Introduction

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The dysmetabolic syndrome is among the fastest growing disease entities in the world today. In the United States, e.g. almost 25% of adults 20 years and older have the syndrome [1]. Its prevalence increases with age, with it affecting almost 50% of US adults 60 years and older. Although the syndrome has many names, including 'Reaven's syndrome', 'syndrome X', the 'insulin resistance syndrome', and the 'metabolic syndrome', its diagnosis centers around a constellation of metabolic derangements including central obesity, dyslipidemias (i.e. high plasma levels of triglycerides and low levels of high-density lipoprotein cholesterol), hypertension, insulin resistance, and glucose intolerance, along with increased prothrombotic and inflammatory markers [2]. The National Cholesterol Education Program, the World Health Organization, and other national and international organizations have delineated differing but related criteria for its diagnosis [2].

This constellation of metabolic abnormalities greatly increases the risk of developing cardiovascular disease [3-6]. It appears that in a few years the dysmetabolic syndrome will overtake cigarette smoking as the strongest risk factor for the development of heart disease in the US. Sadly, the syndrome also is afflicting a growing number of children and adolescents. The prevalence of the syndrome in US children aged 12-19 years is about 1 in 10 [7]. In overweight/obese children, 1 in 3 have the syndrome. Among severely obese children, the prevalence reaches 50%. Two thirds of all adolescents have at least 1 metabolic abnormality [8, 9]. Given the rising prevalence in obesity among children and adolescents, these data are not surprising.

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