## 4 Discussion
This is further proof that once installed, dyslipidemia increases the progress of atherosclerosis, which can be detected early enough to evaluate the cardiovascular risk and aid the medical effort to avoid cardiovascular complications [74]. Triglyceride levels are influenced primarily by dietary habits and in part by physical activity [75]. As obese children have problems with both aspects, it is not a surprise that obese children present higher levels of TG [76]. Fasting triglycerides levels \(>\)150 mg/dL are known to represent a biomarker for cardiovascular risk [77]. Nevertheless, specific roles of TG are still controversial because there is significant personal variability involved in serum levels of TG compared to other more stable parameters like HDL-c [77]. Many studies have shown that TG levels are not directly involved in the increase of CIMT [78; 79]. However, other studies suggest that serum TG's importance in estimating atherosclerotic risk is undervalued and that the lack of consistency in showing a connection could be derived from the fact that TG levels have great variability from one day to another [80]. Some studies have shown discreet correlations of TG levels to CIMT, and, even more specifically, through remnant triglyceride-rich lipoproteins associated with fatty meals [81]. As essential as fats are for human health, the modern diet of both children and adults disregards the ideal proportions of polyunsaturated fatty acids (PUFAs). This imbalance is an aggravating factor for vascular damage. Moreover, genetic variations in children with obesity may influence the metabolism of PUFAs, and the intake requirements for a healthy cardiovascular profile may therefore vary [82; 83]. Our findings support these data: We detected significant correlations between TG levels and CIMT in both obese and overweight children (Table 8, Figure 10a,b). Although mean values were not surprisingly high, we did detect an association of higher TG with higher BMI and sedentary behavior. More data should be assessed in larger groups of obese children and a comparison between fasting TG and postprandial TG levels would be highly recommended. Moreover, non-HDL cholesterol has proven to be an important tool in assessing atherosclerotic risk, as well [84]. Furthermore, a recent longitudinal study has shown that pathological levels of non-HDL-c in youths over 15 years old correlate to high CIMT in adulthood. Its predictive value for high adult CIMT was similar to LDL-c's. It has also been shown that through preventive actions, the effects of youth dyslipidemia can be attenuated if serum lipids are normalized by adulthood [85]. Total cholesterol/HDL-c ratio is one of the better predictors of ischemic coronary events. Its ability to do so is given by the cluster of metabolic disturbances present in individuals with abdominal obesity, insulin resistance, and dyslipidemia; therefore, its prediction value is even more powerful in individuals who have them all [86]. Triglyceride/HDL-c ratio could be a better predictor for cardiometabolic risk and insulin resistance in children than metabolic syndrome status [42; 44; 87]. Our findings showed correlations between CIMT values and non-HDL-c, TC/HDL-c ratio, and TG/HDL-c ratio, and their correlation strengths grew as weight severity based on BMI grew (Table 8, Figure 11). The mean values for these three parameters were influenced by weight excess (Table 9). Over half of the subjects in all three groups presented values higher than ideal for all three parameters, especially in the case of TG/HDL-c ratio (Table 9). Childhood obesity disturbs glucose-insulin metabolism as well, and one of the earliest signs is the impairment of fasting glucose, which highly predicts type 2 diabetes mellitus [88; 89]. However, the problem with impaired fasting glucose (IGF) as a factor for risk evaluation is that it varies substantially between different regions and ethnicities. For instance, IGF in Swedish and American obese children is considerably higher than in central European obese children [90].