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Metabolic syndrome The tendency for risk factors for cardiometabolic 
disease to cluster, now called metabolic syndrome, is well recognized in 
adults (Alberti and Zimmet, 1998). Similar clustering occurs in older chil-
dren and especially adolescents (Cook et al., 2003), and interest in metabol-
ic syndrome has increased, driven by the increased prevalence of pediatric 
obesity and the increasing incidence and earlier onset of type 2 diabetes in 
youth. There is as yet no accepted definition of metabolic syndrome for use 
in pediatric populations (Jolliffe and Janssen, 2007). Typically, adult defini-
tions are extrapolated to children and adolescents, with appropriate adjust-
ments of the thresholds for the defining variables. Perhaps the most com-
mon approach is to emulate the National Cholesterol Education Program 
(NCEP), which defines metabolic syndrome as exceeding thresholds on 
three of five components: waist circumference, blood pressure (systolic or 
diastolic), blood lipids (high-density lipoprotein [HDL] and triglycerides), 
and blood glucose levels (NIH, 2001). 
The concept of metabolic syndrome is useful as it provides an inte-
grated index of risk, and it recently was used to derive health-related 
percent-body-fat standards (Laurson et al., 2011). Based on NHANES 
data, the prevalence of metabolic syndrome varies with the degree of obe-
sity, and it is estimated at 4-6 percent of children and adolescents (Cook 
et al., 2003; Dubose et al., 2007); among obese youth it may be as high as 
30-50 percent (Weiss et al., 2004). Youth with metabolic syndrome have 
an increased risk of type 2 diabetes and cardiovascular disease. In adults a 

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