Burden of Dyslipidemia and Metabolic Syndrome among Indigenous Black African Secondary School Students in Lagos, Nigeria

Introduction: Metabolic syndrome (MetS) is a group of risk factors which together increase the chance of heart disease, stroke, and type 2 diabetes. In MetS, especially among overweight and obese people, blood pressure and blood glucose are elevated, excess body fat accumulates abdominally, and there is dyslipidemia – notably low level of high-density lipoprotein (HDL) cholesterol and high level of triglycerides. Objectives: This study has three objectives: (i) determine the prevalence of dysglycemia and of dyslipidaemia among Nigerian adolescents relative to gender (boys and girls), stage of adolescence (early and late) and BMI-for-age percentile (lean and overweight/obese) (ii) to quantify the burden of lipid abnormalities (excessive Total cholesterol (TC), Triglyceride (TG), High-density lipoprotein cholesterol (HDL) and Low-density lipoprotein (LDL) cholesterol) among Nigerian adolescents, which have appeared as substantial covariates of coronary heart disease (CHD) and (iii).To evaluate the association of overweight/obesity, dysglycemia and dyslipidaemia with MetS at (≥90 th percentile). Population and Methods: An institution-based, cross-sectional, descriptive, epidemiological study was conducted from October 2019 to March 2020. A multi-stage sampling approach was used to recruit 650 students aged 10-19 years in secondary schools within Lagos State of Nigeria. Data were collected using a structured questionnaire and anthropometric measurements. Fasting venous blood samples were collected for plasma glucose and lipid profile analysis. Systolic and diastolic blood pressures were measured. A p-value <0.05 was taken as statistically significant. Twenty-six questionnaires were discarded due to incomplete data. Results: A total of 650 adolescents aged between


Introduction
The alarming rise in the number of children and adolescents who are developing symptomatic diabetes and demonstrable precursors of cardiovascular disease calls for urgent action.Studies from the developed world have established that obesity among adolescents is associated with unfavorable lipid profiles [1] .The increasing frequency of obesity is becoming a vital public health issue.Globally in 2020, 38.9 million were overweight or obese [2] .Though the prevalence of child and adolescent obesity has flattened at elevated levels in most developed countries, it is rising in several low-and middle-income countries [3] .Health-related quality of life is reduced in those with obesity and comorbidities of obesity, such as type 2 diabetes mellitus, fatty liver disease and depression, are more probable in adolescents, especially among the obese [3] .The prevalence of obesity among adults in the 10 high-burden African countries ranges from 13.6% to 31%, while in children and adolescents it ranges from 5% to 16.5% [4] .There is a variation in obesity rates across Africa, though reports indicate that obesity on the continent is increasing [5] .In 2016, the average prevalence of obesity among boys and girls in Africa were 3.2% and 4.7% respectively [5] .Obesity in childhood and adolescence is a major risk factor for the development of obesity, premature death, and disability in adulthood.It is also a risk factor for breathing difficulties, hypertension, early markers of cardiovascular disease, insulin resistance and psychological consequences [6] .It has been earlier recognized that childhood and adolescent obesity is associated with unfavorable lipid profile, suggesting that obese children should be screened for hypercholesterolemia [7] .Lipids, circulating in the blood system as lipoproteins, are made up of unesterified cholesterol, triglycerides, phospholipids, and protein.Abnormalities in plasma lipids (the unfavorable lipid profile), such as (i) high total cholesterol (TC), (ii) high low-density lipoprotein cholesterol (LDL-C) (iii) high non-high-density lipoprotein cholesterol (non-HDL-C) (iv) high triglycerides and (v) low HDL-C, referred to as dyslipidemia, contributes to the occurrence of serious illnesses related to cardiovascular diseases (CVDs) [8] .Elevated serum lipid concentrations, including cholesterol and triglycerides, termed as hyperlipidemia, lead to a higher risk of developing atherosclerotic cardiovascular disease (ACVD).Potential reasons for the increase in CVD rates include lifestyle changes associated with urbanization and epidemiologic and nutritional transitions accompanying economic development now [9][10] [11] .The etiology of dyslipidemia may be multifactorial, including sedentary life, dietary (excessive dietary intake of saturated and trans fats -an important contributor to elevated LDL and excessive intake of refined carbohydrates and simple sugars raises TG); secondary causes (exogenous e.g., alcohol, obesity, drug therapy; endocrine/metabolic e.g., hypothyroidism/hypopituitarism, diabetes mellitus types 1 and 2, Polycystic ovarian syndrome, lipodystrophy; renal e.g., nephrotic syndrome, chronic renal disease; Infections e.g., HIV, Hepatitis; hepatic e.g., obstructive liver disease, biliary cirrhosis; inflammatory disease e.g., Systemic lupus erythematosus; Storage disease e.g., Glycogen storage disease, and others such as idiopathic hypercalcemia Klinefelter syndrome or Kawasaki disease), and genetic causes (monogenetic conditions such as familial hypercholesterolemia or polygenic hypercholesterolemia [12] .Thus, abnormal lipid profile in adolescents with dyslipidemia is like what is seen in adults with premature CVD.Elevated LDL cholesterol levels (hypercholesterolemia) are relatively common in populations consuming a western diet. [13].
Hypercholesterolemia is associated with the development of atherosclerosis, coronary heart disease (CHD), myocardial infarction (MI), and increased mortality [14] which are relatively common in the West [15] but not well studied in Africa.Closely associated with obesity and dyslipidemia (including hypercholesterolemia) is MetS, a subject that has received much attention in recent times, due to increasing awareness of its association with cardiovascular morbidity and mortality.However, it is a concept that dates back to over 5 decades now.Its existence was first observed as clustering of hypertension, hyperglycemia, and gout as described by Kylin in the 1920s.Later, Jean Vague in 1947 noted its association with android obesity [16][17] [18] .Metabolic syndrome is an important public health problem that causes severe mortality and morbidity and is increasing all over the world with the realization that metabolic abnormalities such as insulin resistance (IR), obesity, dyslipidemia, and hypertension (HT) cluster in some patients [19] strongly associated with an increased risk of developing atherosclerotic cardiovascular disease (ACVD) [20] .Although MetS is often known as a health problem in adulthood, it has recently emerged as an essential problem in childhood and adolescence.It is known that an increasing number of children and adolescents are affected by MetS [21][22] though a definite consensus has yet to be reached in the definition and cutoff points for considered risk factors in childhood/adolescent MetS as in adults [23][24] .Studies have associated obesity [25][26] and dyslipidemia [27][28] as key features of MetS and its risk factors for CVD and type 2 diabetes (T2DM).There is paucity of data on lipid profiles and on MetS among adolescent Nigerian.Isolated studies have been conducted on some lipid profiles among Nigerian adolescents [29][30] [31] emphasizing mainly those with diabetes or the relationship between body mass index and lipid profiles.However, most of these studies did not consider the Body Mass Index-for-age percentile of their study populations.Certain cardiovascular risk factor such as obesity, DM, and HT as well as some severe comorbidities and complications are associated with dyslipidaemia [32] requiring more attention to be paid to this increasing health burden among the African adolescents.Dyslipidaemia and associated disorders diseases are once said to be rare in children and adolescents in Africa [33] and up till now, there is a shortage of information on this topic.There is also scarcity of data on the triad of obesity, dyslipidaemia, and MetS among Nigeria adolescents and thus the burden of this syndrome is relatively unknown, leaving a vacuum in its clinical management.It is important to study MetS in adolescents to reduce adult morbidity and mortality due to its complications, reduce CVD, atherosclerosis and other co morbidities and to increase life-expectancy.The objectives of the present study were to determine the prevalence of (i) overweight/obesity and (ii) dyslipidaemia among Nigerian adolescents relative to gender and BMI-for-age percentile.In addition, this study determined, the association of overweight, obesity and dyslipidaemia with MetS at (≥90th percentile).Early onset of dyslipidemia may affect the later life or overall life course of an individual, probably leading to other chronic conditions at such a young age which might hamper adulthood, highlighting how important it is to study this condition even among individuals as young as a 10-19-year-olds.

Populations and Methods
The

Study site
This descriptive, non-experimental, cross-sectional study was conducted in Lagos State, Southwest Nigeria.Lagos, the most economically important city in the country, is also the most populous, the second fastest growing city in Africa.The city had 616 registered public (372, 60.4%) and private (244, 39.6%) secondary schools in the selected Local Government Areas (LGAs) of study [34] .

Study population
The target population was students in government-approved Secondary School Lagos State.The WHO defined the age range for adolescents to be between 10-19 years [35] .

Sample size
The sample size was calculated for a single population with 95% confidence interval, 54% [36] proportion, a margin of error 5%, and allowing for 12% non-response.To ensure that results of the study are representative of all Nigerian ethnic groups resident in Lagos State, the sample size would then be 650 students to cater for attrition and missing data.1).Thus, selection was stratified by junior and senior school years proportional to school size.Exclusion criteria: Those on therapeutic diet or drugs, and those on admissions to a health facility in previous 6 month were excluded from the study.Thus, students with diabetes, those taking lipid-lowering medications, or with a history of vascular/liver/renal or other continuing illness were excluded.Pregnancy, suspected pregnancy, breastfeeding, or use of oral contraceptive were also exclusion criteria.

Measurements
Data on socio-demographic and economic characteristics were gathered from both parents and students.} machine for a very big hand).The average of the three measurements was used.
Participants were asked to fast overnight, after which 5 ml of venous blood was taken.Fasting blood for glucose was collected into fluoride oxalate tubes while the fasting blood for lipids was collected in Lithium heparin tubes.Both were stored at -20ºC before centrifuging for the production of plasma.Randox Glucose-PAP (Randox Laboratories, UK) reagent was used for analyzing FPG and lipid profile (total cholesterol, HDL, low-density lipoprotein (LDL) and triglycerides) were measured using a photo spectrometric analyzer (BioSystems EN ISO 13485 and EN ISO 9001 standards (Barcelona, Spain).

Statistical analysis
Data were presented in the three domains of gender (boys and girls), BMI-for-age percentile (Lean (<85 th percentile), overweight/obese (≥85 th percentile) and stage of adolescence (early=10-14.9years of age; late=15-19.9 years of age).Descriptive statistics were performed for all anthropometric and biochemical data, and values were initially reported as mean (±) standard deviation (SD) and 95% CI for the continuous variables.Analyses were conducted using NCSS version 22 (Kaysville, Utah, USA) and Box plot was drawn using STATA version 13.1 (College Station, Texas, USA).Analysis of variance, Chi-square with odds ratios, bivariate, and multivariate logistic regression were performed.An unadjusted p-value <0.05 was considered statistically significant.Kolmogorov-Smirnov Normality test for normality of data distribution for continuous measures was conducted and when the test failed, Mann-Whitney U-test and Kruskal-Wallis one-way ANOVA were used to determine differences between 2 and 3 medians respectively.Independent Student's t-tests were used to identify differences in anthropometric measurements.MetS severity calculator [38] , which considers the adolescent's height (cm), weight (kg), sex, serum triglyceride, HDL-C, fasting glucose, systolic blood pressure, and ethnicity (non-Hispanic, Black), was used to calculate continuous metabolic syndrome (cMetS) risk score for early occurrence of MetS.

Proportion of study subjects with borderline and high (low for HDL) Fasting Lipid or Blood Glucose (FBG) levels (Table 2).
Though there were no significant differences in their proportions, boys were however more likely to present with impaired FBG, borderline TC, TG and HDL respectively (statistical inferences for these are shown in Table 2).Those in early adolescence were also less likely to present with impaired FBG, but more likely to have borderline TC, TG, and HDL respectively while lean subjects were over two times more likely to have borderline TG compared to overweight/obese subjects.On the contrary, boys were unlikely to have diabetic FBG or high levels of lipids (TC, TG, HDL, LDL) compared to girls; those in early adolescence were over 1½ times more likely to present with diabetic FBG and TC, slightly more likely to have HDL compared to those in late adolescence; and lean subjects were less likely to have diabetic FBG but nine times more likely to present with high TC and about 1½ times more likely to have high HDL.3).
When the median of various lipid among those with and without dyslipidemia were compared, significant variations were apparent in the levels of subjects with dyslipidemia were significantly younger (t-test=2.54,P-value=0.04),had higher BMI-for age (-10.48,P-value<0.00001)and higher WC (cm) (t-test=-4.72,P-value= 0.004) than lean subjects with dyslipidemia.Median levels of TC, TG and HDL were significantly higher among lean subjects with, compared to those without dyslipidemia while median LDL was marginally significant as shown in the Table .Only HDL was significantly higher among overweight obese subjects with dyslipidemia while TG levels between the two groups was marginally significant.

All Boys Girls
Boys vs. Girls
The proportion of boys and girls with 3 or more risk factors MetS was similar (9.1 vs 9.4) as was the proportion of those in early and late adolescence (10.3 vs 8.3) but very dissimilar (5.7% vs 50.0%) among lean and overweight/obese subjects respectively.Those in early adolescence were approximately 1⅓ times more likely to develop ≥3 risk factors for MetS (χ²=0.Multivariate regression analysis (Table 6).
Among all the study subjects, a significant 25.5% of the variance in Mets≥ 90 th percentile is explained by five predictor variables -FBG, TC, TG, HDL, and BMI-for-age percentile after a backward elimination was conducted.The overall relationship between MetS ≥90 th percentile and these five predictor variables was significant and all of them contributed to the observed MetS≥90 th percentile among study subjects.Similarly, among boys, a significant 38.9% of these same predictor variables explained the variations in MetS ≥90 th percentile whereas among girls, a significant 21.5% of the variance in Mets 90 th percentile is explained by four predictor variables -FBG, TG, BMI-for-age percentile, and WC.

Discussion
Published literature and data on severe dyslipidemia among secondary school students in Africa, including Nigeria is rare.This current study investigated the prevalence of overweight/obesity, dyslipidemia and of MetS among 10-19-years-old indigenous Black Nigerian adolescent secondary school students in Lagos, Southwest Nigeria.The application of various criteria in the numerous definitions of MetS has rendered the estimation of its prevalence problematic [45] .At present, there are no agreed guidelines or diagnostic criteria for MetS in the pediatric/adolescent population [46] .There are some key findings in this study that merit discussion.First, the overall prevalence of MetS was 8.3%, higher than the 5.2% reported from India [47] or 1.4% from Tanzania [48] .In consonance with a South African study [49] , MetS was more prevalent among boys than girls, but much higher than the 6.1% among boys and 3.1% among girls reported in South Africa.Studies in different parts of Nigeria have reported different prevalence for MetS among adolescents under different criteria such as HIV [50] , diabetes [29] , and obesity [51] and others with a range from 1.9% to 23.8%.The overall 8.3% prevalence of MetS in this study falls within the range of MetS reported in Nigeria, though it is higher than the 2.2% among 10-17 years reported in Turkey [52] .Further, the 26% prevalence of MetS among overweight/obese subjects falls within the 3-60% earlier reported [53] .National Health and Nutrition Examination Survey I (NHANES I) study (1988-1994), conducted in the USA, demonstrated that MetS features were found in 3% to 14% of all children and adolescents.These rates were reported as 13% to 37% in obese patients in the study [54] .The exact pathophysiology and mechanism of MetS seems complex and are yet to be clearly elucidated.However, Çelebi proposed that abdominal obesity and insulin resistance effectively develop MetS [55] while Rochlani et al suggested that macrophage infiltration occurs in adipose tissue with intra-abdominal obesity, that various cytokines such as TNF-α and IL6 released from macrophages cause inflammation and that this inflammation leads to lipolysis in adipose tissue, increasing circulating free fatty acids, decreased insulin signaling, and decreased glucose transporter (GLUT4) synthesis, resulting in insulin resistance [56] .The preponderance of impaired/diabetic FBG in this study's multivariate regression analysis may attest to the finding of a study which suggested that IR is the key mechanism thought to underlie metabolic syndrome [57][58] .An alternative view of pathway in the development of MetS is activating the renin-angiotensin system (RAS).Obesity and IR cause an elevated production of angiotensin-2 secreted by adipose tissue [56] .It is also suggested [59] that increased lipolysis in IR causes an elevation of free fatty acids in the circulation.The liver produces triglycerides using excess concentration of fatty acids in the blood with simultaneous increase in very low-density lipoprotein (VLDL) production, leading to dyslipidemia [59] .Possibly, adipokines released from visceral adipose tissue may be associated with the development of MetS and CVD [60] and stimulation of the renin-angiotensin system (RAS) may play a vital role in neurohumoral pathway that promotes the development of MetS [61] .The 11.7% prevalence of DM in this study is higher than the 0.4% prevalence reported in Cote d'Ivoire [62] .The prevalence of DM, a syndrome with various linked sub-phenotypes such as mitochondrial disorders, lipodystrophies, and inflammatory disorders involving cytokines [63] is already recognized to increase the probability of developing metabolic syndrome [64] .Foremost phenotypes correlated with DM are dyslipidemias, notably hypertriglyceridemia and low HDL cholesterol levels.Both diabetes and dyslipidemia are strongly associated with increased risk for atherosclerotic vascular disease [63] .
Dyslipidemia, recognized as a global disease of epidemic proportion is also known as a major risk factor for cardiovascular disease with an enormous burden in terms of morbidity, mortality, and medical costs [32] .Atherosclerosis and cardiovascular disease (CVD) are the major health problems associated with dyslipidemia.These disorders are vascular problems associated with more than 17 million deaths worldwide in 2015, a rise of 12.5%t from 2005 onwards [65] .The prevalences of TC ≥200 mg/dL (60.6%),TG≥130 mg/dL (66.7%),HDL<40 mg/dL (43.0%) and LDL≥130 mg/dL (85.9%), in this study are higher than the 2.8%, 19.1%, 58.4% and 3.2% reported from Ethiopia [66] or the 12.1% 4.5%, 28.4% and 9.2% reported from a Ghana [46] .The most prominent dyslipidemia in this study was LDL, contrary to HDL reported in Ethiopia [66] , Ghana [46] and in another study in Nigeria [67] .In variance with another study in India, LDL was significantly higher among boys than girls in this study [68] .High concentration of LDL cholesterol are presently believed to be the primary risk factor for the emergence of atherosclerosis coronary heart disease (ASCHD), myocardial infarction (MI), and increased mortality.Raised LDL cholesterol levels (hypercholesterolemia) are relatively common in populations consuming a western diet and is associated with the development of atherosclerotic plaque (AP) [14] , leading to life-threatening myocardial infarction [69] .The precise pathophysiology of AP -local inflammation, LDL oxidation, macrophage activation, and necrotic core formation -has already been elucidated, though its molecular mechanisms are still unknown [68] .Hypertriglyceridemia is also an independent risk factor for CVD [70] which occurs through (i) abnormalities in hepatic VLDL production, and intestinal chylomicron synthesis (ii) Dysfunctional LPL-mediated lipolysis or (iii) Impaired remnant clearance.Liang et al [71] suggested that hypertriglyceridemia may intensify the risk of ischemic stroke by promoting not only atherosclerosis but also augmenting thrombosis and blood viscosity.On the contrary, hypertriglyceridemia may have been beneficial in patients who have already suffered a stroke [71] .Thus dyslipidemia, diabetic blood glucose and obesity are the triad for MetS and obesity on its own, is linked to non-alcoholic fatty liver disease (NAFLD), to abnormal lipid profiles and liver enzyme abnormalities [72] .The overall 43.0% prevalence of abnormally low HDL in this study is lower than the 61.2% reported from another Nigerian study [67] but higher than the 12.8% reported from Saudi Arabia [73] , and the 40.6% reported from Brazil [74] .The principal function of HDL, composed of cholesterol, triglycerides, and various apolipoproteins, is to transport cholesterol from the peripheral tissues to the liver, thus performing biodistribution of lipids [75] and in the process, scavenge excess cholesterol through reverse cholesterol transport (RCT) or exchange it with apoB particles (e.g., LDL) [76] for disposal.Its anti-atherogenic and anti-inflammatory properties serve in lowering the size of the plaque and its associated inflammation [77] .In this study, there was no significant variation in SBP or DBP (mm Hg) among those with and without dyslipidemia.However, SBP (mm Hg) was significantly higher among those in late compared to those in early adolescence and among overweight/obese subjects than among the lean subjects.The relationship between hypertension and dyslipidemia, obesity, as well as insulin resistance (MetS), further increases the overall cardiovascular risk of an individual.Although SBP is recognized as a risk factor that increases the chance of MetS, it was not associated with that condition in the adolescent population of this study.

Study limitations
There are some limitations in the study that need consideration.First, the study's main limitation is its relatively small sample size, which may restrict its ability to fully uncover the deteriorating metabolic conditions in this population.Blood pressures were measured with different measuring instruments in different adolescent stages, and this could have resulted in a bias.In the methodology, bias may have been introduced in the sample selection as the proportion of girls outweighed that of boys and some of the overweight or obese students may have been left out.
Also, the study was conducted in the southwestern area bordering the Atlantic ocean and not in the northern arid area or the mountainous middle area of the country.For this reason, the results may not be generalized or interpreted as national, requesting for a national study on dyslipidemia and MetS among secondary schools' adolescents.NHLBI guide for references of MetS in adults was used as a reference.While this may be justifiable due to lack of established cut-off values for adolescents, especially indigenous Black Africans, the application may result in an underestimation of the prevalence of central obesity in this population of study.In general, there is no agreed definition of MetS among adolescents globally and hardly any clinical guidelines or cut-off points for any of the variables for MetS among Black Africans.For this reason, the definitions, cut-off points and variables used for the identification of MetS in American and European literatures were used in this study.
Lastly, nutrition, dietary and physical exercise aspects of the participants have not been considered in this study though these play in MetS but will be considered in a future study.This study only focused on quantity of lipoproteins.As such, the quality and functionality of HDL or its dysfunctionality such as a lower apoA-I content, lower antioxidant ability, smaller size, and ambiguous shape were not considered.These will be addressed in a future study.

Conclusion and Recommendation
This study has documented the prevalence of dyslipidemia and that of MetS as 8.5% and 8.3% respectively among the adolescents in Lagos Nigeria.Findings from this study suggest that appropriate and satisfactory monitoring of lipid profile among adolescents in Nigeria is urgently needed.The elevated prevalence of lipid anomalies and MetS in the cohort of this study demands decisive lifestyle intervention approaches and policies for the prevention and control of significant cardiovascular and other risk factors.Health promotion, especially in regard to nutrition, diet and eating habits among adolescents should be an integral aspect of educational curriculum in Nigerian secondary schools.Governments at all levels and other service providers should not only frequently screen and instruct adolescents with diabetes and hypertension towards adopting healthy lifestyle but also male them recognize the eventual outcome of lipid abnormalities and their comorbidities in their adulthood.Decisionmakers should lay stronger emphasis on establishing and reinforcing the early detection and prevention of lipid abnormalities among adolescents in Nigeria.Hence, periodic fasting lipid profile screening for adolescents, especially secondary school students is recommended to be mandatory biennially during the students' tenure.This will enhance early detection and treatment and reduce the high burden of this underdiagnosed and undertreated disease.Results from this study would be useful contribution towards enhancing knowledge towards dyslipidemia and MetS and perhaps can be utilized for effective policies and programs implications and in proposing guidelines for the diagnosis of MetS in Nigerian and African children and adolescents.Finally, health care providers caring for youth should adopt effective treatment for those at highest risk.

Declaration of Competing Interest
The authors declare no competing interest.
Qeios, CC-BY 4.0 • Article, January 3, 2024 Qeios ID: S522VG.2 • https://doi.org/10.32388/S522VG.2 2/21 present descriptive, epidemiological study was conducted by the Department of Biochemistry and Nutrition of the Nigerian Institute of Medical Research.Primary data were collected from recruited secondary school students, aged 10-19 years in Lagos State, Nigeria.Recruitment into the study, which included 624 participants (241 boys and 383 girls) was from October 2019 to March 2020.Written informed consents were obtained from parents and each participating student gave verbal assent.The study protocol was approved by the Institutional Review Board of the Nigerian Institute of Medical Research (NIMR IRB (IRB/18/062)) and the study was conducted in accordance with the Declaration of Helsinki (2000).

Figure 1 .
Figure 1.Flowchart of recruitment of study participants

Figure 2 .
Figure 2. Box plot for lipid profiles by gender and stage of adolescence and BMI-for age percentile (Lean and Overweight/Obese) in Nigerian Secondary schools Mainland LGA with 100 secondary schools) SD, and 2 LGAs (Ojo with 247 and Mushin with 47 secondary schools.Using probability proportional to size (PPS), different arms of classes -Year 1, 2 and 3 of Junior Secondary School (JSS) (mainly aged 10-15 years) and Year 1, 2 and 3 of Senior Secondary School (SSS) (mainly age 16-19 years), since there were many arms in either JSS or SSS.Finally, systematic sampling technique was used to select students in selected arms of each class (Figure

Table 1 .
Anthropometric and clinical characteristics of the study subjects, 2020.

Table 3 .
Comparative analysis of presence or absence of dyslipidemia relative to gender, lean or overweight/obese and stage of adolescence of the study subjects.

Table 4 .
Specific risk factors for MetS and its prevalence as demarcated by the occurrence of known potential risk factors relative to gender, stage of adolescence and BMI-forage.

Table 5 .
Frequency distribution of risk factors for MetS relative to gender, BMI-for-age percentile, and stage of adolescence.

Table 6 .
Multivariate regression analysis with MetS 90 th percentile as dependent variable and key predictor variables for all subjects, all boys, and all girls respectively in the study.
For all the study subjects, five predictor variables -Fasting blood glucose, Total cholesterol, Triglyceride, High-density lipoprotein, and BMI-for-age percentile -significantly (P-value<0.00001)explain 25.5% of the variance in the outcome variable -MetS ≥90 th percentile.One unit change in MetS 95 th percentile is associated with decrease in age and increase in other predictor variables.