Obesity and the Metabolic Syndrome in Children and Adolescents

To the Editor: Weiss et al. (June 3 issue) 1 report the prevalence of the metabolic syndrome in children and adolescents on the basis of their findings with the use of specific markers. Hepatic manifestations of the metabolic syndrome include nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. 2 , 3 A valuable biomarker for both of these disorders is an elevated alanine aminotransferase level. 4 We conducted a study involving 37 overweight children (body-mass index [BMI] z score, 1.5 to 2.0) and 145 obese children (BMI z score, greater than 2.0) who were otherwise healthy to investigate the prevalence of elevated levels of liver . . .