Risk Factors IDF [36] WHO [44] NCEP [33] I DPAIA [35] Age 10 to <16 years   12 to 19 years   MS Diagnosis Obesity plus 2 or more RF 3 or more RF 3 or more RF   Obesity WC ≥ 90th percentile or adult cut-off if lower BMI>95th percentile WC ≥ 90th percentile BMI>85th percentile according to sex and age Glycemic homeostasis Fasting glucose ≥ 5.6 mmol/L (100 mg/dL) or known Diabetes Mellitus type2 · Hyperinsulinemia prepubertal >15 mU/L;(31) (stage 1 Tanner) pubertal>30 mU/L; (31) (stages 2-4 Tanner) Post-pubertal ≥ 20 mU/L (stage 5 Tanner) · Fasting glucose ≥ 6.1 mM/L · Glucose intolerance · Glucose at 120 min ≥ 7.8 mM/L Fasting glucose ≥ 110 mg/dL Plasma Insulin >15 um/L Elevated Arterial Pressure Systolic BP ≥ 130 mmHg o r Diastolic BP ≥ 85 mmHg SBP>95th percentile for age, sex and stature NHBPEP [46] SBP/DBP ≥ 90th percentile for age and sex and stature NHBPEP [45] SBP and/or DBP in >90th and >95th percentiles or always that BP >120/80 mmHg Dyslipidemia · TG ≥1.7 mmol/L (150 mg/dL) · HDL <1.03 mmol/L (40 mg/dL) · TG >105 mg/dL for< 10 years >13 6mg/dL for ≥ 10 years · HDL <35 mg/dL · TC>95th percentile · TG ≥110 mg/dL · HDL ≤ 40 mg/dL TC < 150 mg/dL LDL <100 mg/dL HDL ≥ 45 mg/dL TG <100 mg/dL MS = metabolic syndrome; RF = risk factors; IDF = International Diabetes Federation; WHO = World Health Organization; NCEP = National Cholesterol Education Program - Adult Treatment Panel III; I DPAIA = Guidelines for the Prevention of Atherosclerosis in Childhood and Adolescence, BMI = body mass index, WC = waist circumference, TC= total cholesterol; TG = triglycerides, HDL = high density lipoprotein, SBP = systolic blood pressure, DBP = diastolic blood pressure; mm Hg = millimeters of mercury; mg/dL = milligrams per deciliter; mM / L = millimoles per liter

Table 4: Diagnostic Criteria for Metabolic Syndrome adapted for children and adolescents proposed by IDF, WHO, NCEP and I DPAID.

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