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We obtained informed consent from their guardians after explaining the procedure and purpose of the test thoroughly, and the study was approved by the Institutional Review Board of Ewha Womans University. Diagnosis of metabolic syndrome The diagnosis of MS was based on modified Cook's definitions (Table 1). In our study, the cut off value of fasting glucose was 100 mg/dL. MS was defined as having more than three components for their age and gender of the following metabolic abnormalities: abdominal obesity, [waist circumference (WC) �� 90 percentile], hypertriglyceridemia [serum triglyceride �� 110 (mg/dL)], low high density lipoprotein-cholesterol (HDL-C click here adolescents Anthropometric measurement We obtained anthropometric data of weight, height, WC, BMI, fat mass, and fat % from both groups. WC was measured with a tapeline at the mid-waist point between the lowest margin of the 12th rib and the mid portion of the superior iliac crest at minimal respiration. BMI was calculated by dividing the body weight in kilograms by height in meters. Fat mass and fat % were estimated by bioelectric impedance analysis (InBody 720, Biospace Co., Ltd., Seoul, Korea). Blood pressure was measured using an automatic oscillometric method, Dinamap, Procare-200 (GE Medical System, Milwaukee, WI, USA) in a supine position after 10 minutes of adequate rest. Laboratory measurement Blood was drawn from check details all 91 adolescents, who had fasted for 14 hours prior to their blood sampling to determine the following parameters: blood glucose, total cholesterol (TC), HDL-C, low density lipoprotein-cholesterol (LDL-C), triglyceride (TG), aspartate aminotransferase, alanine aminotransferase (ALT). And, high sensitive C-reactive protein was also estimated. Insulin resistance was measured by the homeostasis model binedaline assessment of insulin resistance (HOMA-IR), which was calculated by dividing the multiple of insulin (?U/mL) and serum glucose (mmol/L). Echocardiographic parameters Echocardiography was performed using the IE33 machine (Philips Medical System, Andover, MA, USA) with an S5-1 transducer. Standard parasternal and apical views were acquired. Complete two-dimensional (2D) and M-mode echocardiogram, pulsed, color-flow Doppler, and TDI (Fig. 1) were obtained in the left lateral decubitus position. We measured the following LV parameters by M-mode echocardiography: interventricular septal wall thickness, posterior wall thickness, and LV end diastolic dimension at the chordae tendina level. The LV mass (LVM) and LV mass index (LVMI) were calculated. Ejection fraction (EF) was determined by using the biplane Simpson formula and fractional shortening was calculated using LV internal dimensions. Fig.