Sample Solution

-BP ≥90th percentile according to age and sex
Waist circumference percentiles for the Indian Population were published recently by Khadilkar et al (18). They have suggested a cut-off of 70th percentile for WC, to screen for Metabolic Syndrome in Indian children.

5. Nonalcoholic Fatty Liver Disease (NAFLD):
Nonalcoholic fatty liver disease (NAFLD) constitutes a spectrum of conditions, ranging from steatosis to nonalcoholic steatohepatitis (NASH) and cirrhosis, in the absence of excessive alcohol consumption. The prevalence of NAFLD is 34.2% in obese children & adolescents and the reported prevalence is highest in Asia (19).
Most children are asymptomatic, while some may complain of right upper quadrant pain or abdominal discomfort. NAFLD aggravates hepatic insulin resistance, thereby increasing the risk of developing T2DM.
The liver SAFETY (Screening ALT for Elevation in Today’s Youth) study was conducted to develop ALT thresholds and the cut-off of ALT >25 for boys and >22 for girls were suggested for screening NAFLD in children (20).

6. Polycystic Ovary Syndrome (PCOS):
Increased adiposity, especially abdominal, is associated with hyperandrogenemia and increased metabolic risk. The diagnosis of PCOS in an adolescent girl should be made based on the presence of clinical and/or biochemical evidence of hyperandrogenism (after exclusion of other pathologies) in the presence of persistent oligomenorrhea (21). Polycystic ovary morphology on ultrasound is not reliable to make a diagnosis in adolescents because multi-follicular ovaries are a feature of normal puberty that subsides with onset of regular menstrual cycles (22).