articulo original “valores de circunferencia de cintura de acuerdo a los percentiles de estatura:...

7/25/2019 Articulo Original VALORES DE CIRCUNFERENCIA DE CINTURA DE ACUERDO A LOS PERCENTILES DE ESTATURA: UN

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ARCHIVOS DE INVESTIGACIN MEDICA 42 (2011) 515-522

ARTICULO ORIGINAL

VALORES DE CIRCUNFERENCIA DE CINTURA DE ACUERDO A LOSPERCENTILES DE ESTATURA: UNA PROPUESTA PARA EVALUAR

OBESIDAD ABDOMINAL EN NIOS Y ADOLESCENTES MEXICANOS ENTR6 Y 16 AOS DE EDAD.

AUTORES: MIGUEL KLNDER-KLNDER AND SAMUEL FLORES-HUERTA

ANTECEDENTES Y O !ETIVOS: El per !e"r# $%&r%'()ere(%&*+ ,e %&("'r* e- '( 'e(&(,&%*,#r *("r#p#!/"r&%# p*r* ,&*0(#-"&%*r # e-&,*, * ,#!&(*l e("re l#- ,&)ere("e- 0r'p#- ,ee,*,e- &(%l'2e(,# (&3#- 2 *,#le-%e("e-. Se ,e-%#(#%e -& l* "*ll* p'e,e !#,&)&%*r e-"e&(,&%*,#r &(,epe(,&e("e ,e #"r*- 4*r&* le- %#!# l* e,*, 0/(er# # l* e"(&%&,*,. E!pre(,&!#-e-"e e-"', p*r* ,e"er!&(*r -& el per !e"r# ,e %&("'r* ,e (&3#- 2 *,#le-%e("e- !'e-"r*4*r&*%(e- e( l* "*ll* ,e *%'er,# * l#- per%e("&le- ,e e-"*"'r* 2 pr#p#(e!#- e-"#- 4*l#re-%#!# re)ere(%&* p*r* e4*l'*r l* # e-&,*, * ,#!&(*l e( (&3#-.

METODOS: Re*l&5*!#- '( e-"', "r*(-4er-*l *(*l "&%# ,#(,e el pe-# l* "*ll* 2 el per !e"r#,e %&("'r* )'er#( !e,&,#- e( (&3#- 2 *,#le-%e("e- 'e *-&-"e( * e-%'el*- pr&!*r&*- e( l*C&',*, ,e M/7&%#. E( el e-"', )'er#( &(%l'&,#- 889 &(,&4&,'#- e("re 6 2 16 *3#- ,e e,*,.U-*(,# re0re-&;( l&(e*l )'er#( e-"&!*,#- l#- 4*l#re- ,e per !e"r# ,e %&("'r* ,e *%'er,# * l*e,*, 2 0/(er# p#r l#- -&0'&e("e- per%e("&le- ,e e-"*"'r*: 1< => >< 9> 2 ?


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E( l* *%"'*l&,*, el (,&%e ,e !*-* %#rp#r*l $IMC+ $ GM=+ e- elgold standard p*r*%l*-&)&%*r el e-"*,# ('"r&%(*l ,e (&3#- 2 *,'l"#- &(%l'2e(,# &(,&4&,'#- %#( -# repe-# e-&,*, -&( e! *r0# %#!# el IMC (# !&,e l* ,&-"r& '%&;( ,e 0r*-* l* %&r%'()ere(%&*%&("'r* * -&,# pr#p'e-"* p*r* !e,&r l* 0r*-* * ,#!&(*l '( !e,&%&;( *l"*!e("e *%%e-& le 2) %&l ,e # "e(er e( l* %l (&%* 2 e( e-"',- ep&,e!l;0&%#- ,#(,e %#( p'("#- ,e %#r"*pr#p&*,#- p'e,e 4*l#r*r ,e !*(er* )&* le l* # e-&,*, * ,#!&(*l. L* # e-&,*, * ,#!&(*l e-

!*2#r!e("e *-#%&*,* *l r&e-0# ,e e7per&!e("*r e()er!e,*,e- !e"* ;l&%*- 2 %*r,&*%*- 'el* # e-&,*, 0e(er*l. E-"e ,*"# p'e,e -er &(%l'&,# e( l*- 0' *- ,e l* Fe,er*%&;( I("er(*%(*l,e D&* e"e- %#!# '( %#!p#(e("e (e%e-*r p*r* - (,r#!e !e"* ;l&%# e( (&3#-.

E( l* *%"'*l&,*, "#,#- l#- &()#r!e- rel*%(*,#- %#( el per !e"r# ,e %&("'r* e( (&3#- 2*,#le-%e("e- !'e-"r*( 4*l#re- ,e per !e"r# ,e %&("'r* '-*(,# '(* ,&-"r& '%&;( per%e("&le-"r*"&)&%*,* p#r e,*, 2 0/(er#. U(# ,e l*- re)ere(%&*- ! - "&le- p*r* e4*l'*r per !e"r# ,e%&("'r* e( (&3#- 2 *,#le-%e("e- ,e-"*%; l* &!p#r"*(%&* ,e l* r*5* 2 l* e"(&%&,*, %#!# )*%"#r

'e &("er4&e(e( e( l*- !e,&,*- ,el per !e"r# ,e %&("'r*@ p#r 'e l#- 4*l#re- ,e per !e"r# ,e%&("'r* e("re Me7&%*(#H*!er&%*(#- -#( ! - *l"#- 'e * 'ell#- e(%#("r*,#- e("re l*-p# l*%(e- ,e *)r#*!er&%*(#- 2 e'r#pe#H*!er&%*(#-.

S&( e! *r0# e( l*- # -er4*%(e- ,e ('e-"r# e-"', ,e pre-&;( *r"er&*l e( (&3#-pr#p'-&!#- l* &p;"e-&- 'e el per !e"r# ,e %&("'r* e-" ,&re%"*!e("e rel*%(*,# %#( l* "*ll*,e l#- &(,&4&,'#- %#!# #%'rre %#( l* pre-&;( *r"er&*l. Se0 ( ('e-"r#- %#(#%&!&e("#- (&(0e-"', * rep#r"*,# 'e l#- 4*l#re- ,e per !e"r# ,e %&("'r* *( %*! &*,# e("re l#- (&3#- 2*,#le-%e("e- %#( e,*, 2 0/(er#- -&!&l*re- e( )'(%&;( * l*- ,&)ere("e- "*ll*-. S& e-"# -e%#()&r!* e-"e e% # p#,r * -er !'2 "&l p*r* %l*-&)&%*r *pr#p&*,*!e("e l* # e-&* ,#!&(*l e( (&3#- 2 *,#le-%e("e- ,e *%'er,# * -' e-"*"'r*.

P#r e-"* r*5;( e( e-"e *r" %'l# *(*l&5*!#- %#!# l*- !e,&,*- ,el per !e"r# ,e %&("'r*!'e-"r* 4*r&*%(e- ,e *%'er,# * l* e-"*"'r* e( (&3#- 2 *,#le-%e("e- 'e 4&4e( e( l* C&',*,,e Me7&%# 2 "*! &/( pr#p#(e!#- 4*l#re- ,e re)ere(%&* p*r* %l*-&)&%*r l* # e-&,*, * ,#!&(*e( (&3#- !e7&%*(#-.

MATERIAL Y M"TODOSDe-p'/- ,e # "e(er el %#(-e("&!&e("# &()#r!*,# ,e "#,#- l#- (&3#- 2 *,#le-%e("e- 2 el

%#(-e("&!&e("# &()#r!*,# e-%r&"# p#r -'- p*,re- l#- p*r"&%&p*("e- )'er#( re%l'"*,#- ,e 19e-%'el*- pr&!*r&*- ,e l* C&',*, ,e M/7&%# $ e-%'el*- p l&%*- 2 ? e-%'el*- pr&4*,*-+. Ele-"', )'e *pr# *,# p#r el %#!&"/ &(-"&"'%(*l ,e /"&%* e &(4e-"&0*%&;( ,e ('e-"r# #-p&"*

L*- !e,&%(e- *("r#p#!/"r&%*- )'er#( "#!*,*- p#r '( ('"r&;l#0# %*p*%&"*,#*- (,#-e e( l*- 0' *- &("er(*%(*le-. El pe-# 2 l* e-"*"'r* $"*ll*+ )'er#( !e,&,#- -&(

5*p*"#- 2 %#( l#- -' e"#- e( e-"', '-*(,# r#p* l&0er*. El pe-# )'e !e,&,# '-*(,# '(*e-%*l* ,&0&"*l l# ! - %er%*(# *l .

L* %&r%'()ere(%&* $per !e"r#+ ,e %&("'r* )'e "#!*,* *l )&(*l ,e l* e7 *l*%&;( %#( '(%&("* )le7& le (# el -"&%* $-e%* =


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ANALISIS ESTADISTICOL* !e,&* 2 l* ,e-4&*%&;( e-" (,*r -e # "'4&er#( ,el pe-# l* e-"*"'r* $"*ll*+ 2 el

per !e"r# ,e %&("'r*. El (,&%e ,e !*-* %#rp#r*l $IMC+ 2 l* pr#p#r%&;( %&("'r*G"*ll* )'e%*l%'l*,#- -e0 ( l* e,*, 2 0/(er#. L#- per%e("&le- ,e e-"*"'r* e IMC ,e %*,* p*r"&%&p*("e)'er#( e-"&!*,#- '-*(,# %#!# re)ere(%&* * CDC =< 9> 2 ?< )'er#( e7p'e-"#- $De!#-"r*,#-+ p#r 0/(er# e( )'(%&;( ,e l* e,*, 2p#r %*,* per%e("&l ,e "*ll*. L#- 4*l#re- %*l%'l*,#- ,e per !e"r# ,e %&("'r* &(%l'2e(,# * 'ell#-per%e("&le- %#(-&,er*,#- %#!# p'("#- ,e %#r"e p*r* %l*-&)&%*r # e-&,*, %e("r*l. T*! &re*l&5*!#- '(* re0re-&;( l&(e*l -&!ple !#,&)&%*,* %#( el )&( ,e !#-"r*r l* !*0(&"', ,e l**-#%&*%&;( e("re l*- 4*r&* le- &(%l'2e(,# e( l* re0re-&;( %'*l&"*"&4* e( rel*%&;( %per&!e"r# ,e %&("'r*.

Del !&-!# !#,# %#( el )&( ,e ,e"er!&(*r -& l* "*ll* $e-"*"'r*+ ,e l#- (&3#- "&e(e&()l'e(%&* e( el ,&*0(;-"&%# ,e # e-&,*, %e("r*l l* pre4*le(%&* ,e e-"e ,&*0(;-"&%# e( ('e-"rp# l*%&;( )'e e-"&!*,# p#r el %r&"er ,e Fer( (,e5 # *3*,&e(,# el per !e"r# ,e %&("'r*!#,&)&%*,# p#r el per%e("&l ,e "*ll* p*r* )#r!*r '( %r&"er.

F&(*l!e("e l#- 4*l#re- ,el per !e"r# ,e %&("'r* ,el per%e("&l ?< ,e l#- (&3#- !e7&%*(#-)'er#( 0r*)&%*,#- e( #r,e( p*r* %#!p*r*r l#- 4*l#re- ,e #"r*- p# l*%(e- %#!# l* C &(*T'r%* E-p*3#l* Ale!*(* Br&"*(&%* C*(*,&e(-e Me7&%#H*!er&%*(* 2 Me7&%*(*T#,#- l#- *( l&-&- e-"*, -"&%#- )'er#( re*l&5*,#- p#r S"*"*GSE 11. >< 9> 2 ?


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-&0(&)&%*(%&* e-"*, -"&%*. L* "* l* J !'e-"r* ,e *%'er,# *l 0/(er# 2 p#r %*,* *3# ,e e,*, e4*l#r %*l%'l*,# ,e per !e"r# ,e %&("'r* ,e l#- per%e("&le- >< 9> 2 ? >< 9> 2 ?< ,e e-"*"'r* per# *'!e("* e( l#- per%e("&le- p#r *rr& * ,e e-"e (&4el.

L* "* l* > ,e-%r& e l* *-#%&*%&;( e("re el per !e"r# ,e %&("'r* %#( l#- per%e("&lee,*, 2 e-"*"'r* # "e(&,#- ,e *%'er,# *l 0/(er#. E( l#- (&3#- p#,e!#- # -er4*r 'e p*r*%*,* *3# ,e e,*, el per !e"r# ,e %&("'r* *'!e("* ,e =.8 * =.> %! lle4*(,# * %* # '( -&!ple* '-"e e( l*- re0re-(e- l&(e*le- !&e("r*- 'e p#r %*,* 1< p'("#- ,e per%e("&l ,e "*ll* elper !e"r# ,e %&("'r* *'!e("* = %!. E( l*- !' ere- p#r %*,* *3# ,e e,*, el per !e"r# ,e%&("'r* *'!e("* =.> # =. %! !&e("r*- 'e p*r* %*,* 1< p'("#- ,e per%e("&l ,e "*ll* el


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per !e"r# ,e %&("'r* *'!e("* 1%!. P*r* l#- #! re- l* e,*, 2 l* e-"*"'r* repre-e("*( elJ= ,e 4*r&* &l&,*, ,e %&r%'()ere(%&* ,e %&("'r* 2 p*r* l*- (&3*- e-"#- !&-!#- &(,&%*,#rrepre-e("*( el >< ,e l* 4*r&* &l&,*, ,el per !e"r# ,e %&("'r*

TA LA 2: V& /# # %6&$ $# #/ 6# / $# *%, 3/& ' / /*%+, $# *%, 3/&= &/#>/# %+, / #/*#, % $# ,%; ' &$ # *#, # #>?, # >@,#/ =>H>< > 2 9> re-pe%"&4*!e("e. S&( e! *r0# -& * '-"*!#- el per !e"r# ,e %&p#r el per%e("&l ,e e-"*"'r* $"*ll*+ l* pre4*le(%&* ,e # e-&,*, %e("r*l p*r* l*- !&-!*-%*"e0#r *- -er&*( ,e ?.1 11.9 ?.> 2 ?.J re-pe%"&4*!e("e. L*- pre4*le(%&*- )'er#(e-"*, -"&%*!e("e ,&)ere("e- e("re l#- !/"#,#- '-*,#-.

TA LA


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L* )&0'r* 1 repre-e("* l#- 4*l#re- ,e %&r%'()ere(%&* ,e %&("'r* p#r 0/(er# 2 e,*, $e(*3#-+ %#!p*r*(,# l*- ,&)ere("e- %'r4*- # "e(&,*- e( ('!er#-#- e-"',-. C*,* l (e* ,e l*%'r4* repre-e("* el per%e("&l ?< ,e %&r%'()ere(%&* ,e %&("'r* %#( l* e7%ep%&;( ,e &(%l%'r4*- ,el pre-e("e e-"', 'e %#rre-p#(,e( %#( el per%e("&l ?< %&r%'()ere(%&*- 2 "*! &/(%#( el per%e("&l >< ,e e-"*"'r*.

E( l* %#l'!(* ,e l#- (&3#- 2 l*- (&3*- e- p#-& le # -er4*r 'e l#- 4*l#re- ,e%&r%'()ere(%&* ,e %&("'r* ,e (&3#- 2 *,#le-%e("e- ,e l*- p# l*%(e- ,e r*( Bre"*3*

A'-"r*l&* C*(*, T'r ' * 2 C &(* -#( ! - * #- 'e l#- 4*l#re- ,e %&r%'()ere(%&* ,e%&("'r* ,e #"r#- e-"',- ,#(,e p*r"&%&p*r#( (&3#- 2 *,#le-%e("e- !e7&%*(#- 2 !e7&%#H*!er&%*(#- &(%l'2e(,# l#- ,e e-"e e-"',. A-&!&-!# !&e("r*- 'e l* e,*, *'!e("* e((&3#- 2 (&3*- !e7&%*(*- e- ! - *l"* l* "e(,e(%&* ,e l#- 4*l#re- ,e C e( l* p# l*%&;(!e7&%*(* 'e l* "e(,e(%&* 'e !'e-"r*( l#- 4*l#re- C ,e l*- p# l*%(e- re-"*("e-.

P#r l# "*("# p*r* *! #- 0/(er#- * l#- 1< 2 16 *3#- ,e e,*, l* %&r%'()ere(%&* ,e%&("'r* e( !e7&%*(#- # !e7&%#H*!er&%*(#- e- ! - *l"* 'e e( l*- p# l*%(e- re-"*("e- %#(l*- !&-!*- e,*,e-.

DISCUSIONL* !e,&%&;( ,el per !e"r# ,e %&("'r* e- '( pr#%e,&!&e("# *%%e-& le e( e-"',- %l (&%

2 ep&,e!l;0&%#- "*("# e( (&3#- %#!# *,'l"#-@ -&( e! *r0# *%"'*l!e("e (# *2 '( *%'er,#*%er%* ,el !e #r -&" ,#(,e p'e,e -er "#!*,* l* !e,&%&;( p*r* e-"* le%er 0r*-* * ,#!&(*l-' %'" (e* # &("r** ,#!&(*l. E( (&3#- 2 *,#le-%e("e- e- %#!pl&%*,# 4*l#r*r l* 0r*-** ,#!&(*l '-*(,# -#l# per !e"r# ,e %&("'r* p#r 'e %#("&('*!e("e e-" %*! &*(,# el pe-#l* e-"*"'r* 2 l* %#!p#-&%&;( %#rp#r*l. E( %'*("# *l per !e"r# ,e %&("'r* 2 l* e-"*"'r* e( l#-*,'l"#- e-"#- p*r !e"r#- *("r#p#!/"r&%#- p*re%e( (# "e(er rel*%&;( *l0'(*. E( l#- (&3#- l*

*-#%&*%&;( 'e *2 e("re e-"#- p*r !e"r#- (# * -&,# ,e-%r&"*. S&( e! *r0# e( e-"e e-"',-e ,e!'e-"r* 'e e( (&3#- 2 *,#le-%e("e- l#- per%e("&le- ,e %&r%'()ere(%&* ,e %&("'r* 2 ,ee-"*"'r* e-" ( ,&re%"*!e("e rel*%(*,#-@ e( l#- &(,&4&,'#- %#( l#- per%e("&le- ,e e-"*"'r*! - * #- e- !e(#r l* %&r%'()ere(%&* ,e %&("'r* 'e e( l#- &(,&4&,'#- 'e "&e(e( l#-per%e("&le- ! - *l"#- ,e e-"*"'r* $%*,* per%e("&l ,e e-"*"'r* "&e(e -' pr#p 4*l#r ,e%&r%'()ere(%&* ,e %&("'r*+. E-"* e4&,e(%&* e- l* pr&(%&p*l %#("r& '%&;( ,e e-"e e-"',.

C#!# l#- e-"',- 'e -e pre-e("*( e( l* )&0'r* 1 !'e-"r*( l#- 4*l#re- ,e%&r%'()ere(%&* ,e %&("'r* p*r* %*,* *3# ,e e,*, 2 p#r 0/(er# ,e-%r& &e(,# 4*l#re- ,e


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per !e"r# ,e %&("'r* ,e *%'er,# * l#- ,&)ere("e- r*(0#- ,e per%e("&le-: 8G?9 >G?> 1


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!e7&%*(* l*- "* l*- ,e per !e"r# ,e %&("'r* pr#p'e-"*- e( e-"e e-"', p'e,e( -er p#"e(%&*l!e("e '"&l&5*,*- e( *pl&%*%(e- "*("# %l (&%* %#!# ep&,e!l;0&%* '"&l&per%e("&le- ,e r&e-0# 9> 2 ?< ,e per !e"r# ,e %&("'r* pr#p'e-"#- p#r Fer( (,e5 e" *l. Per#* '-"*(,# l#- 4*l#re- ,e per !e"r# ,e %&("'r* p#r "*ll* 2 "e(&e(,# e( %'e("* 'e "&e(e( 'e -er 4*l&,*,#- p#r #"r#- e-"',- l#(0&"',&(*le- 'e &(%l'2*( e"(&%&,*, e("re -'- 4*r&* le-.

E- &("ere-*("e # -er4*r 'e l#- 4*l#re- ,el per !e"r# ,e %&("'r* ,e l#- (&3#- 2*,#le-%e("e- !e7&%*(#- '("# %#( l#- 4*l#re- ,e (&3#- (#r"e*!er&%*(#- ,e ,e-%e(,e(%&*!e7&%*(* 2 l#- p*r"&%&p*("e- ,e e-"e e-"', -#( -&!&l*re- p#-& le!e("e p#r 'e %#!p*r"e()'er"e- 4 (%'l#- 0e(/"&%#- 2 "*! &/( %#( &()l'e(%&*- *! &e("*le- p*re%&,*-. S&( e! *r0# eel per,# repre-e("*,# e( l* )&0'r* 1 l#- 4*l#re- ,el per !e"r# ,e %&("'r* e( l*- p# l*%(e-!e7&%*(*- -#( ! - *l"#- 'e l#- ,e (&3#- 2 *,#le-%e("e ,e Re&(# U(&,# A'-"r*l&* C &(* 2T'r ' * pr# * le!e("e p#r 'e "&e(e( ,&)ere("e- %*r*%"er -"&%*- /"(&%*-. A'( *- ,*,* le4&,e(%&* ,#(,e l* "*ll* &()l'2e e( l#- 4*l#re- ,el per !e"r# ,e %&("'r* l*- ('e4*- re)ere(%&*-"#!*( e-"* rel*%&;( e( %'e("* ,e er *( -er * '-"*,#- ,e *%'er,# *l p* - # * l* re0&;(.

E( %#(%l'-&;( p#r 'e el per !e"r# ,e %&("'r* !'e-"r* 4*r&*%(e- ,&re%"*!e("e*-#%&*,*- %#( l#- per%e("&le- ,e "*ll* (#-#"r#- pr#p#(e!#- e-"&!*r el r&e-0# ,e # e-&,*,* ,#!&(*l * '-"*(,# el per !e"r# ,e %&("'r* 2 "#!*(,# e( %'e("* l#- per%e("&le- ,e e-"*"'r*.E-"* *pr#7&!*%&;( p'e,e -er "&l p*r* pre4e(&r %l*-&)&%*%(e- err;(e*- ,e &(,&4&,'#- *l"

* #- %#!# &(,&4&,'#- %#( # e-&,*, * ,#!&(*l l*- %'*le- p'e,e( #%'rr&r -& el per !e"r# ,e%&("'r* e- e4*l'*,# -#l*!e("e p#r e,*, 2 0/(er#. U(* *pr#p&*,* %l*-&)&%*%&;( "*! &/( p'e,e*2',*r * pre4e(&r el r&e-0# ,e e()er!e,*,e- !e"* ;l&%*- 2 %*r,*-%'l*re- e( (&3#- 2*,#le-%e("e-.

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