International Journal of Pediatrics F 2.508 3.294 1.968 6.317 6.275 3.976 3.139 0.930 0.514 2.492 2.938 4.085 P .066 .025 .125 <.0001 <.0001 .010 .029 .431 .674 .065 .038 <.001 VO2Max: 0.048 Age: 0.017 Age: 0.026 VO2Max: 0.034 Age: 0.039 %FM: 0.018 %FM: 0.045 4 Systolic BP Diastolic BP Fasting Glucose Fasting Insulin HOMA-IR Triglycerides HDL Cholesterol LDL Cholesterol AST ALT Fibrinogen Sedimentation rate F 1.938 0.201 1.476 5.683 4.530 2.384 1.055 0.846 1.051 3.829 4.21 4.077 P .129 .896 .226 .001 .005 .073 .371 .472 .373 .012 .008 .009 VO2Max: 0.002 VO2Max: 0.001 VO2Max: 0.073 Age: 0.040 % FM: 0.007 Table 3: Multivariate regression between metabolic risk factors and VO2Max, using age and % fat mass as covariates. Girls Boys Tanner stage did not signiﬁcantly enter in any model tested. The increase in liver transaminases is associated to other components of MS, particularly to insulin resistance [15, 16, 33, 36]; the precise relationship between fatty liver and MS is not precisely known but is likely to also involve insulin resistance [37, 38]; in addition, the present study shows that it is under regulation of CRF, such as other risk factors [38]. So far, no speciﬁc treatment of nonalcoholic fatty disease has been proposed [39]; it is known that weight loss improves liver dysfunction [32, 33]; the present observation suggests that lifestyle interventions aimed at enhancing CRF should also be eﬃcient in improving liver parameters. 5. Conclusions CRF is one of the parameters associated with individual metabolic risk factors in young overweight subjects, together with age and percentage of fat mass. As expected, the main relationship was found with insulin resistance. CRF was also associated with other variables often associated with metabolic risk of obesity, that is, transaminases and inﬂammation. The relationships diﬀered between boys and girls and were not inﬂuenced by their pubertal stage. They were observed from young age and increased continuously with the factors studied. This supports the need to treat overweight as soon as it is detected; improving CRF is one of the ways which could be used to prevent the complications of obesity. References [1] S. R. Daniels, D. K. Arnett, R. H. Eckel et al., “Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment,” Circulation, vol. 111, no. 15, pp. 1999–2012, 2005. [2] E. Mimoun, Y. Aggoun, M. Pousset et al., “Association of arterial stiﬀness and endothelial dysfunction with metabolic syndrome in obese children,” Journal of Pediatrics, vol. 153, no. 1, pp. 65–70, 2008. [3] R. M. Steele, S. Brage, K. Corder, N. J. Wareham, and U. Ekelund, “Physical activity, cardiorespiratory ﬁtness, and the metabolic syndrome in youth,” Journal of Applied Physiology, vol. 105, no. 1, pp. 342–351, 2008. [4] B. Fernhall and S. Agiovlasitis, “Arterial function in youth: window into cardiovascular risk,” Journal of Applied Physiol- ogy, vol. 105, no. 1, pp. 325–333, 2008. [5] G. D. C. Ball, G. Q. Shaibi, M. L. Cruz, M. P. Watkins, M. J. Weigensberg, and M. I. Goran, “Insulin sensitivity, cardiorespiratory ﬁtness, and physical activity in overweight hispanic youth,” Obesity Research, vol. 12, no. 1, pp. 77–85, 2004. [6] C. Bouziotas, Y. Koutedakis, A. Nevill et al., “Greek adoles- cents, ﬁtness, fatness, fat intake, activity, and coronary heart disease risk,” Archives of Disease in Childhood, vol. 89, no. 1, pp. 41–44, 2004. [7] G. Imperatore, Y. J. Cheng, D. E. Williams, J. Fulton, and E. W. Gregg, “Physical activity, cardiovascular ﬁtness, and insulin sensitivity among U.S. adolescents: the National Health and Nutrition Examination Survey, 1999–2002,” Diabetes Care, vol. 29, no. 7, pp. 1567–1572, 2006. [8] U. Ekelund, S. Anderssen, L. B. Andersen et al., “Prevalence and correlates of the metabolic syndrome in a population- based sample of European youth,” American Journal of Clinical Nutrition, vol. 89, no. 1, pp. 90–96, 2009. [9] J. R. Ruiz, N. S. Rizzo, F. B. Ortega, H. M. Loit, T. Veidebaum, and M. Sjo¨stro¨m, “Markers of insulin resistance are associated with fatness and ﬁtness in school-aged children: the European Youth Heart Study,” Diabetologia, vol. 50, no. 7, pp. 1401– 1408, 2007. [10] K. To¨ro¨k, Z. Szele´nyi, J. Po´ rsza´sz, and D. Molna´r, “Low physical performance in obese adolescent boys with metabolic syndrome,” International Journal of Obesity and Related Metabolic Disorders, vol. 25, no. 7, pp. 966–970, 2001. [11] G. Q. Shaibi, G. D. C. Ball, M. L. Cruz, M. J. Weigensberg, G. J. Salem, and M. I. Goran, “Cardiovascular ﬁtness and physical activity in children with and without impaired glucose tolerance,” International Journal of Obesity, vol. 30, no. 1, pp. 45–49, 2006. [12] K. D. DuBose, J. C. Eisenmann, and J. E. Donnelly, “Aerobic ﬁtness attenuates the metabolic syndrome score in normal- weight, at-risk-for-overweight, and overweight children,” Pediatrics, vol. 120, no. 5, pp. e1262–e1268, 2007.