Because no universally accepted definition of the MetS exists for adolescents, the definition proposed by Cook et al. [15] was used. The MetS was defined as 3 or more of the following: Fasting TGs ≥ 110 mg/dl; HDL-C < 40 mg/dl; WC ≥ 90th percentile for age and sex, according to national reference curves [16]; systolic blood pressure and/or diastolic blood pressure ≥ 90th percentile for sex, age, and height, based on the recommended cut-off points of the National Heart, Lung, and Blood Institute [17] and for fasting blood glucose ≥ 100 mg/dl, according to recent recommendations of the American Diabetes Association [18].

Type 2 diabetes was defined according to criteria of the American Diabetes Association criteria. Participants aged ≥ 20 years old, who met at least one of these criteria were considered as having T2DM: FPG ≥ 126 mg/dl, 2-h PCPG ≥ 200 mg/dl or taking anti‐diabetic medication [19]. However, for participants aged < 20 years, T2DM was defined as FPG ≥ 126 mg/dl or taking anti‐diabetic medication.

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