FMD was assessed as the

percentage change from baseline to maximal diameter of the brachial VX-809 chemical structure artery with reactive hyperemia. The average of three measurements at each timepoint was used to derive the maximum FMD. Repeated measurements on the same subjects (that were done in 50 controls randomly selected from the 150 healthy study children) gave coefficients of variation less than 10%. For the American Heart Association (AHA),14 MS is diagnosed in the presence of any three of the following five constituent risks: central obesity as determined by WC, hypertension, low HDL values, elevated triglyceride values, and glucose impairment. We used the pediatric AHA definition,15 which is based on the AHA adult definition but uses pediatric reference standards for BP, WC, triglycerides, and HDL cholesterol. Thus, in our study central obesity was defined as a WC ≥90th percentile for age and gender; hypertriglyceridemia as triglycerides ≥90th percentile for age and gender; low HDL cholesterol as concentrations ≤10th percentile for age and gender; elevated BP as systolic or diastolic BP ≥90th percentile for age, gender, and height percentile;

and impaired fasting glucose as glucose ≥5.6 mmol/L. IR was determined by a homeostasis model assessment of insulin resistance (HOMA-IR).16 We considered HOMA-IR values ≥90th percentile for age and sex of those observed in our population of healthy lean subjects as an indicator of IR. Statistical analyses were performed using the SPSS package. Data are expressed selleck products either as frequencies or means learn more with 95% confidence intervals (CIs).

Distributions of continuous variables were examined for skewness and kurtosis and were logarithmically transformed, when appropriate. Geometric means are reported for total and HDL cholesterol, triglycerides, APO A-1, APO B, CRPHS, insulin, and HOMA-IR values. Differences between groups were tested for significance using analysis of variance (ANOVA) for quantitative variables with the Bonferroni correction for multiple comparisons, and chi-square test for qualitative variables. Pearson’s correlation and linear regression coefficients were used to examine the relationship between variables, both in the entire population and separately in controls and in obese children. The independence of the association of NAFLD with FMD as well as with cIMT was assessed by multivariate linear regression analysis (when the dependent variable was continuous) or logistic (when the dependent variable was dichotomous). For this purpose, subjects were stratified into those having FMD ≤10th percentile of values observed in healthy lean subjects versus those showing FMD >10th. Likewise, increased cIMT was defined as ≥90th percentile of values observed in healthy lean subjects.