2.1. Physical examination

All participants were physically examined. We measured their weight, height, and waist circumference (WC). To calculate the Body Mass Index (BMI) value we used the formula BMI= Weight (kg)/Height² (m) (54) and interpreted it by using the 2022 extended growth charts for BMI for age and sex (59). The waist-to-height ratio (WHR) was also calculated by using the formula WHR = WC (m)/Height (m) (60). WC values were interpreted by using the percentiles proposed by Zong et al. (54). Only children with a BMI > 95^th percentile and a WC > 90^th percentile were included in the study group. Tanner stages were determined for each participant (Tanner 1 represents pre-puberty; Tanner 2-4 represents puberty; Tanner 5 represents post-puberty) (61). The presence of acanthosis nigricans was noted (62). Post-pubertal girls were asked whether they had regular or irregular menses. Irregular menses were considered the menstrual cycles <21 or >35 days, or missing ≥ 3 menses in a row, in girls who had their menarche at least 2 years before (50).