 | 14 | 69 |
| 2017 September | 41 | 15 | 56 |
| 2017 August | 40 | 10 | 50 |
| 2017 July | 24 | 11 | 35 |
| 2017 June | 38 | 6 | 44 |
| 2017 May | 39 | 16 | 55 |
| 2017 April | 22 | 9 | 31 |
| 2017 March | 32 | 6 | 38 |
| 2017 February | 29 | 6 | 35 |
| 2017 January | 32 | 12 | 44 |
| 2016 December | 47 | 8 | 55 |
| 2016 November | 61 | 13 | 74 |
| 2016 October | 86 | 31 | 117 |
| 2016 September | 77 | 32 | 109 |
| 2016 August | 0 | 1 | 1 |
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