disease at a younger age. Hence identification and treatment of youth with dyslipidemia is of utmost importance. Fasting lipid profile should be done. If the S.cholesterol level is high, hypothyroidism should be ruled out.
Children with lipid abnormalities should be managed initially for 3 to 6 months with diet changes, increased physical activity, reduced screen time, and caloric restriction. Indications for pharmacotherapy in children with dyslipidemia are mentioned in chapter on lipid disorders in children.
3. Hypertension:
It is estimated that about 60% of pediatric patients with hypertension have essential hypertension. Among the patients with essential hypertension 75% are obese, thus the most common cause of pediatric hypertension is obesity. Definition of Pre-hypertension and hypertension is given below(16). White-coat hypertension is present when BP readings in health care facilities are greater than the 95th percentile but are normotensive outside a clinical setting. Any abnormal BP reading should be repeated twice by auscultation if performed with oscillometric device.

TABLE 5
Prehypertension Stage 1 Hypertension Stage 2 Hypertension
BP percentile for age & gender >90th to <95th ≥95th to <99th +5mmHg ≥99th +5mmHg

METABOLIC SYNDROME (MS)
Metabolic Syndrome is also known as syndrome X and is characterized by:
-Obesity (abdominal)
-Atherogenic dyslipidemia (elevated triglyceride [TG] levels, high low-density lipoprotein [LDL] particles, and low high-density lipoprotein cholesterol levels
-Raised blood pressure
-Abnormality of glucose metabolism (impaired fasting glucose or GTT)
-Prothrombic inflammatory vascular environment
The presence of this cluster of factors increases the risk of cardiovascular events.
Childhood obesity predisposes to endothelial dysfunction, carotid intimal medial thickening, and the development of early aortic and coronary arterial fibrous plaques. Sleep apnea and obesity related hypoventilation might contribute to pulmonary arterial hypertension.
MS has been a well-defined entity in adults but the definition in children is still variable. Prevalence rates in the pediatric age group vary depending on the criteria used.