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          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Odds ratios</span> entre la lactancia materna y la obesidad de ni&#241;os&#47;as de 2 a 5 a&#241;os&#44; ajustados por variables del&#47;de la ni&#241;o&#47;a&#44; de la madre&#44; del hogar y del entorno&#46; El grupo de referencia en todos los modelos es la categor&#237;a lactancia materna &#60; 6 meses en cada pa&#237;s&#46;</p> <p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Modelo A&#58; modelo crudo&#44; incluye como variable de resultado dos categor&#237;as &#40;obesidad y peso normal&#41; y como variable exposici&#243;n la lactancia materna en dos categor&#237;as &#40;&#8805; 6 meses y &#60; 6 meses&#41;&#46;</p> <p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Modelo B&#58; modelo A ajustado por los factores del&#47;de la ni&#241;o&#47;a &#40;edad en meses y sexo&#41;&#46;</p> <p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Modelo C&#58; modelo A ajustado por los factores de la madre &#40;edad en a&#241;os&#44; nivel de educaci&#243;n&#44; IMC categorizado y estado civil&#41;&#46;</p> <p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Modelo D&#58; modelo A ajustado por el nivel socioecon&#243;mico &#40;&#237;ndice de riqueza&#41;&#46;</p> <p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Modelo E&#58; modelo A ajustado por los factores del entorno &#40;lugar de residencia&#44; urbano vs&#46; rural&#41;&#46;</p> <p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Modelo F&#58; modelo completo&#44; ajustado por todas las variables antes mencionadas y que fueron incluidas en los modelos A&#44; B&#44; C&#44; D y E&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El sobrepeso y la obesidad son un problema de salud p&#250;blica en todo el mundo&#46; Seg&#250;n estimaciones de la Organizaci&#243;n Mundial de la Salud&#44; en 2016 los&#47;las ni&#241;os&#47;as menores de 5 a&#241;os con sobrepeso y obesidad superaron los 41 millones<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">1</span></a>&#46; Seg&#250;n la FAO &#40;Food and Agriculture Organization&#41;&#44; en Am&#233;rica Latina y el Caribe la obesidad en los&#47;las menores de 5 a&#241;os se increment&#243; de un 6&#44;6&#37; en el a&#241;o 1990 a un 7&#44;2&#37; en 2015&#46; En los &#250;ltimos 7 a&#241;os&#44; los porcentajes de sobrepeso en menores de 5 a&#241;os en Bolivia&#44; Colombia y Per&#250; fueron del 8&#44;7&#37;&#44; el 4&#44;8&#37; y el 7&#44;2&#37;&#44; respectivamente<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">2</span></a>&#46; Por otro lado&#44; en estos pa&#237;ses las tasas de lactancia materna exclusiva&#44; principal estrategia nutricional mundial en menores de 6 meses&#44; fueron del 64&#44;3&#37;&#44; el 42&#44;8&#37; y el 68&#44;4&#37;&#44; respectivamente<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La lactancia materna no solo est&#225; asociada a una mejor nutrici&#243;n infantil&#44; sino que adem&#225;s es un factor de protecci&#243;n para mortalidad y diversas enfermedades&#46; Se estima que la lactancia materna exclusiva podr&#237;a prevenir la muerte de hasta 823&#46;000 ni&#241;os&#47;as anualmente<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">3</span></a>&#46; El sobrepeso y la obesidad han tomado importancia en las &#250;ltimas d&#233;cadas por el incremento de las enfermedades no transmisibles en todas las edades y en todo el mundo<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En los estudios en pa&#237;ses de ingresos altos se ha observado menos probabilidad de obesidad en ni&#241;os&#47;as que lactaron en comparaci&#243;n con los&#47;las que no lactaron o lo hicieron un corto tiempo<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; El nivel socioecon&#243;mico es uno de los principales condicionantes para que la mujer decida brindar lactancia materna a su hijo<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">7&#44;8</span></a>&#59; a esto se suman&#44; entre otros factores&#44; la estructura familiar&#44; el ingreso salarial&#44; el nivel educativo y la edad de la mujer<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Asimismo&#44; las poblaciones de algunos pa&#237;ses latinoamericanos&#44; como Bolivia&#44; Colombia y Per&#250;&#44; conviven entre niveles elevados de desnutrici&#243;n y retraso de crecimiento lineal juntamente con tasas en crecimiento de sobrepeso y obesidad&#44; inclusive en las zonas rurales&#46; Este contexto representa un escenario interesante de estudio por diferentes motivos&#58; primero&#44; porque la diarrea y la desnutrici&#243;n disminuyen el efecto protector de la lactancia<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">9</span></a>&#59; segundo&#44; porque la desnutrici&#243;n cr&#243;nica est&#225; asociada con una mayor probabilidad de obesidad<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">10</span></a>&#59; y tercero&#44; porque los pa&#237;ses de Am&#233;rica Latina se encuentran en plena transici&#243;n epidemiol&#243;gica y demogr&#225;fica que se acompa&#241;a de cambios sociales &#40;mujeres con mayores roles y responsabilidades dentro y fuera del hogar&#41; y comerciales &#40;mayor uso del biber&#243;n&#44; de leches maternizadas y de pr&#225;cticas de amamantamiento&#41;&#44; as&#237; como de una modificaci&#243;n en los patrones de alimentaci&#243;n&#44; los h&#225;bitos alimentarios y la actividad f&#237;sica<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">11&#44;12</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Estos antecedentes sugieren que la asociaci&#243;n entre el tiempo de lactancia y el sobrepeso y la obesidad en los pa&#237;ses de Latinoam&#233;rica podr&#237;a tener algunas diferencias respecto a la literatura disponible&#46; Por lo tanto&#44; el objetivo del presente estudio fue determinar si la lactancia materna &#8805; 6 meses se asocia con menor sobrepeso y obesidad en ni&#241;os de 2 a 5 a&#241;os de edad&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todo</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o del estudio</span><p id="par0030" class="elsevierStylePara elsevierViewall">Estudio transversal utilizando informaci&#243;n extra&#237;da de las Demographic Health Survey&#46; Se eligieron tres pa&#237;ses de la regi&#243;n andina&#58; Bolivia &#40;Encuesta Demogr&#225;fica y de Salud Familiar 2008&#41;&#44; Colombia &#40;Encuesta de Demograf&#237;a y Salud&#47;Encuesta de la Situaci&#243;n Nutricional 2010&#41; y Per&#250; &#40;Encuesta Demogr&#225;fica y de Salud Familiar 2010&#41;&#46; En Bolivia&#44; Colombia y Per&#250;&#44; la tasa de respuesta fue&#44; en promedio&#44; del 96&#37;&#44; el 94&#37; y el 98&#37;&#44; respectivamente<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">13&#8211;15</span></a>&#46; El dise&#241;o muestral permite un nivel de inferencia nacional y departamental &#40;regional&#41;&#44; as&#237; como rural y urbano&#46; Las bases de datos y los informes que detallan estos aspectos fueron descargadas y est&#225;n disponibles en la p&#225;gina web de Demographic Health Survey &#40;<a href="https://dhsprogram.com/">https&#58;&#47;&#47;dhsprogram&#46;com&#47;</a>&#41;&#46; Estos y otros aspectos t&#233;cnicos de cada encuesta se ofrecen en detalle en la <a class="elsevierStyleCrossRef" href="#sec0105">tabla I del Ap&#233;ndice <span class="elsevierStyleItalic">online</span></a>&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Poblaci&#243;n de estudio</span><p id="par0035" class="elsevierStylePara elsevierViewall">Para el an&#225;lisis se incluyeron los datos de las madres y del&#47;de la &#250;ltimo&#47;a hijo&#47;a menor&#44; en el momento de la entrevista&#44; que tuviera informaci&#243;n antropom&#233;trica y de lactancia &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Se consider&#243; la informaci&#243;n del&#47;de la &#250;ltimo&#47;a hijo&#47;a para minimizar el sesgo de memoria&#46; En &#250;ltima instancia se cont&#243; con 1&#46;686 observaciones para Bolivia&#44; 4&#46;329 para Colombia y 2&#46;570 para Per&#250;&#46; La poblaci&#243;n no incluida en el estudio se presenta en detalle en la <a class="elsevierStyleCrossRef" href="#sec0105">tabla II del Ap&#233;ndice <span class="elsevierStyleItalic">online</span></a>&#44; en la cual puede observarse que la mayor&#237;a de las variables tuvieron similar distribuci&#243;n&#44; con excepci&#243;n del &#237;ndice de masa corporal &#40;IMC&#41; del&#47;de la ni&#241;o&#47;a &#40;menor para el sobrepeso&#41; y del lugar de residencia &#40;mayor para zona urbana&#41; para Bolivia&#44; el IMC de la madre &#40;mayor en sobrepeso y obesidad&#41; para Colombia&#44; y el nivel de educaci&#243;n &#40;menor para sin educaci&#243;n&#44; primaria y secundaria&#44; y mayor para el nivel superior&#41;&#44; el IMC de la madre &#40;menor para sobrepeso y mayor para obesidad&#41; y el lugar de residencia &#40;mayor para zona urbana y menor para zona rural&#41; para Per&#250;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Variables dependientes</span><p id="par0040" class="elsevierStylePara elsevierViewall">Las variables de desenlace fueron el sobrepeso y la obesidad infantil evaluadas usando el IMC basado en puntuaciones Z para la edad&#46; El sobrepeso y la obesidad se definieron como &#8805; 1-2 desviaciones est&#225;ndar y &#8805; 2-5 desviaciones est&#225;ndar&#44; respectivamente<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">16</span></a>&#46; Tanto el peso como la talla se midieron con t&#233;cnicas estandarizadas&#44; utilizando tall&#237;metros y balanzas calibradas&#46; El peso se obtuvo con ropa ligera y sin zapatos&#44; usando una balanza electr&#243;nica con una precisi&#243;n de 0&#44;1<span class="elsevierStyleHsp" style=""></span>kg&#59; la medici&#243;n de la talla se realiz&#243; con un tall&#237;metro con una precisi&#243;n de 0&#44;1<span class="elsevierStyleHsp" style=""></span>cm&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Variable independiente</span><p id="par0045" class="elsevierStylePara elsevierViewall">La variable exposici&#243;n&#44; medida por autorreporte de la madre&#44; fue la lactancia materna &#8805; 6 meses &#40;<span class="elsevierStyleItalic">versus</span> lactancia &#60; 6 meses o no lactancia&#41;&#44; considerando que ha iniciado la lactancia antes de las 24 horas desde el nacimiento y no ha recibido ning&#250;n tipo de l&#237;quido diferente durante los primeros 3 d&#237;as de vida&#59; es decir&#44; se trata de lactancia predominantemente materna dado que durante los meses siguientes no se asegura de manera precisa la ingesta de otro tipo de l&#237;quidos o alimentos<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">17&#44;18</span></a>&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Variables confusoras</span><p id="par0050" class="elsevierStylePara elsevierViewall">Las covariables utilizadas en el an&#225;lisis fueron&#44; para los&#47;las ni&#241;os&#47;as&#44; la edad y el sexo&#59; en cuanto al entorno&#44; el lugar de residencia &#40;urbano y rural&#41;&#59; y para las madres&#44; la edad &#40;en a&#241;os&#41;&#44; el estado civil&#44; el IMC categorizado &#40;obesidad con IMC &#8805; 30&#44; sobrepeso con IMC &#8805; 25 y &#60; 30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; normal con IMC entre 18&#44;5 y 24&#44;9&#44; y delgadez con IMC &#60; 18&#44;5&#41;&#44; el nivel educativo &#40;m&#225;ximo alcanzado&#41; y el nivel socioecon&#243;mico medido utilizando los quintiles del &#237;ndice de riqueza &#40;los quintiles 1 a 5 se calcularon considerando las zonas a las que pertenec&#237;an &#8212;rural o urbana&#8212;&#44; y cabe precisar que para generar estos quintiles y mantener el peso ponderado del muestreo original se utiliz&#243; el factor de expansi&#243;n&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">An&#225;lisis estad&#237;stico</span><p id="par0055" class="elsevierStylePara elsevierViewall">Se utiliz&#243; Stata versi&#243;n 14 &#40;Stata Corp LP&#44; College Station&#44; TX&#44; USA&#41; tanto para el procedimiento de estimaci&#243;n como para el manejo de las bases de datos&#46; En las estimaciones se incluyeron las ponderaciones que tienen en cuenta el dise&#241;o complejo y multiet&#225;pico de las encuestas nacionales&#46; As&#237;&#44; tanto los an&#225;lisis descriptivos como los modelos bivariables y multivariables se realizaron usando el comando <span class="elsevierStyleItalic">svy</span> para muestras complejas&#46; Dado que para el presente an&#225;lisis solo se incluy&#243; una submuestra de la poblaci&#243;n total de mujeres y el&#47;la &#250;ltimo&#47;a hijo&#47;a de 2 a 5 a&#241;os que tuvieron todos los datos necesarios para los an&#225;lisis&#44; se us&#243; la opci&#243;n <span class="elsevierStyleItalic">subpop</span> que permiti&#243; calcular correctamente los errores est&#225;ndar de las diferentes regresiones&#46; El an&#225;lisis de la potencia de la muestra para evaluar la obesidad fue del 81&#44;6&#37;&#44; y para el sobrepeso fue del 48&#44;5&#37;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Para el an&#225;lisis descriptivo se utilizaron proporciones o porcentajes para variables categ&#243;ricas&#44; y promedios y desviaci&#243;n est&#225;ndar para variables num&#233;ricas&#46; Para el an&#225;lisis bivariable se utiliz&#243; la prueba de ji al cuadrado&#44; y para el an&#225;lisis multivariable se utilizaron los modelos de regresi&#243;n multinomial para calcular las <span class="elsevierStyleItalic">odds ratios</span> &#40;OR&#41; y los intervalos de confianza del 95&#37; &#40;IC95&#37;&#41;&#46; La prevalencia de la principal variable de resultado &#40;obesidad&#41; fue cercana al 10&#37;&#59; por ello&#44; las estimaciones calculadas son referenciales y cercanas a las razones de prevalencia<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">19</span></a>&#46; Se incluyeron las variables en orden jer&#225;rquico<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">20</span></a>&#58; primero los factores relacionados con el&#47;la ni&#241;o&#47;a&#44; luego los de la madre y finalmente el nivel socioecon&#243;mico del hogar y el lugar de residencia&#46; Este orden jer&#225;rquico&#44; considerando la plausibilidad epidemiol&#243;gica de cada factor&#44; permiti&#243; tener cinco modelos distintos para poder observar la asociaci&#243;n de cada grupo de factores&#46; Finalmente&#44; los factores evaluados ingresaron a un modelo completo final &#40;sexto modelo&#41; que permiti&#243; responder la pregunta de investigaci&#243;n&#46; El modelo final&#44; ajustado por todos los confusores&#44; fue estimado considerando dos grupos de edad&#44; &#8804; 42 meses y &#62; 42 meses&#44; para poder identificar diferencias en la fuerza de la asociaci&#243;n &#40;<a class="elsevierStyleCrossRef" href="#sec0105">tabla III del Ap&#233;ndice <span class="elsevierStyleItalic">online</span></a>&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Aspectos &#233;ticos</span><p id="par0065" class="elsevierStylePara elsevierViewall">El presente estudio fue un an&#225;lisis secundario utilizando informaci&#243;n an&#243;nima de tres encuestas nacionales&#44; y no represent&#243; ning&#250;n tipo de riesgo para los&#47;las participantes&#46; El protocolo de este estudio fue aprobado por el Comit&#233; Institucional de &#201;tica de la Universidad Peruana Cayetano Heredia &#40;c&#243;digo SIDISI&#58; 58976&#41;&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Resultados</span><p id="par0070" class="elsevierStylePara elsevierViewall">Se incluyeron 1&#46;686&#44; 4&#46;329 y 2&#46;570 pares de madre-hijo&#47;a de las encuestas de Bolivia&#44; Colombia y Per&#250;&#44; respectivamente&#46; M&#225;s del 40&#37; de los&#47;las ni&#241;os&#47;as en Bolivia fueron clasificados en la categor&#237;a de sobrepeso u obesidad&#44; el 25&#37; en Colombia y el 30&#37; en Per&#250;&#46; La prevalencia de lactancia materna &#8805; 6 meses fue &#62; 70&#37; en los tres pa&#237;ses&#44; con frecuencias cercanas o &#62; 90&#37; en Bolivia y Per&#250;&#46; En los tres pa&#237;ses&#44; la mitad de las madres presentaban sobrepeso u obesidad&#44; y la mayor parte de la poblaci&#243;n infantil de 2 a 5 a&#241;os resid&#237;an en zonas urbanas&#44; llegando a un 75&#37; en Colombia&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">El an&#225;lisis bivariable &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41; mostr&#243;&#44; para Bolivia y Per&#250;&#44; que la lactancia materna estuvo relacionada con el IMC del&#47;de la ni&#241;o&#47;a &#40;p &#60; 0&#46;001&#41;&#44; pero no en Colombia &#40;p &#61; 0&#44;098&#41;&#46; Adem&#225;s&#44; se evidenci&#243; en los tres pa&#237;ses que el IMC de la madre fue una de las principales covariables relacionadas con el IMC del&#47;de la ni&#241;o&#47;a &#40;p &#60; 0&#44;01&#41;&#46; Los an&#225;lisis complementarios muestran que la proporci&#243;n de lactancia &#8805; 6 meses fue disminuyendo seg&#250;n el IMC de la madre&#44; siendo relevante en Per&#250;&#46; Asimismo&#44; el nivel educativo de la madre&#44; el nivel socioecon&#243;mico &#40;quintiles&#41; y el lugar de residencia se relacionaron con el IMC de la poblaci&#243;n infantil de 2 a 5 a&#241;os solo en Per&#250; &#40;p &#60; 0&#44;05&#41;&#46; La <a class="elsevierStyleCrossRef" href="#sec0105">tabla III del Ap&#233;ndice <span class="elsevierStyleItalic">online</span></a> muestra el incremento y adem&#225;s que al evaluar subgrupos de edad&#44; &#8805; 3&#44;5 a&#241;os&#44; se observ&#243; una fuerte asociaci&#243;n con el sobrepeso y la obesidad solo en Bolivia&#46; En los&#47;las ni&#241;os&#47;as mayores de 3&#44;5 a&#241;os se encontr&#243; asociaci&#243;n con la obesidad solo en Bolivia y con sobrepeso en Per&#250;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se muestra la fuerza de la asociaci&#243;n&#46; Para el modelo ajustado se observ&#243;&#44; de un lado&#44; una menor probabilidad de obesidad en los&#47;las ni&#241;os&#47;as que lactaron &#8805; 6 meses en comparaci&#243;n con quienes no lactaron o lo hicieron &#60; 6 meses &#40;70&#37;&#44; 29&#37; y 51&#37; menos para Bolivia&#44; Colombia y Per&#250;&#44; respectivamente&#41;&#46; Pese a que la asociaci&#243;n fue espuria para Colombia y Bolivia&#44; y solo consistente para Per&#250;&#44; se observ&#243; una menor probabilidad de sobrepeso en los&#47;las ni&#241;os&#47;as que lactaron &#8805; 6 meses en comparaci&#243;n con quienes lactaron &#60; 6 meses&#46; Adem&#225;s&#44; para Colombia y Per&#250;&#44; el quinto y el cuarto quintiles del nivel socioecon&#243;mico presentaron 2&#44;15 &#40;IC95&#37;&#58; 1&#44;15-4&#44;02&#41; y 2&#44;38 &#40;IC95&#37;&#58; 1&#44;17-4&#44;85&#41; veces mayor probabilidad de obesidad&#44; respectivamente&#44; en comparaci&#243;n con el quintil m&#225;s pobre de ambos pa&#237;ses&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">La relaci&#243;n entre lactancia materna y sobrepeso evaluada mediante regresi&#243;n log&#237;stica multinomial&#44; con un ajuste de variables de manera jer&#225;rquica seg&#250;n variables del&#47;de la ni&#241;o&#47;a&#44; de la madre&#44; del hogar y del entorno&#44; evidenci&#243; para Per&#250; una menor probabilidad de obesidad en los&#47;las ni&#241;os&#47;as de 2 a 5 a&#241;os que lactaron &#8805; 6 meses en comparaci&#243;n con quienes no lactaron o lo hicieron &#60; 6 meses&#46; La fuerza de la asociaci&#243;n se perdi&#243; al ajustar por variables de la madre&#44; de residencia y todas las variables&#46; Para Bolivia y Colombia no se evidenci&#243; asociaci&#243;n entre la lactancia materna y el sobrepeso &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#fig0015">figura 3</a> se presenta la relaci&#243;n entre lactancia materna y obesidad&#44; y se observa que para Bolivia y Per&#250; hubo menor riego de obesidad en los&#47;las ni&#241;os&#47;as de 2 a 5 a&#241;os que lactaron &#8805; 6 meses en comparaci&#243;n con quienes no lactaron o lo hicieron &#60; 6 meses&#46; Solo en el caso de Bolivia esta relaci&#243;n se mantuvo en el modelo final&#44; ajustado por todas las variables&#46; En Colombia&#44; la fuerza de la asociaci&#243;n fue m&#225;s d&#233;bil y en varios de los modelos se perdi&#243;&#44; sobre todo al ser ajustados por variables de la madre &#40;modelo C&#41;&#44; nivel socioecon&#243;mico del hogar &#40;modelo D&#41;&#44; lugar de residencia &#40;modelo E&#41; y por todas las variables &#40;modelo F&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discusi&#243;n</span><p id="par0095" class="elsevierStylePara elsevierViewall">En el presente estudio&#44; llevado a cabo con datos poblacionales de representatividad nacional en tres pa&#237;ses de Latinoam&#233;rica&#44; se encontr&#243; asociaci&#243;n entre la lactancia materna y la obesidad infantil en ni&#241;os de 2 a 5 a&#241;os en Bolivia y marginalmente en Colombia y Per&#250;&#46; Esta asociaci&#243;n mostr&#243; que la poblaci&#243;n infantil de 3 a 5 a&#241;os que tuvieron lactancia materna &#8805; 6 meses mostr&#243; una menor probabilidad de obesidad&#44; estimada en el 70&#37;&#44; el 51&#37; y el 29&#37; en Bolivia&#44; Per&#250; y Colombia&#44; en comparaci&#243;n con su contraparte que tuvo lactancia materna &#60; 6 meses&#46; As&#237; mismo&#44; esta relaci&#243;n tuvo la misma direcci&#243;n&#44; pero una asociaci&#243;n marginal&#44; para la asociaci&#243;n de lactancia materna y sobrepeso&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Nuestros resultados concuerdan en la direcci&#243;n de la asociaci&#243;n reportada previamente&#44; pero la magnitud de la asociaci&#243;n inversa fue heterog&#233;nea en los tres pa&#237;ses&#44; siendo incluso m&#225;s alta para Bolivia y Per&#250;&#46; Con anterioridad&#44; los hallazgos de una revisi&#243;n sistem&#225;tica y metaan&#225;lisis de 13 estudios indicaron que los periodos m&#225;s largos de lactancia materna se asociaron con una reducci&#243;n de la obesidad del 26&#37; &#40;IC95&#37;&#58; 22-30&#41;&#46; Comprender la magnitud de los efectos de la lactancia materna en distintas poblaciones tiene relevancia&#44; dado que los beneficios&#44; incluso en periodos cortos de lactancia &#40;&#8805; 3 meses&#41;&#44; reducen la obesidad infantil<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">21</span></a>&#44; y a largo plazo puede incluso reducir el riesgo de diabetes tipo 2 en la etapa adulta<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">22&#44;23</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Los factores que podr&#237;an explicar las diferencias en la asociaci&#243;n estudiada est&#225;n relacionados con caracter&#237;sticas del&#47;de la ni&#241;o&#47;a y de su madre&#44; el nivel socioecon&#243;mico y el entorno&#46; El presente estudio presenta&#44; en los modelos de regresi&#243;n para Colombia y Per&#250;&#44; un mayor efecto de las caracter&#237;sticas maternas&#44; el nivel socioecon&#243;mico y el entorno&#44; lo cual no se observa en Bolivia&#46; La literatura emp&#237;rica muestra que el estatus socioecon&#243;mico afecta a la lactancia materna debido a las diferencias en el acceso a la educaci&#243;n&#44; en particular a la educaci&#243;n para la salud<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">24</span></a>&#46; Por otro lado&#44; no se observ&#243; un patr&#243;n consistente al evaluar subgrupos a los 3&#44;5 a&#241;os&#59; sin embargo&#44; es posible que estrategias focalizadas y ausencia de alimentaci&#243;n complementaria podr&#237;an visibilizar un mayor efecto protector de la lactancia&#44; como aparentemente podr&#237;an estar mostrando los resultados de Bolivia&#46; Son necesarios estudios de causa-efecto&#44; controlando alimentaci&#243;n complementaria y otras variables clave&#44; para confirmar este efecto temprano de la lactancia materna&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Entre los factores maternos&#44; el IMC aten&#250;o la asociaci&#243;n entre lactancia materna y obesidad&#44; sobre todo en Per&#250; y Colombia&#46; La literatura describe que la obesidad materna disminuye la probabilidad de lactancia<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">25</span></a>&#44; y entre los factores fisiol&#243;gicos se reporta que la lactog&#233;nesis ocurre tard&#237;amente en las mujeres con obesidad en comparaci&#243;n con las que tienen peso normal<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Los modelos multivariables ajustados por variables confusoras evidencian&#44; para el nivel socioecon&#243;mico&#44; m&#225;s del 100&#37; de probabilidad de obesidad para el quintil m&#225;s alto de riqueza en Colombia y para el cuarto quintil en Per&#250;&#44; en comparaci&#243;n con el quintil m&#225;s pobre&#44; mientras que este patr&#243;n no fue el mismo para Bolivia&#59; asociaciones similares se han descrito en los Estados Unidos&#44; M&#233;xico y Brasil<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">27&#8211;29</span></a>&#46; Adicionalmente&#44; en Colombia se ha documentado un incremento m&#225;s r&#225;pido en las tasas de obesidad y sobrepeso para los &#237;ndices de riqueza m&#225;s bajos comparados con los m&#225;s altos<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">30</span></a>&#46; Entre los factores del entorno&#44; el lugar de residencia &#40;urbano o rural&#41; aten&#250;o la asociaci&#243;n entre lactancia materna y obesidad en los tres pa&#237;ses&#46; La urbanizaci&#243;n est&#225; asociada con una disminuci&#243;n de la lactancia materna&#44; y las tasas m&#225;s altas se encuentran en zonas rurales<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Por otro lado&#44; entre las caracter&#237;sticas del&#47;de la ni&#241;o&#47;a se ha descrito que la alimentaci&#243;n complementaria disminuye el papel protector de la lactancia y aumenta la probabilidad de obesidad<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">31</span></a>&#46; En los informes nacionales se ha reportado que los&#47;las ni&#241;os&#47;as menores que lactan desde los 2 meses tambi&#233;n reciben leche en polvo&#58; un 16&#46;0-19&#44;2&#37; en Bolivia<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a>&#44; un 26&#44;3&#37; en Colombia<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">15</span></a> y un 18&#44;7&#37; en Per&#250;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">14</span></a>&#46; Estudios recientes han demostrado que las madres que son incentivadas a usar leche en polvo tienen menor posibilidad de dar leche materna<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">32</span></a>&#46; Estas diferencias podr&#237;an explicar en parte los distintos niveles de la asociaci&#243;n en los tres pa&#237;ses&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Cabe precisar&#44; entre las limitaciones del presente estudio&#44; que su dise&#241;o transversal no permite sustentar la relaci&#243;n causa-efecto entre la lactancia materna &#8805; 6 meses y el sobrepeso o la obesidad del ni&#241;o&#46; Sin embargo&#44; la direccionalidad de nuestras estimaciones se corresponde con la de diversos estudios longitudinales en los que se ha observado que los efectos de la lactancia materna &#62; 6 meses se asocian con menores tasas de obesidad infantil<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">3&#44;33</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Por otro lado&#44; el sesgo de memoria podr&#237;a afectar los datos acerca de la duraci&#243;n exacta de la lactancia&#59; sin embargo&#44; esta limitaci&#243;n se minimiz&#243; incluyendo solo informaci&#243;n del&#47;de la &#250;ltimo&#47;a hijo&#47;a de 2 a 5 a&#241;os&#46; El ajuste con el IMC categorizado de la madre se utiliz&#243; como <span class="elsevierStyleItalic">proxy</span> frente a la ausencia de informaci&#243;n sobre el peso pregestacional y la ganancia de peso durante el embarazo&#59; no obstante&#44; se reconoce la limitaci&#243;n de no incluir estas variables en el an&#225;lisis multivariable&#46; Esta encuesta tambi&#233;n tiene la limitaci&#243;n de no recoger la actividad f&#237;sica&#44; y adem&#225;s la alimentaci&#243;n complementaria se valor&#243; solo en sus aspectos generales&#44; por lo cual no fue posible incluirlos en los an&#225;lisis&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Finalmente&#44; algunos estudios en madres latinoamericanas han identificado que existen creencias arraigadas sobre la idea de que los&#47;las ni&#241;os&#47;as con mayor peso son m&#225;s saludables<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">34</span></a>&#44; lo cual determina los h&#225;bitos de alimentaci&#243;n&#46; Por la naturaleza de las encuestas&#44; el presente estudio no ha abordado este aspecto&#44; pero tales creencias culturales son un factor clave que debe ser evaluado en futuros estudios para comprender y abordar esta relaci&#243;n de manera integral y poder generar estrategias apropiadas al contexto de cada pa&#237;s&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Entre las fortalezas del estudio destacan la representatividad nacional para los tres pa&#237;ses estudiados&#44; la comparabilidad de los datos y la oportunidad &#250;nica de presentar estimaciones con distintas fuerzas de asociaci&#243;n&#44; se&#241;alando la riqueza de informaci&#243;n que permite entender un mismo fen&#243;meno en distintos contextos&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusiones</span><p id="par0145" class="elsevierStylePara elsevierViewall">Los ni&#241;os de 2 a 5 a&#241;os de Bolivia que recibieron lactancia materna &#8805; 6 meses tuvieron menos posibilidad de tener obesidad&#44; y una relaci&#243;n similar&#44; pero marginalmente&#44; se observ&#243; en Colombia y Per&#250;&#46; Si bien existen diferencias en cuanto a los factores individuales&#44; maternos&#44; socioecon&#243;micos y del entorno &#40;residencia&#41;&#44; existe un patr&#243;n similar en los tres pa&#237;ses&#46; Se observ&#243; que los factores relacionados con la madre&#44; sobre todo el IMC&#44; atenuaron la fuerza de la asociaci&#243;n de inter&#233;s&#46; Asimismo&#44; se evidenci&#243; una mayor probabilidad de obesidad solo en el cuarto y el quinto quintiles de riqueza en Per&#250; y Colombia&#44; respectivamente&#46; Este estudio evidencia la importancia de fortalecer las estrategias que promuevan la lactancia materna como factor protector y de prevenci&#243;n para la obesidad durante la ni&#241;ez en Latinoam&#233;rica y en otros contextos similares&#44; tomando como un agente clave para este fin la educaci&#243;n sobre el estado nutricional infantil en las madres latinoamericanas&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Editor responsable del art&#237;culo</span><p id="par0160" class="elsevierStylePara elsevierViewall">Juan Alguacil&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Declaraci&#243;n de transparencia</span><p id="par0165" class="elsevierStylePara elsevierViewall">El autor principal &#40;garante responsable del manuscrito&#41; afirma que este manuscrito es un reporte honesto&#44; preciso y transparente del estudio que se remite a <span class="elsevierStyleSmallCaps">Gaceta Sanitaria&#44;</span> que no se han omitido aspectos importantes del estudio&#44; y que las discrepancias del estudio seg&#250;n lo previsto &#40;y&#44; si son relevantes&#44; registradas&#41; se han explicado&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Contribuciones de autor&#237;a</span><p id="par0170" class="elsevierStylePara elsevierViewall">A&#46; Paca-Palao y J&#46;J&#46; Miranda concibieron la idea del estudio&#46; A&#46; Paca-Palao y C&#46;A&#46; Huayanay Espinoza profundizaron la revisi&#243;n de la literatura&#44; formularon la estrategia de an&#225;lisis y elaboraron la primera versi&#243;n del manuscrito&#46; C&#46;A&#46; Huayanay Espinoza prepar&#243; la base de datos&#46; A&#46; Paca-Palao y C&#46;A&#46; Huayanay Espinoza hicieron los an&#225;lisis estad&#237;sticos&#46; C&#46;A&#46; Huayanay Espinoza&#44; D&#46;C&#46; Parra y G&#46; Velasquez-Melendez dieron asistencia con acceso a la informaci&#243;n de Colombia y Bolivia&#44; respectivamente&#44; y contribuyeron en las fases iniciales de conceptualizar el estudio de investigaci&#243;n&#46; Todas las personas firmantes contribuyeron a la interpretaci&#243;n de los resultados&#44; revisaron las distintas versiones del manuscrito y aprobaron la versi&#243;n final&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Financiaci&#243;n</span><p id="par0195" class="elsevierStylePara elsevierViewall">Este trabajo fue desarrollado como tesis de maestr&#237;a de APP&#44; Maestr&#237;a en Investigaci&#243;n Epidemiol&#243;gica&#44; Universidad Peruana Cayetano Heredia&#44; apoyado por el Fogarty International Center&#44; US National Institutes of Health &#40;D43 TW007393&#41;&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">A&#46; Paca-Palao reporta haber realizado este estudio como Becaria Naval Medical Research Unit&#44; NAMRU-6&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">D&#46;C&#46; Parra agradece al Instituto Colombiano de Bienestar Familiar y a PROFAMILIA por brindar apoyo y permitir el uso de la Encuesta Nacional de Demograf&#237;a y Salud y las bases de datos de la Encuesta Nacional de Estado Nutricional de Colombia y a Daniel Ayala por su valioso apoyo y aporte en la gesti&#243;n de datos y el an&#225;lisis estad&#237;stico&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">J&#46;J&#46; Miranda reporta recibir o haber recibido apoyo para desarrollar actividades de investigaci&#243;n por parte de Alliance for Health Policy and Systems Research &#40;HQHSR1206660&#41;&#44; the Bernard Lown Scholars in Cardiovascular Health Program at Harvard T&#46;H&#46; Chan School of Public Health &#40;BLSCHP-1902&#41;&#44; Bloomberg Philanthropies&#44; FONDECYT via CIENCIACTIVA&#47;CONCYTEC&#44; British Council&#44; British Embassy and the Newton-Paulet Fund &#40;223-2018&#44; 224-2018&#41;&#44; DFID&#47;MRC&#47;Wellcome Global Health Trials &#40;MR&#47;M007405&#47;1&#41;&#44; Fogarty International Center &#40;R21TW009982&#44; D71TW010877&#41;&#44; Grand Challenges Canada &#40;0335-04&#41;&#44; International Development Research Center Canada &#40;IDRC 106887&#44; 108167&#41;&#44; Inter-American Institute for Global Change Research &#40;IAI CRN3036&#41;&#44; Medical Research Council &#40;MR&#47;P008984&#47;1&#44; MR&#47;P024408&#47;1&#44; MR&#47;P02386X&#47;1&#41;&#44; National Cancer Institute &#40;1P20CA217231&#41;&#44; National Heart&#44; Lung and Blood Institute &#40;HHSN268200900033C&#44; 5U01HL114180&#44; 1UM1HL134590&#41;&#44; National Institute of Mental Health &#40;1U19MH098780&#41;&#44; Swiss National Science Foundation &#40;40P740-160366&#41;&#44; Wellcome &#40;074833&#47;Z&#47;04&#47;Z&#44; 093541&#47;Z&#47;10&#47;Z&#44; 107435&#47;Z&#47;15&#47;Z&#44; 103994&#47;Z&#47;14&#47;Z&#44; 205177&#47;Z&#47;16&#47;Z&#44; 214185&#47;Z&#47;18&#47;Z&#41; and the World Diabetes Foundation &#40;WDF15-1224&#41;&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflictos de intereses</span><p id="par0180" class="elsevierStylePara elsevierViewall">Ninguno&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Determinar si la lactancia materna &#8805; 6 meses se asocia con menor sobrepeso y obesidad en ni&#241;os&#47;as de 2 a 5 a&#241;os de edad&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis transversal de datos de encuestas nacionales de demograf&#237;a y salud de Bolivia&#44; Colombia y Per&#250;&#46; Se definieron sobrepeso y obesidad seg&#250;n los criterios de la Organizaci&#243;n Mundial de la Salud&#46; Se calcul&#243; la <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41; utilizando regresi&#243;n log&#237;stica multinomial&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de obesidad en ni&#241;os&#47;as de 2 a 5 a&#241;os fue del 10&#44;4&#37; &#40;intervalo de confianza del 95&#37; &#91;IC95&#37;&#93;&#58; 8&#44;2-12&#44;6&#41; en Bolivia&#44; del 4&#44;9&#37; &#40;IC95&#37;&#58; 4&#44;0-5&#44;8&#41; en Colombia y del 6&#44;4&#37; &#40;IC95&#37;&#58; 5&#44;2-8&#44;0&#41; en Per&#250;&#46; La lactancia materna &#8805; 6 meses en la poblaci&#243;n estudiada fue del 89&#44;9&#37; &#40;IC95&#37;&#58; 87&#44;8-91&#44;9&#41; en Bolivia&#44; del 73&#44;9&#37; &#40;IC95&#37;&#58; 72&#44;2-75&#44;6&#41; en Colombia y del 92&#44;8&#37; &#40;IC95&#37;&#58; 91&#44;2-94&#44;4&#41; en Per&#250;&#46; Se encontr&#243; evidencia de asociaci&#243;n entre lactancia materna &#8805; 6 meses y menor posibilidad de obesidad en comparaci&#243;n con no lactancia o lactancia &#60; 6 meses para Bolivia &#40;OR &#61; 0&#44;30&#59; IC95&#37;&#58; 0&#44;16-0&#44;57&#41;&#44; y una asociaci&#243;n marginal para Colombia &#40;OR &#61; 0&#44;71&#59; IC95&#37;&#58; 0&#44;47-1&#44;06&#41; y Per&#250; &#40;OR &#61; 0&#44;49&#59; IC95&#37;&#58; 0&#44;23-1&#44;04&#41;&#46; No hubo evidencia de asociaci&#243;n entre lactancia materna y sobrepeso&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La lactancia materna &#8805; 6 meses est&#225; asociada con una menor posibilidad de tener obesidad en ni&#241;os&#47;as de 2 a 5 a&#241;os en Bolivia&#46; Este patr&#243;n fue similar&#44; pero marginal&#44; para Colombia y Per&#250;&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To determine if breastfeeding for at least the first six months of life is associated with overweight and obesity in children 2 to 5 years old&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Cross sectional analysis of data from national demographic and health surveys conducted in Bolivia&#44; Colombia and Peru&#46; Overweight and obesity were defined using World Health Organization standard definitions&#46; Odds ratios &#40;OR&#41; were calculated using multinomial logistic regression&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The prevalence of obesity in children 2 to 5 years old was 10&#46;4&#37; &#40;95&#37; confidence interval &#91;95&#37;<span class="elsevierStyleSmallCaps">C</span>I&#93;&#58; 8&#46;2-12&#46;6&#41; in Bolivia&#44; 4&#46;9&#37; in Colombia &#40;95&#37;CI&#58; 4&#46;0-5&#46;8&#41;&#44; and 6&#46;4&#37; &#40;95&#37;CI&#58; 5&#46;2-8&#46;0&#41; in Peru&#46; Prevalence of exclusive breastfeeding for at least the first 6 months in the study population was 89&#46;9&#37; &#40;95&#37;CI&#58; 87&#46;8-91&#46;9&#41; in Bolivia&#44; 73&#46;9&#37; &#40;95&#37;CI&#58; 72&#46;2-75&#46;6&#41; in Colombia&#44; and 92&#46;8&#37; &#40;95&#37;CI&#58; 91&#46;2-92&#46;4&#41; in Peru&#46; Exclusive breastfeeding was associated with a decreased risk of obesity in children as compared to no breastfeeding or breastfeeding for less than 6 months in Bolivia &#40;OR &#61; &#46;30&#59; 95&#37;CI&#58; &#46;16-&#46;57&#41; and a marginal association in Colombia &#40;OR &#61; &#46;71&#59; 95&#37;CI&#58; &#46;47-1&#46;06&#41; and Peru &#40;OR &#61; &#46;49&#59; 95&#37;CI&#58; 0&#46;23-1&#46;04&#41;&#46; No association between breastfeeding and overweight was found&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Exclusive breastfeeding for at least the first six months of life decreases the risk of obesity in children 2 to 5 years old in Bolivia&#46; A similar but weaker pattern was observed for children in Colombia and Peru&#46;</p></span>"
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Odds ratios</span> entre la lactancia materna y el sobrepeso de ni&#241;os&#47;as de 2 a 5 a&#241;os&#44; ajustados por variables del&#47;de la ni&#241;o&#47;a&#44; de la madre&#44; del hogar y del entorno&#46; El grupo de referencia en todos los modelos es la categor&#237;a lactancia materna &#60; 6 meses en cada pa&#237;s&#46;</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Modelo A&#58; modelo crudo&#44; incluye como variable de resultado dos categor&#237;as &#40;sobrepeso y peso normal&#41; y como variable exposici&#243;n la lactancia materna en dos categor&#237;as &#40;&#8805; 6 meses y &#60; 6 meses&#41;&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Modelo B&#58; modelo A ajustado por los factores del&#47;de la ni&#241;o&#47;a &#40;edad en meses y sexo&#41;&#46;</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Modelo C&#58; modelo A ajustado por los factores de la madre &#40;edad en a&#241;os&#44; nivel de educaci&#243;n&#44; IMC categorizado y estado civil&#41;&#46;</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Modelo D&#58; modelo A ajustado por el nivel socioecon&#243;mico &#40;&#237;ndice de riqueza&#41;&#46;</p> <p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Modelo E&#58; modelo A ajustado por los factores del entorno &#40;lugar de residencia&#44; urbano vs&#46; rural&#41;&#46;</p> <p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Modelo F&#58; modelo completo&#44; ajustado por todas las variables antes mencionadas y que fueron incluidas en los modelos A&#44; B&#44; C&#44; D y E&#46;</p>"
        ]
      ]
      2 => array:7 [
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        "etiqueta" => "Figura 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1514
            "Ancho" => 2083
            "Tamanyo" => 103270
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Odds ratios</span> entre la lactancia materna y la obesidad de ni&#241;os&#47;as de 2 a 5 a&#241;os&#44; ajustados por variables del&#47;de la ni&#241;o&#47;a&#44; de la madre&#44; del hogar y del entorno&#46; El grupo de referencia en todos los modelos es la categor&#237;a lactancia materna &#60; 6 meses en cada pa&#237;s&#46;</p> <p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Modelo A&#58; modelo crudo&#44; incluye como variable de resultado dos categor&#237;as &#40;obesidad y peso normal&#41; y como variable exposici&#243;n la lactancia materna en dos categor&#237;as &#40;&#8805; 6 meses y &#60; 6 meses&#41;&#46;</p> <p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Modelo B&#58; modelo A ajustado por los factores del&#47;de la ni&#241;o&#47;a &#40;edad en meses y sexo&#41;&#46;</p> <p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Modelo C&#58; modelo A ajustado por los factores de la madre &#40;edad en a&#241;os&#44; nivel de educaci&#243;n&#44; IMC categorizado y estado civil&#41;&#46;</p> <p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Modelo D&#58; modelo A ajustado por el nivel socioecon&#243;mico &#40;&#237;ndice de riqueza&#41;&#46;</p> <p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Modelo E&#58; modelo A ajustado por los factores del entorno &#40;lugar de residencia&#44; urbano vs&#46; rural&#41;&#46;</p> <p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Modelo F&#58; modelo completo&#44; ajustado por todas las variables antes mencionadas y que fueron incluidas en los modelos A&#44; B&#44; C&#44; D y E&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabla "
            "rol" => "short"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; IC95&#37;&#58; intervalo de confianza del 95&#37;&#59; IMC&#58; &#237;ndice de masa corporal&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Caracter&#237;sticas</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Bolivia &#40;1686&#41;</th><th class="td" title="\n
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                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Colombia &#40;4329&#41;</th><th class="td" title="\n
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                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Per&#250; &#40;2570&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NormalN &#61; 981&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SobrepesoN &#61; 537&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ObesidadN &#61; 168&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NormalN &#61; 3239&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SobrepesoN &#61; 884&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ObesidadN &#61; 206&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NormalN &#61; 1800&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SobrepesoN &#61; 631&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ObesidadN &#61; 139&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="16" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Lactancia</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lactancia materna &#60; 6 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">174&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#44;54 &#40;38&#44;1-57&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;3 &#40;21&#44;5-39&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;2 &#40;12&#44;5-31&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;093&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#44;2 &#40;67&#44;7-74&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;4 &#40;19&#44;2-25&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;4 &#40;4&#44;5-8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">144&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#44;69 &#40;40&#44;2-61&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#44;23 &#40;23&#44;5-45&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;07 &#40;6&#44;5-23&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lactancia materna &#8805; 6 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;512&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#44;2 &#40;53-9-60&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#44;7 &#40;30&#44;7-36&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;1 &#40;7&#44;3-11&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;236&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#44;4 &#40;72&#44;3-76&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">54&#44;5 &#40;49&#44;9-59&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#44;9 &#40;7&#44;3-12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;400&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">72&#44;82 &#40;69&#44;9-75&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23 &#40;20&#44;2-25&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  <table border="0" frame="\n
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                  \t\t\t\t  " rowspan="3" align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caracter&#237;sticas</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Bolivia &#40;1686&#41;</th><th class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Obesidad</th><th class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sobrepeso</th><th class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Obesidad</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ORc &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ORa &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ORc &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ORa &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ORc &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ORa &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ORc &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ORa &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ORc &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ORa &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ORc &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ORa &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="13" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Lactancia</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lactancia materna &#60; 6 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lactancia materna &#8805; 6 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;92 &#40;0&#44;6-1&#44;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;80 &#40;0&#44;5-1&#44;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;34 &#40;0&#44;19-0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;30 &#40;0&#44;16-0&#44;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;90 &#40;0&#44;73-1&#44;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Edad del ni&#241;o en meses &#40;media &#177; DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0&#44;97-1&#44;02&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo del ni&#241;o</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Femenino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Masculino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Edad de la madre en a&#241;os &#40;media &#177; DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0&#44;97-1&#44;02&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0&#44;98-1&#44;02&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="13" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Nivel de educaci&#243;n de la madre</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sin educaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Primaria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Secundaria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;66 &#40;0&#44;37-1&#44;15&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Superior&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;6 &#40;0&#44;32-1&#44;11&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0&#44;44-2&#44;28&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="13" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IMC categorizado de la madre</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sobrepeso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;89 &#40;1&#44;23-2&#44;91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;96 &#40;1&#44;24-3&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;74 &#40;1&#44;33-2&#44;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;79 &#40;1&#44;36-2&#44;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2&#44;23 &#40;1&#44;24-4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;06 &#40;1&#44;17-3&#44;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Obesidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;3 &#40;0&#44;93-1&#44;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;35 &#40;0&#44;93-1&#44;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;86 &#40;1&#44;64-4&#44;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;18 &#40;1&#44;71-5&#44;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;99 &#40;1&#44;52-2&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;16 &#40;1&#44;64-2&#44;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;73 &#40;1&#44;68-4&#44;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;12 &#40;1&#44;87-5&#44;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;79 &#40;1&#44;98-3&#44;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;92 &#40;2&#44;05-4&#44;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;4 &#40;2&#44;81-10&#44;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;75 &#40;2&#44;59-8&#44;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="13" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estado civil de la madre</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Casada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Soltera&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;9 &#40;0&#44;54-1&#44;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;95 &#40;0&#44;56-1&#44;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;57 &#40;0&#44;21-1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;61 &#40;0&#44;24-1&#44;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;06 &#40;0&#44;73-1&#44;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;98 &#40;0&#44;66-1&#44;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;46 &#40;0&#44;72-2&#44;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;58 &#40;0&#44;74-3&#44;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;8 &#40;0&#44;46-1&#44;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;85 &#40;0&#44;47-1&#44;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;52 &#40;0&#44;12-2&#44;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;59 &#40;0&#44;13-2&#44;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Convivientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;81 &#40;0&#44;61-1&#44;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;75 &#40;0&#44;55-1&#44;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;92 &#40;0&#44;53-1&#44;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;81 &#40;0&#44;49-1&#44;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;81 &#40;0&#44;64-1&#44;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;77 &#40;0&#44;6-1&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;18 &#40;0&#44;72-1&#44;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;44 &#40;0&#44;84-2&#44;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;9 &#40;0&#44;69-1&#44;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;92 &#40;0&#44;71-1&#44;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;66 &#40;0&#44;39-1&#44;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;84 &#40;0&#44;48-1&#44;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No viven juntos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;83 &#40;0&#44;51-1&#44;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;92 &#40;0&#44;55-1&#44;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;97 &#40;0&#44;39-2&#44;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;97 &#40;0&#44;4-2&#44;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;75 &#40;0&#44;54-1&#44;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;76 &#40;0&#44;55-1&#44;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;11 &#40;0&#44;6-2&#44;06&#41;&nbsp;\t\t\t\t\t\t\n
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                          "etal" => true
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Original
Asociación entre lactancia materna y probabilidad de obesidad en la infancia en tres países latinoamericanos
Association between exclusive breastfeeding and obesity in children: a cross-sectional study of three Latin American countries
Ada Paca-Palaoa,b,c,d, Carlos A. Huayanay-Espinozac, Diana C. Parrae, Gustavo Velasquez-Melendezf, J. Jaime Mirandac,g,
Autor para correspondencia
Jaime.Miranda@upch.pe

Autor para correspondencia.
a Facultad de Salud Pública y Administración Carlos Vidal Layseca, Universidad Peruana Cayetano Heredia, Lima, Perú
b Ex Beca Naval Medical Research Unit, NAMRU-6
c CRONICAS Centro de Excelencia de Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
d Ministerio de Educación, Lima, Perú
e Program of Physical Therapy and Department of Surgery, Institute for Public Health, Washington University in St Louis School of Medicine, St Louis, MO, USA
f Department of Maternal and Child Nursing and Public Health, Escola de Enfermagem, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil
g Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Perú
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          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Odds ratios</span> entre la lactancia materna y la obesidad de ni&#241;os&#47;as de 2 a 5 a&#241;os&#44; ajustados por variables del&#47;de la ni&#241;o&#47;a&#44; de la madre&#44; del hogar y del entorno&#46; El grupo de referencia en todos los modelos es la categor&#237;a lactancia materna &#60; 6 meses en cada pa&#237;s&#46;</p> <p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Modelo A&#58; modelo crudo&#44; incluye como variable de resultado dos categor&#237;as &#40;obesidad y peso normal&#41; y como variable exposici&#243;n la lactancia materna en dos categor&#237;as &#40;&#8805; 6 meses y &#60; 6 meses&#41;&#46;</p> <p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Modelo B&#58; modelo A ajustado por los factores del&#47;de la ni&#241;o&#47;a &#40;edad en meses y sexo&#41;&#46;</p> <p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Modelo C&#58; modelo A ajustado por los factores de la madre &#40;edad en a&#241;os&#44; nivel de educaci&#243;n&#44; IMC categorizado y estado civil&#41;&#46;</p> <p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Modelo D&#58; modelo A ajustado por el nivel socioecon&#243;mico &#40;&#237;ndice de riqueza&#41;&#46;</p> <p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Modelo E&#58; modelo A ajustado por los factores del entorno &#40;lugar de residencia&#44; urbano vs&#46; rural&#41;&#46;</p> <p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Modelo F&#58; modelo completo&#44; ajustado por todas las variables antes mencionadas y que fueron incluidas en los modelos A&#44; B&#44; C&#44; D y E&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El sobrepeso y la obesidad son un problema de salud p&#250;blica en todo el mundo&#46; Seg&#250;n estimaciones de la Organizaci&#243;n Mundial de la Salud&#44; en 2016 los&#47;las ni&#241;os&#47;as menores de 5 a&#241;os con sobrepeso y obesidad superaron los 41 millones<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">1</span></a>&#46; Seg&#250;n la FAO &#40;Food and Agriculture Organization&#41;&#44; en Am&#233;rica Latina y el Caribe la obesidad en los&#47;las menores de 5 a&#241;os se increment&#243; de un 6&#44;6&#37; en el a&#241;o 1990 a un 7&#44;2&#37; en 2015&#46; En los &#250;ltimos 7 a&#241;os&#44; los porcentajes de sobrepeso en menores de 5 a&#241;os en Bolivia&#44; Colombia y Per&#250; fueron del 8&#44;7&#37;&#44; el 4&#44;8&#37; y el 7&#44;2&#37;&#44; respectivamente<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">2</span></a>&#46; Por otro lado&#44; en estos pa&#237;ses las tasas de lactancia materna exclusiva&#44; principal estrategia nutricional mundial en menores de 6 meses&#44; fueron del 64&#44;3&#37;&#44; el 42&#44;8&#37; y el 68&#44;4&#37;&#44; respectivamente<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La lactancia materna no solo est&#225; asociada a una mejor nutrici&#243;n infantil&#44; sino que adem&#225;s es un factor de protecci&#243;n para mortalidad y diversas enfermedades&#46; Se estima que la lactancia materna exclusiva podr&#237;a prevenir la muerte de hasta 823&#46;000 ni&#241;os&#47;as anualmente<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">3</span></a>&#46; El sobrepeso y la obesidad han tomado importancia en las &#250;ltimas d&#233;cadas por el incremento de las enfermedades no transmisibles en todas las edades y en todo el mundo<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En los estudios en pa&#237;ses de ingresos altos se ha observado menos probabilidad de obesidad en ni&#241;os&#47;as que lactaron en comparaci&#243;n con los&#47;las que no lactaron o lo hicieron un corto tiempo<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; El nivel socioecon&#243;mico es uno de los principales condicionantes para que la mujer decida brindar lactancia materna a su hijo<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">7&#44;8</span></a>&#59; a esto se suman&#44; entre otros factores&#44; la estructura familiar&#44; el ingreso salarial&#44; el nivel educativo y la edad de la mujer<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Asimismo&#44; las poblaciones de algunos pa&#237;ses latinoamericanos&#44; como Bolivia&#44; Colombia y Per&#250;&#44; conviven entre niveles elevados de desnutrici&#243;n y retraso de crecimiento lineal juntamente con tasas en crecimiento de sobrepeso y obesidad&#44; inclusive en las zonas rurales&#46; Este contexto representa un escenario interesante de estudio por diferentes motivos&#58; primero&#44; porque la diarrea y la desnutrici&#243;n disminuyen el efecto protector de la lactancia<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">9</span></a>&#59; segundo&#44; porque la desnutrici&#243;n cr&#243;nica est&#225; asociada con una mayor probabilidad de obesidad<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">10</span></a>&#59; y tercero&#44; porque los pa&#237;ses de Am&#233;rica Latina se encuentran en plena transici&#243;n epidemiol&#243;gica y demogr&#225;fica que se acompa&#241;a de cambios sociales &#40;mujeres con mayores roles y responsabilidades dentro y fuera del hogar&#41; y comerciales &#40;mayor uso del biber&#243;n&#44; de leches maternizadas y de pr&#225;cticas de amamantamiento&#41;&#44; as&#237; como de una modificaci&#243;n en los patrones de alimentaci&#243;n&#44; los h&#225;bitos alimentarios y la actividad f&#237;sica<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">11&#44;12</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Estos antecedentes sugieren que la asociaci&#243;n entre el tiempo de lactancia y el sobrepeso y la obesidad en los pa&#237;ses de Latinoam&#233;rica podr&#237;a tener algunas diferencias respecto a la literatura disponible&#46; Por lo tanto&#44; el objetivo del presente estudio fue determinar si la lactancia materna &#8805; 6 meses se asocia con menor sobrepeso y obesidad en ni&#241;os de 2 a 5 a&#241;os de edad&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todo</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o del estudio</span><p id="par0030" class="elsevierStylePara elsevierViewall">Estudio transversal utilizando informaci&#243;n extra&#237;da de las Demographic Health Survey&#46; Se eligieron tres pa&#237;ses de la regi&#243;n andina&#58; Bolivia &#40;Encuesta Demogr&#225;fica y de Salud Familiar 2008&#41;&#44; Colombia &#40;Encuesta de Demograf&#237;a y Salud&#47;Encuesta de la Situaci&#243;n Nutricional 2010&#41; y Per&#250; &#40;Encuesta Demogr&#225;fica y de Salud Familiar 2010&#41;&#46; En Bolivia&#44; Colombia y Per&#250;&#44; la tasa de respuesta fue&#44; en promedio&#44; del 96&#37;&#44; el 94&#37; y el 98&#37;&#44; respectivamente<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">13&#8211;15</span></a>&#46; El dise&#241;o muestral permite un nivel de inferencia nacional y departamental &#40;regional&#41;&#44; as&#237; como rural y urbano&#46; Las bases de datos y los informes que detallan estos aspectos fueron descargadas y est&#225;n disponibles en la p&#225;gina web de Demographic Health Survey &#40;<a href="https://dhsprogram.com/">https&#58;&#47;&#47;dhsprogram&#46;com&#47;</a>&#41;&#46; Estos y otros aspectos t&#233;cnicos de cada encuesta se ofrecen en detalle en la <a class="elsevierStyleCrossRef" href="#sec0105">tabla I del Ap&#233;ndice <span class="elsevierStyleItalic">online</span></a>&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Poblaci&#243;n de estudio</span><p id="par0035" class="elsevierStylePara elsevierViewall">Para el an&#225;lisis se incluyeron los datos de las madres y del&#47;de la &#250;ltimo&#47;a hijo&#47;a menor&#44; en el momento de la entrevista&#44; que tuviera informaci&#243;n antropom&#233;trica y de lactancia &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Se consider&#243; la informaci&#243;n del&#47;de la &#250;ltimo&#47;a hijo&#47;a para minimizar el sesgo de memoria&#46; En &#250;ltima instancia se cont&#243; con 1&#46;686 observaciones para Bolivia&#44; 4&#46;329 para Colombia y 2&#46;570 para Per&#250;&#46; La poblaci&#243;n no incluida en el estudio se presenta en detalle en la <a class="elsevierStyleCrossRef" href="#sec0105">tabla II del Ap&#233;ndice <span class="elsevierStyleItalic">online</span></a>&#44; en la cual puede observarse que la mayor&#237;a de las variables tuvieron similar distribuci&#243;n&#44; con excepci&#243;n del &#237;ndice de masa corporal &#40;IMC&#41; del&#47;de la ni&#241;o&#47;a &#40;menor para el sobrepeso&#41; y del lugar de residencia &#40;mayor para zona urbana&#41; para Bolivia&#44; el IMC de la madre &#40;mayor en sobrepeso y obesidad&#41; para Colombia&#44; y el nivel de educaci&#243;n &#40;menor para sin educaci&#243;n&#44; primaria y secundaria&#44; y mayor para el nivel superior&#41;&#44; el IMC de la madre &#40;menor para sobrepeso y mayor para obesidad&#41; y el lugar de residencia &#40;mayor para zona urbana y menor para zona rural&#41; para Per&#250;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Variables dependientes</span><p id="par0040" class="elsevierStylePara elsevierViewall">Las variables de desenlace fueron el sobrepeso y la obesidad infantil evaluadas usando el IMC basado en puntuaciones Z para la edad&#46; El sobrepeso y la obesidad se definieron como &#8805; 1-2 desviaciones est&#225;ndar y &#8805; 2-5 desviaciones est&#225;ndar&#44; respectivamente<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">16</span></a>&#46; Tanto el peso como la talla se midieron con t&#233;cnicas estandarizadas&#44; utilizando tall&#237;metros y balanzas calibradas&#46; El peso se obtuvo con ropa ligera y sin zapatos&#44; usando una balanza electr&#243;nica con una precisi&#243;n de 0&#44;1<span class="elsevierStyleHsp" style=""></span>kg&#59; la medici&#243;n de la talla se realiz&#243; con un tall&#237;metro con una precisi&#243;n de 0&#44;1<span class="elsevierStyleHsp" style=""></span>cm&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Variable independiente</span><p id="par0045" class="elsevierStylePara elsevierViewall">La variable exposici&#243;n&#44; medida por autorreporte de la madre&#44; fue la lactancia materna &#8805; 6 meses &#40;<span class="elsevierStyleItalic">versus</span> lactancia &#60; 6 meses o no lactancia&#41;&#44; considerando que ha iniciado la lactancia antes de las 24 horas desde el nacimiento y no ha recibido ning&#250;n tipo de l&#237;quido diferente durante los primeros 3 d&#237;as de vida&#59; es decir&#44; se trata de lactancia predominantemente materna dado que durante los meses siguientes no se asegura de manera precisa la ingesta de otro tipo de l&#237;quidos o alimentos<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">17&#44;18</span></a>&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Variables confusoras</span><p id="par0050" class="elsevierStylePara elsevierViewall">Las covariables utilizadas en el an&#225;lisis fueron&#44; para los&#47;las ni&#241;os&#47;as&#44; la edad y el sexo&#59; en cuanto al entorno&#44; el lugar de residencia &#40;urbano y rural&#41;&#59; y para las madres&#44; la edad &#40;en a&#241;os&#41;&#44; el estado civil&#44; el IMC categorizado &#40;obesidad con IMC &#8805; 30&#44; sobrepeso con IMC &#8805; 25 y &#60; 30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; normal con IMC entre 18&#44;5 y 24&#44;9&#44; y delgadez con IMC &#60; 18&#44;5&#41;&#44; el nivel educativo &#40;m&#225;ximo alcanzado&#41; y el nivel socioecon&#243;mico medido utilizando los quintiles del &#237;ndice de riqueza &#40;los quintiles 1 a 5 se calcularon considerando las zonas a las que pertenec&#237;an &#8212;rural o urbana&#8212;&#44; y cabe precisar que para generar estos quintiles y mantener el peso ponderado del muestreo original se utiliz&#243; el factor de expansi&#243;n&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">An&#225;lisis estad&#237;stico</span><p id="par0055" class="elsevierStylePara elsevierViewall">Se utiliz&#243; Stata versi&#243;n 14 &#40;Stata Corp LP&#44; College Station&#44; TX&#44; USA&#41; tanto para el procedimiento de estimaci&#243;n como para el manejo de las bases de datos&#46; En las estimaciones se incluyeron las ponderaciones que tienen en cuenta el dise&#241;o complejo y multiet&#225;pico de las encuestas nacionales&#46; As&#237;&#44; tanto los an&#225;lisis descriptivos como los modelos bivariables y multivariables se realizaron usando el comando <span class="elsevierStyleItalic">svy</span> para muestras complejas&#46; Dado que para el presente an&#225;lisis solo se incluy&#243; una submuestra de la poblaci&#243;n total de mujeres y el&#47;la &#250;ltimo&#47;a hijo&#47;a de 2 a 5 a&#241;os que tuvieron todos los datos necesarios para los an&#225;lisis&#44; se us&#243; la opci&#243;n <span class="elsevierStyleItalic">subpop</span> que permiti&#243; calcular correctamente los errores est&#225;ndar de las diferentes regresiones&#46; El an&#225;lisis de la potencia de la muestra para evaluar la obesidad fue del 81&#44;6&#37;&#44; y para el sobrepeso fue del 48&#44;5&#37;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Para el an&#225;lisis descriptivo se utilizaron proporciones o porcentajes para variables categ&#243;ricas&#44; y promedios y desviaci&#243;n est&#225;ndar para variables num&#233;ricas&#46; Para el an&#225;lisis bivariable se utiliz&#243; la prueba de ji al cuadrado&#44; y para el an&#225;lisis multivariable se utilizaron los modelos de regresi&#243;n multinomial para calcular las <span class="elsevierStyleItalic">odds ratios</span> &#40;OR&#41; y los intervalos de confianza del 95&#37; &#40;IC95&#37;&#41;&#46; La prevalencia de la principal variable de resultado &#40;obesidad&#41; fue cercana al 10&#37;&#59; por ello&#44; las estimaciones calculadas son referenciales y cercanas a las razones de prevalencia<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">19</span></a>&#46; Se incluyeron las variables en orden jer&#225;rquico<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">20</span></a>&#58; primero los factores relacionados con el&#47;la ni&#241;o&#47;a&#44; luego los de la madre y finalmente el nivel socioecon&#243;mico del hogar y el lugar de residencia&#46; Este orden jer&#225;rquico&#44; considerando la plausibilidad epidemiol&#243;gica de cada factor&#44; permiti&#243; tener cinco modelos distintos para poder observar la asociaci&#243;n de cada grupo de factores&#46; Finalmente&#44; los factores evaluados ingresaron a un modelo completo final &#40;sexto modelo&#41; que permiti&#243; responder la pregunta de investigaci&#243;n&#46; El modelo final&#44; ajustado por todos los confusores&#44; fue estimado considerando dos grupos de edad&#44; &#8804; 42 meses y &#62; 42 meses&#44; para poder identificar diferencias en la fuerza de la asociaci&#243;n &#40;<a class="elsevierStyleCrossRef" href="#sec0105">tabla III del Ap&#233;ndice <span class="elsevierStyleItalic">online</span></a>&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Aspectos &#233;ticos</span><p id="par0065" class="elsevierStylePara elsevierViewall">El presente estudio fue un an&#225;lisis secundario utilizando informaci&#243;n an&#243;nima de tres encuestas nacionales&#44; y no represent&#243; ning&#250;n tipo de riesgo para los&#47;las participantes&#46; El protocolo de este estudio fue aprobado por el Comit&#233; Institucional de &#201;tica de la Universidad Peruana Cayetano Heredia &#40;c&#243;digo SIDISI&#58; 58976&#41;&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Resultados</span><p id="par0070" class="elsevierStylePara elsevierViewall">Se incluyeron 1&#46;686&#44; 4&#46;329 y 2&#46;570 pares de madre-hijo&#47;a de las encuestas de Bolivia&#44; Colombia y Per&#250;&#44; respectivamente&#46; M&#225;s del 40&#37; de los&#47;las ni&#241;os&#47;as en Bolivia fueron clasificados en la categor&#237;a de sobrepeso u obesidad&#44; el 25&#37; en Colombia y el 30&#37; en Per&#250;&#46; La prevalencia de lactancia materna &#8805; 6 meses fue &#62; 70&#37; en los tres pa&#237;ses&#44; con frecuencias cercanas o &#62; 90&#37; en Bolivia y Per&#250;&#46; En los tres pa&#237;ses&#44; la mitad de las madres presentaban sobrepeso u obesidad&#44; y la mayor parte de la poblaci&#243;n infantil de 2 a 5 a&#241;os resid&#237;an en zonas urbanas&#44; llegando a un 75&#37; en Colombia&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">El an&#225;lisis bivariable &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41; mostr&#243;&#44; para Bolivia y Per&#250;&#44; que la lactancia materna estuvo relacionada con el IMC del&#47;de la ni&#241;o&#47;a &#40;p &#60; 0&#46;001&#41;&#44; pero no en Colombia &#40;p &#61; 0&#44;098&#41;&#46; Adem&#225;s&#44; se evidenci&#243; en los tres pa&#237;ses que el IMC de la madre fue una de las principales covariables relacionadas con el IMC del&#47;de la ni&#241;o&#47;a &#40;p &#60; 0&#44;01&#41;&#46; Los an&#225;lisis complementarios muestran que la proporci&#243;n de lactancia &#8805; 6 meses fue disminuyendo seg&#250;n el IMC de la madre&#44; siendo relevante en Per&#250;&#46; Asimismo&#44; el nivel educativo de la madre&#44; el nivel socioecon&#243;mico &#40;quintiles&#41; y el lugar de residencia se relacionaron con el IMC de la poblaci&#243;n infantil de 2 a 5 a&#241;os solo en Per&#250; &#40;p &#60; 0&#44;05&#41;&#46; La <a class="elsevierStyleCrossRef" href="#sec0105">tabla III del Ap&#233;ndice <span class="elsevierStyleItalic">online</span></a> muestra el incremento y adem&#225;s que al evaluar subgrupos de edad&#44; &#8805; 3&#44;5 a&#241;os&#44; se observ&#243; una fuerte asociaci&#243;n con el sobrepeso y la obesidad solo en Bolivia&#46; En los&#47;las ni&#241;os&#47;as mayores de 3&#44;5 a&#241;os se encontr&#243; asociaci&#243;n con la obesidad solo en Bolivia y con sobrepeso en Per&#250;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se muestra la fuerza de la asociaci&#243;n&#46; Para el modelo ajustado se observ&#243;&#44; de un lado&#44; una menor probabilidad de obesidad en los&#47;las ni&#241;os&#47;as que lactaron &#8805; 6 meses en comparaci&#243;n con quienes no lactaron o lo hicieron &#60; 6 meses &#40;70&#37;&#44; 29&#37; y 51&#37; menos para Bolivia&#44; Colombia y Per&#250;&#44; respectivamente&#41;&#46; Pese a que la asociaci&#243;n fue espuria para Colombia y Bolivia&#44; y solo consistente para Per&#250;&#44; se observ&#243; una menor probabilidad de sobrepeso en los&#47;las ni&#241;os&#47;as que lactaron &#8805; 6 meses en comparaci&#243;n con quienes lactaron &#60; 6 meses&#46; Adem&#225;s&#44; para Colombia y Per&#250;&#44; el quinto y el cuarto quintiles del nivel socioecon&#243;mico presentaron 2&#44;15 &#40;IC95&#37;&#58; 1&#44;15-4&#44;02&#41; y 2&#44;38 &#40;IC95&#37;&#58; 1&#44;17-4&#44;85&#41; veces mayor probabilidad de obesidad&#44; respectivamente&#44; en comparaci&#243;n con el quintil m&#225;s pobre de ambos pa&#237;ses&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">La relaci&#243;n entre lactancia materna y sobrepeso evaluada mediante regresi&#243;n log&#237;stica multinomial&#44; con un ajuste de variables de manera jer&#225;rquica seg&#250;n variables del&#47;de la ni&#241;o&#47;a&#44; de la madre&#44; del hogar y del entorno&#44; evidenci&#243; para Per&#250; una menor probabilidad de obesidad en los&#47;las ni&#241;os&#47;as de 2 a 5 a&#241;os que lactaron &#8805; 6 meses en comparaci&#243;n con quienes no lactaron o lo hicieron &#60; 6 meses&#46; La fuerza de la asociaci&#243;n se perdi&#243; al ajustar por variables de la madre&#44; de residencia y todas las variables&#46; Para Bolivia y Colombia no se evidenci&#243; asociaci&#243;n entre la lactancia materna y el sobrepeso &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#fig0015">figura 3</a> se presenta la relaci&#243;n entre lactancia materna y obesidad&#44; y se observa que para Bolivia y Per&#250; hubo menor riego de obesidad en los&#47;las ni&#241;os&#47;as de 2 a 5 a&#241;os que lactaron &#8805; 6 meses en comparaci&#243;n con quienes no lactaron o lo hicieron &#60; 6 meses&#46; Solo en el caso de Bolivia esta relaci&#243;n se mantuvo en el modelo final&#44; ajustado por todas las variables&#46; En Colombia&#44; la fuerza de la asociaci&#243;n fue m&#225;s d&#233;bil y en varios de los modelos se perdi&#243;&#44; sobre todo al ser ajustados por variables de la madre &#40;modelo C&#41;&#44; nivel socioecon&#243;mico del hogar &#40;modelo D&#41;&#44; lugar de residencia &#40;modelo E&#41; y por todas las variables &#40;modelo F&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discusi&#243;n</span><p id="par0095" class="elsevierStylePara elsevierViewall">En el presente estudio&#44; llevado a cabo con datos poblacionales de representatividad nacional en tres pa&#237;ses de Latinoam&#233;rica&#44; se encontr&#243; asociaci&#243;n entre la lactancia materna y la obesidad infantil en ni&#241;os de 2 a 5 a&#241;os en Bolivia y marginalmente en Colombia y Per&#250;&#46; Esta asociaci&#243;n mostr&#243; que la poblaci&#243;n infantil de 3 a 5 a&#241;os que tuvieron lactancia materna &#8805; 6 meses mostr&#243; una menor probabilidad de obesidad&#44; estimada en el 70&#37;&#44; el 51&#37; y el 29&#37; en Bolivia&#44; Per&#250; y Colombia&#44; en comparaci&#243;n con su contraparte que tuvo lactancia materna &#60; 6 meses&#46; As&#237; mismo&#44; esta relaci&#243;n tuvo la misma direcci&#243;n&#44; pero una asociaci&#243;n marginal&#44; para la asociaci&#243;n de lactancia materna y sobrepeso&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Nuestros resultados concuerdan en la direcci&#243;n de la asociaci&#243;n reportada previamente&#44; pero la magnitud de la asociaci&#243;n inversa fue heterog&#233;nea en los tres pa&#237;ses&#44; siendo incluso m&#225;s alta para Bolivia y Per&#250;&#46; Con anterioridad&#44; los hallazgos de una revisi&#243;n sistem&#225;tica y metaan&#225;lisis de 13 estudios indicaron que los periodos m&#225;s largos de lactancia materna se asociaron con una reducci&#243;n de la obesidad del 26&#37; &#40;IC95&#37;&#58; 22-30&#41;&#46; Comprender la magnitud de los efectos de la lactancia materna en distintas poblaciones tiene relevancia&#44; dado que los beneficios&#44; incluso en periodos cortos de lactancia &#40;&#8805; 3 meses&#41;&#44; reducen la obesidad infantil<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">21</span></a>&#44; y a largo plazo puede incluso reducir el riesgo de diabetes tipo 2 en la etapa adulta<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">22&#44;23</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Los factores que podr&#237;an explicar las diferencias en la asociaci&#243;n estudiada est&#225;n relacionados con caracter&#237;sticas del&#47;de la ni&#241;o&#47;a y de su madre&#44; el nivel socioecon&#243;mico y el entorno&#46; El presente estudio presenta&#44; en los modelos de regresi&#243;n para Colombia y Per&#250;&#44; un mayor efecto de las caracter&#237;sticas maternas&#44; el nivel socioecon&#243;mico y el entorno&#44; lo cual no se observa en Bolivia&#46; La literatura emp&#237;rica muestra que el estatus socioecon&#243;mico afecta a la lactancia materna debido a las diferencias en el acceso a la educaci&#243;n&#44; en particular a la educaci&#243;n para la salud<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">24</span></a>&#46; Por otro lado&#44; no se observ&#243; un patr&#243;n consistente al evaluar subgrupos a los 3&#44;5 a&#241;os&#59; sin embargo&#44; es posible que estrategias focalizadas y ausencia de alimentaci&#243;n complementaria podr&#237;an visibilizar un mayor efecto protector de la lactancia&#44; como aparentemente podr&#237;an estar mostrando los resultados de Bolivia&#46; Son necesarios estudios de causa-efecto&#44; controlando alimentaci&#243;n complementaria y otras variables clave&#44; para confirmar este efecto temprano de la lactancia materna&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Entre los factores maternos&#44; el IMC aten&#250;o la asociaci&#243;n entre lactancia materna y obesidad&#44; sobre todo en Per&#250; y Colombia&#46; La literatura describe que la obesidad materna disminuye la probabilidad de lactancia<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">25</span></a>&#44; y entre los factores fisiol&#243;gicos se reporta que la lactog&#233;nesis ocurre tard&#237;amente en las mujeres con obesidad en comparaci&#243;n con las que tienen peso normal<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Los modelos multivariables ajustados por variables confusoras evidencian&#44; para el nivel socioecon&#243;mico&#44; m&#225;s del 100&#37; de probabilidad de obesidad para el quintil m&#225;s alto de riqueza en Colombia y para el cuarto quintil en Per&#250;&#44; en comparaci&#243;n con el quintil m&#225;s pobre&#44; mientras que este patr&#243;n no fue el mismo para Bolivia&#59; asociaciones similares se han descrito en los Estados Unidos&#44; M&#233;xico y Brasil<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">27&#8211;29</span></a>&#46; Adicionalmente&#44; en Colombia se ha documentado un incremento m&#225;s r&#225;pido en las tasas de obesidad y sobrepeso para los &#237;ndices de riqueza m&#225;s bajos comparados con los m&#225;s altos<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">30</span></a>&#46; Entre los factores del entorno&#44; el lugar de residencia &#40;urbano o rural&#41; aten&#250;o la asociaci&#243;n entre lactancia materna y obesidad en los tres pa&#237;ses&#46; La urbanizaci&#243;n est&#225; asociada con una disminuci&#243;n de la lactancia materna&#44; y las tasas m&#225;s altas se encuentran en zonas rurales<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Por otro lado&#44; entre las caracter&#237;sticas del&#47;de la ni&#241;o&#47;a se ha descrito que la alimentaci&#243;n complementaria disminuye el papel protector de la lactancia y aumenta la probabilidad de obesidad<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">31</span></a>&#46; En los informes nacionales se ha reportado que los&#47;las ni&#241;os&#47;as menores que lactan desde los 2 meses tambi&#233;n reciben leche en polvo&#58; un 16&#46;0-19&#44;2&#37; en Bolivia<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a>&#44; un 26&#44;3&#37; en Colombia<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">15</span></a> y un 18&#44;7&#37; en Per&#250;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">14</span></a>&#46; Estudios recientes han demostrado que las madres que son incentivadas a usar leche en polvo tienen menor posibilidad de dar leche materna<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">32</span></a>&#46; Estas diferencias podr&#237;an explicar en parte los distintos niveles de la asociaci&#243;n en los tres pa&#237;ses&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Cabe precisar&#44; entre las limitaciones del presente estudio&#44; que su dise&#241;o transversal no permite sustentar la relaci&#243;n causa-efecto entre la lactancia materna &#8805; 6 meses y el sobrepeso o la obesidad del ni&#241;o&#46; Sin embargo&#44; la direccionalidad de nuestras estimaciones se corresponde con la de diversos estudios longitudinales en los que se ha observado que los efectos de la lactancia materna &#62; 6 meses se asocian con menores tasas de obesidad infantil<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">3&#44;33</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Por otro lado&#44; el sesgo de memoria podr&#237;a afectar los datos acerca de la duraci&#243;n exacta de la lactancia&#59; sin embargo&#44; esta limitaci&#243;n se minimiz&#243; incluyendo solo informaci&#243;n del&#47;de la &#250;ltimo&#47;a hijo&#47;a de 2 a 5 a&#241;os&#46; El ajuste con el IMC categorizado de la madre se utiliz&#243; como <span class="elsevierStyleItalic">proxy</span> frente a la ausencia de informaci&#243;n sobre el peso pregestacional y la ganancia de peso durante el embarazo&#59; no obstante&#44; se reconoce la limitaci&#243;n de no incluir estas variables en el an&#225;lisis multivariable&#46; Esta encuesta tambi&#233;n tiene la limitaci&#243;n de no recoger la actividad f&#237;sica&#44; y adem&#225;s la alimentaci&#243;n complementaria se valor&#243; solo en sus aspectos generales&#44; por lo cual no fue posible incluirlos en los an&#225;lisis&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Finalmente&#44; algunos estudios en madres latinoamericanas han identificado que existen creencias arraigadas sobre la idea de que los&#47;las ni&#241;os&#47;as con mayor peso son m&#225;s saludables<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">34</span></a>&#44; lo cual determina los h&#225;bitos de alimentaci&#243;n&#46; Por la naturaleza de las encuestas&#44; el presente estudio no ha abordado este aspecto&#44; pero tales creencias culturales son un factor clave que debe ser evaluado en futuros estudios para comprender y abordar esta relaci&#243;n de manera integral y poder generar estrategias apropiadas al contexto de cada pa&#237;s&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Entre las fortalezas del estudio destacan la representatividad nacional para los tres pa&#237;ses estudiados&#44; la comparabilidad de los datos y la oportunidad &#250;nica de presentar estimaciones con distintas fuerzas de asociaci&#243;n&#44; se&#241;alando la riqueza de informaci&#243;n que permite entender un mismo fen&#243;meno en distintos contextos&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusiones</span><p id="par0145" class="elsevierStylePara elsevierViewall">Los ni&#241;os de 2 a 5 a&#241;os de Bolivia que recibieron lactancia materna &#8805; 6 meses tuvieron menos posibilidad de tener obesidad&#44; y una relaci&#243;n similar&#44; pero marginalmente&#44; se observ&#243; en Colombia y Per&#250;&#46; Si bien existen diferencias en cuanto a los factores individuales&#44; maternos&#44; socioecon&#243;micos y del entorno &#40;residencia&#41;&#44; existe un patr&#243;n similar en los tres pa&#237;ses&#46; Se observ&#243; que los factores relacionados con la madre&#44; sobre todo el IMC&#44; atenuaron la fuerza de la asociaci&#243;n de inter&#233;s&#46; Asimismo&#44; se evidenci&#243; una mayor probabilidad de obesidad solo en el cuarto y el quinto quintiles de riqueza en Per&#250; y Colombia&#44; respectivamente&#46; Este estudio evidencia la importancia de fortalecer las estrategias que promuevan la lactancia materna como factor protector y de prevenci&#243;n para la obesidad durante la ni&#241;ez en Latinoam&#233;rica y en otros contextos similares&#44; tomando como un agente clave para este fin la educaci&#243;n sobre el estado nutricional infantil en las madres latinoamericanas&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Editor responsable del art&#237;culo</span><p id="par0160" class="elsevierStylePara elsevierViewall">Juan Alguacil&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Declaraci&#243;n de transparencia</span><p id="par0165" class="elsevierStylePara elsevierViewall">El autor principal &#40;garante responsable del manuscrito&#41; afirma que este manuscrito es un reporte honesto&#44; preciso y transparente del estudio que se remite a <span class="elsevierStyleSmallCaps">Gaceta Sanitaria&#44;</span> que no se han omitido aspectos importantes del estudio&#44; y que las discrepancias del estudio seg&#250;n lo previsto &#40;y&#44; si son relevantes&#44; registradas&#41; se han explicado&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Contribuciones de autor&#237;a</span><p id="par0170" class="elsevierStylePara elsevierViewall">A&#46; Paca-Palao y J&#46;J&#46; Miranda concibieron la idea del estudio&#46; A&#46; Paca-Palao y C&#46;A&#46; Huayanay Espinoza profundizaron la revisi&#243;n de la literatura&#44; formularon la estrategia de an&#225;lisis y elaboraron la primera versi&#243;n del manuscrito&#46; C&#46;A&#46; Huayanay Espinoza prepar&#243; la base de datos&#46; A&#46; Paca-Palao y C&#46;A&#46; Huayanay Espinoza hicieron los an&#225;lisis estad&#237;sticos&#46; C&#46;A&#46; Huayanay Espinoza&#44; D&#46;C&#46; Parra y G&#46; Velasquez-Melendez dieron asistencia con acceso a la informaci&#243;n de Colombia y Bolivia&#44; respectivamente&#44; y contribuyeron en las fases iniciales de conceptualizar el estudio de investigaci&#243;n&#46; Todas las personas firmantes contribuyeron a la interpretaci&#243;n de los resultados&#44; revisaron las distintas versiones del manuscrito y aprobaron la versi&#243;n final&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Financiaci&#243;n</span><p id="par0195" class="elsevierStylePara elsevierViewall">Este trabajo fue desarrollado como tesis de maestr&#237;a de APP&#44; Maestr&#237;a en Investigaci&#243;n Epidemiol&#243;gica&#44; Universidad Peruana Cayetano Heredia&#44; apoyado por el Fogarty International Center&#44; US National Institutes of Health &#40;D43 TW007393&#41;&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">A&#46; Paca-Palao reporta haber realizado este estudio como Becaria Naval Medical Research Unit&#44; NAMRU-6&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">D&#46;C&#46; Parra agradece al Instituto Colombiano de Bienestar Familiar y a PROFAMILIA por brindar apoyo y permitir el uso de la Encuesta Nacional de Demograf&#237;a y Salud y las bases de datos de la Encuesta Nacional de Estado Nutricional de Colombia y a Daniel Ayala por su valioso apoyo y aporte en la gesti&#243;n de datos y el an&#225;lisis estad&#237;stico&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">J&#46;J&#46; Miranda reporta recibir o haber recibido apoyo para desarrollar actividades de investigaci&#243;n por parte de Alliance for Health Policy and Systems Research &#40;HQHSR1206660&#41;&#44; the Bernard Lown Scholars in Cardiovascular Health Program at Harvard T&#46;H&#46; Chan School of Public Health &#40;BLSCHP-1902&#41;&#44; Bloomberg Philanthropies&#44; FONDECYT via CIENCIACTIVA&#47;CONCYTEC&#44; British Council&#44; British Embassy and the Newton-Paulet Fund &#40;223-2018&#44; 224-2018&#41;&#44; DFID&#47;MRC&#47;Wellcome Global Health Trials &#40;MR&#47;M007405&#47;1&#41;&#44; Fogarty International Center &#40;R21TW009982&#44; D71TW010877&#41;&#44; Grand Challenges Canada &#40;0335-04&#41;&#44; International Development Research Center Canada &#40;IDRC 106887&#44; 108167&#41;&#44; Inter-American Institute for Global Change Research &#40;IAI CRN3036&#41;&#44; Medical Research Council &#40;MR&#47;P008984&#47;1&#44; MR&#47;P024408&#47;1&#44; MR&#47;P02386X&#47;1&#41;&#44; National Cancer Institute &#40;1P20CA217231&#41;&#44; National Heart&#44; Lung and Blood Institute &#40;HHSN268200900033C&#44; 5U01HL114180&#44; 1UM1HL134590&#41;&#44; National Institute of Mental Health &#40;1U19MH098780&#41;&#44; Swiss National Science Foundation &#40;40P740-160366&#41;&#44; Wellcome &#40;074833&#47;Z&#47;04&#47;Z&#44; 093541&#47;Z&#47;10&#47;Z&#44; 107435&#47;Z&#47;15&#47;Z&#44; 103994&#47;Z&#47;14&#47;Z&#44; 205177&#47;Z&#47;16&#47;Z&#44; 214185&#47;Z&#47;18&#47;Z&#41; and the World Diabetes Foundation &#40;WDF15-1224&#41;&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflictos de intereses</span><p id="par0180" class="elsevierStylePara elsevierViewall">Ninguno&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Determinar si la lactancia materna &#8805; 6 meses se asocia con menor sobrepeso y obesidad en ni&#241;os&#47;as de 2 a 5 a&#241;os de edad&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis transversal de datos de encuestas nacionales de demograf&#237;a y salud de Bolivia&#44; Colombia y Per&#250;&#46; Se definieron sobrepeso y obesidad seg&#250;n los criterios de la Organizaci&#243;n Mundial de la Salud&#46; Se calcul&#243; la <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41; utilizando regresi&#243;n log&#237;stica multinomial&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de obesidad en ni&#241;os&#47;as de 2 a 5 a&#241;os fue del 10&#44;4&#37; &#40;intervalo de confianza del 95&#37; &#91;IC95&#37;&#93;&#58; 8&#44;2-12&#44;6&#41; en Bolivia&#44; del 4&#44;9&#37; &#40;IC95&#37;&#58; 4&#44;0-5&#44;8&#41; en Colombia y del 6&#44;4&#37; &#40;IC95&#37;&#58; 5&#44;2-8&#44;0&#41; en Per&#250;&#46; La lactancia materna &#8805; 6 meses en la poblaci&#243;n estudiada fue del 89&#44;9&#37; &#40;IC95&#37;&#58; 87&#44;8-91&#44;9&#41; en Bolivia&#44; del 73&#44;9&#37; &#40;IC95&#37;&#58; 72&#44;2-75&#44;6&#41; en Colombia y del 92&#44;8&#37; &#40;IC95&#37;&#58; 91&#44;2-94&#44;4&#41; en Per&#250;&#46; Se encontr&#243; evidencia de asociaci&#243;n entre lactancia materna &#8805; 6 meses y menor posibilidad de obesidad en comparaci&#243;n con no lactancia o lactancia &#60; 6 meses para Bolivia &#40;OR &#61; 0&#44;30&#59; IC95&#37;&#58; 0&#44;16-0&#44;57&#41;&#44; y una asociaci&#243;n marginal para Colombia &#40;OR &#61; 0&#44;71&#59; IC95&#37;&#58; 0&#44;47-1&#44;06&#41; y Per&#250; &#40;OR &#61; 0&#44;49&#59; IC95&#37;&#58; 0&#44;23-1&#44;04&#41;&#46; No hubo evidencia de asociaci&#243;n entre lactancia materna y sobrepeso&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La lactancia materna &#8805; 6 meses est&#225; asociada con una menor posibilidad de tener obesidad en ni&#241;os&#47;as de 2 a 5 a&#241;os en Bolivia&#46; Este patr&#243;n fue similar&#44; pero marginal&#44; para Colombia y Per&#250;&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To determine if breastfeeding for at least the first six months of life is associated with overweight and obesity in children 2 to 5 years old&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Cross sectional analysis of data from national demographic and health surveys conducted in Bolivia&#44; Colombia and Peru&#46; Overweight and obesity were defined using World Health Organization standard definitions&#46; Odds ratios &#40;OR&#41; were calculated using multinomial logistic regression&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The prevalence of obesity in children 2 to 5 years old was 10&#46;4&#37; &#40;95&#37; confidence interval &#91;95&#37;<span class="elsevierStyleSmallCaps">C</span>I&#93;&#58; 8&#46;2-12&#46;6&#41; in Bolivia&#44; 4&#46;9&#37; in Colombia &#40;95&#37;CI&#58; 4&#46;0-5&#46;8&#41;&#44; and 6&#46;4&#37; &#40;95&#37;CI&#58; 5&#46;2-8&#46;0&#41; in Peru&#46; Prevalence of exclusive breastfeeding for at least the first 6 months in the study population was 89&#46;9&#37; &#40;95&#37;CI&#58; 87&#46;8-91&#46;9&#41; in Bolivia&#44; 73&#46;9&#37; &#40;95&#37;CI&#58; 72&#46;2-75&#46;6&#41; in Colombia&#44; and 92&#46;8&#37; &#40;95&#37;CI&#58; 91&#46;2-92&#46;4&#41; in Peru&#46; Exclusive breastfeeding was associated with a decreased risk of obesity in children as compared to no breastfeeding or breastfeeding for less than 6 months in Bolivia &#40;OR &#61; &#46;30&#59; 95&#37;CI&#58; &#46;16-&#46;57&#41; and a marginal association in Colombia &#40;OR &#61; &#46;71&#59; 95&#37;CI&#58; &#46;47-1&#46;06&#41; and Peru &#40;OR &#61; &#46;49&#59; 95&#37;CI&#58; 0&#46;23-1&#46;04&#41;&#46; No association between breastfeeding and overweight was found&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Exclusive breastfeeding for at least the first six months of life decreases the risk of obesity in children 2 to 5 years old in Bolivia&#46; A similar but weaker pattern was observed for children in Colombia and Peru&#46;</p></span>"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flujograma de los datos de las poblaciones incluidas en el an&#225;lisis&#46;</p>"
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Odds ratios</span> entre la lactancia materna y el sobrepeso de ni&#241;os&#47;as de 2 a 5 a&#241;os&#44; ajustados por variables del&#47;de la ni&#241;o&#47;a&#44; de la madre&#44; del hogar y del entorno&#46; El grupo de referencia en todos los modelos es la categor&#237;a lactancia materna &#60; 6 meses en cada pa&#237;s&#46;</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Modelo A&#58; modelo crudo&#44; incluye como variable de resultado dos categor&#237;as &#40;sobrepeso y peso normal&#41; y como variable exposici&#243;n la lactancia materna en dos categor&#237;as &#40;&#8805; 6 meses y &#60; 6 meses&#41;&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Modelo B&#58; modelo A ajustado por los factores del&#47;de la ni&#241;o&#47;a &#40;edad en meses y sexo&#41;&#46;</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Modelo C&#58; modelo A ajustado por los factores de la madre &#40;edad en a&#241;os&#44; nivel de educaci&#243;n&#44; IMC categorizado y estado civil&#41;&#46;</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Modelo D&#58; modelo A ajustado por el nivel socioecon&#243;mico &#40;&#237;ndice de riqueza&#41;&#46;</p> <p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Modelo E&#58; modelo A ajustado por los factores del entorno &#40;lugar de residencia&#44; urbano vs&#46; rural&#41;&#46;</p> <p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Modelo F&#58; modelo completo&#44; ajustado por todas las variables antes mencionadas y que fueron incluidas en los modelos A&#44; B&#44; C&#44; D y E&#46;</p>"
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        "figura" => array:1 [
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          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Odds ratios</span> entre la lactancia materna y la obesidad de ni&#241;os&#47;as de 2 a 5 a&#241;os&#44; ajustados por variables del&#47;de la ni&#241;o&#47;a&#44; de la madre&#44; del hogar y del entorno&#46; El grupo de referencia en todos los modelos es la categor&#237;a lactancia materna &#60; 6 meses en cada pa&#237;s&#46;</p> <p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Modelo A&#58; modelo crudo&#44; incluye como variable de resultado dos categor&#237;as &#40;obesidad y peso normal&#41; y como variable exposici&#243;n la lactancia materna en dos categor&#237;as &#40;&#8805; 6 meses y &#60; 6 meses&#41;&#46;</p> <p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Modelo B&#58; modelo A ajustado por los factores del&#47;de la ni&#241;o&#47;a &#40;edad en meses y sexo&#41;&#46;</p> <p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Modelo C&#58; modelo A ajustado por los factores de la madre &#40;edad en a&#241;os&#44; nivel de educaci&#243;n&#44; IMC categorizado y estado civil&#41;&#46;</p> <p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Modelo D&#58; modelo A ajustado por el nivel socioecon&#243;mico &#40;&#237;ndice de riqueza&#41;&#46;</p> <p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Modelo E&#58; modelo A ajustado por los factores del entorno &#40;lugar de residencia&#44; urbano vs&#46; rural&#41;&#46;</p> <p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Modelo F&#58; modelo completo&#44; ajustado por todas las variables antes mencionadas y que fueron incluidas en los modelos A&#44; B&#44; C&#44; D y E&#46;</p>"
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          "leyenda" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; IC95&#37;&#58; intervalo de confianza del 95&#37;&#59; IMC&#58; &#237;ndice de masa corporal&#46;</p>"
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                  \t\t\t\t" scope="col">Caracter&#237;sticas</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NormalN &#61; 3239&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ObesidadN &#61; 206&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NormalN &#61; 1800&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Lactancia</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lactancia materna &#60; 6 meses&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">174&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">47&#44;54 &#40;38&#44;1-57&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30&#44;3 &#40;21&#44;5-39&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;093&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">71&#44;2 &#40;67&#44;7-74&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">22&#44;4 &#40;19&#44;2-25&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#44;4 &#40;4&#44;5-8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lactancia materna &#8805; 6 meses&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo del ni&#241;o</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t  " colspan="16" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Estado civil de la madre</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">858&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#44;6 &#40;8&#44;1-13&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Nivel socioecon&#243;mico</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1 &#40;el m&#225;s bajo&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ORa &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ORa &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ORc &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ORa &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ORc &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ORc &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ORc &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ORa &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lactancia materna &#8805; 6 meses&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Edad del ni&#241;o en meses &#40;media &#177; DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo del ni&#241;o</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Femenino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Masculino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Edad de la madre en a&#241;os &#40;media &#177; DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;98 &#40;0&#44;96-0&#44;99&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0&#44;97-1&#44;02&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0&#44;98-1&#44;02&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;03 &#40;1-1&#44;07&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;01 &#40;0&#44;97-1&#44;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="13" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Nivel de educaci&#243;n de la madre</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sin educaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Primaria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;86 &#40;0&#44;51-1&#44;45&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;81 &#40;0&#44;45-1&#44;45&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;64 &#40;0&#44;74-3&#44;63&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;2 &#40;0&#44;54-32&#44;76&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;49 &#40;0&#44;18-1&#44;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Secundaria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;42 &#40;0&#44;7-41&#44;98&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Superior&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0&#44;44-2&#44;28&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;94 &#40;0&#44;88-4&#44;26&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;05 &#40;0&#44;89-4&#44;68&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#44;59 &#40;1-57&#44;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">6&#44;09 &#40;0&#44;75-49&#44;48&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;81 &#40;0&#44;48-1&#44;39&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;76 &#40;0&#44;67-4&#44;67&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;94 &#40;0&#44;27-3&#44;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="13" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IMC categorizado de la madre</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sobrepeso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;28 &#40;0&#44;97-1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;32 &#40;0&#44;99-1&#44;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;04 &#40;1&#44;19-3&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;25 &#40;1&#44;33-3&#44;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;34 &#40;1&#44;07-1&#44;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;43 &#40;1&#44;13-1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;89 &#40;1&#44;23-2&#44;91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;96 &#40;1&#44;24-3&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;74 &#40;1&#44;33-2&#44;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;79 &#40;1&#44;36-2&#44;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2&#44;23 &#40;1&#44;24-4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;06 &#40;1&#44;17-3&#44;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Obesidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;3 &#40;0&#44;93-1&#44;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;35 &#40;0&#44;93-1&#44;95&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;16 &#40;1&#44;64-2&#44;84&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;73 &#40;1&#44;68-4&#44;43&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;12 &#40;1&#44;87-5&#44;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2&#44;92 &#40;2&#44;05-4&#44;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">5&#44;4 &#40;2&#44;81-10&#44;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">4&#44;75 &#40;2&#44;59-8&#44;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="13" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estado civil de la madre</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Casada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Soltera&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;9 &#40;0&#44;54-1&#44;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;95 &#40;0&#44;56-1&#44;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;57 &#40;0&#44;21-1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;61 &#40;0&#44;24-1&#44;58&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;06 &#40;0&#44;73-1&#44;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;98 &#40;0&#44;66-1&#44;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;46 &#40;0&#44;72-2&#44;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;58 &#40;0&#44;74-3&#44;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;8 &#40;0&#44;46-1&#44;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;85 &#40;0&#44;47-1&#44;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;52 &#40;0&#44;12-2&#44;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;59 &#40;0&#44;13-2&#44;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Convivientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;81 &#40;0&#44;61-1&#44;09&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;75 &#40;0&#44;55-1&#44;03&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;92 &#40;0&#44;53-1&#44;61&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;81 &#40;0&#44;64-1&#44;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;77 &#40;0&#44;6-1&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;18 &#40;0&#44;72-1&#44;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No viven juntos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="13" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Nivel socioecon&#243;mico</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1 &#40;el m&#225;s bajo&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>5 &#40;el m&#225;s alto&#41;&nbsp;\t\t\t\t\t\t\n
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          "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">&#191;Qu&#233; se sabe sobre el tema&#63;</span><p id="par0150" class="elsevierStylePara elsevierViewall">La lactancia materna provee un efecto protector contra el sobrepeso y la obesidad&#44; principalmente en etapas tempranas de la vida&#44; y tiene efectos positivos en la salud&#44; pues disminuye la probabilidad de sobrepeso&#44; obesidad&#44; hipertensi&#243;n arterial y diabetes&#44; incluso en etapas posteriores a la ni&#241;ez&#46; En los pa&#237;ses en desarrollo&#44; la morbilidad vinculada a enfermedades como la diarrea y la desnutrici&#243;n cr&#243;nica en infantes puede reducir el efecto protector de la lactancia materna&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">&#191;Qu&#233; a&#241;ade el estudio realizado a la literatura&#63;</span><p id="par0155" class="elsevierStylePara elsevierViewall">En los ni&#241;os y las ni&#241;as de pa&#237;ses de renta media y baja se observ&#243; que la lactancia materna tuvo un efecto protector&#44; aunque heterog&#233;neo&#44; para el sobrepeso y la obesidad&#46; El efecto protector de la lactancia materna fue m&#225;s fuerte en los&#47;las mayores de 42 meses&#44; especialmente en Per&#250; y Bolivia&#46; La promoci&#243;n de la lactancia materna prolongada podr&#237;a ser una estrategia efectiva para la prevenci&#243;n del sobrepeso y de la obesidad infantil en pa&#237;ses de Latinoam&#233;rica&#46;</p></span></span>"
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Información del artículo
ISSN: 02139111
Idioma original: Español
DOI:10.1016/j.gaceta.2019.09.002
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