Because first graders are critical for excess weight gain, we assessed components of the metabolic syndrome (MetS) using the pediatric definition of the International Diabetes Federation (IDF). We compared four MetS components as defined by the IDF with age- and gender-specific components in 2228 first graders at the age of 6. The growth curves were derived from 22113 children and adolescents who participated in the PEP Family Heart Study. The aim was to determine in first graders precise values of waist circumference (WC), blood pressure (BP), triglycerides (TG), and HDL-Cholesterol (HDL-C) based on growth curves that were developed for a large German population of youths and to assess the prevalence in terms of both definitions at this critical age. The prevalence of high blood pressure for age was 13% compared with only 2% according to IDF. Because of this considerable divergence, we propose to define MetS components based on national growth curves. 1. Introduction There is still no universally accepted definition of the metabolic syndrome (MetS) in children and adolescents because of heterogeneous criteria as adult cut offs, ignoring the effects of growth, and lack of cut points for waist circumference (WC) and for lipid levels throughout youth [1]. The International Diabetes Federation (IDF) defined MetS criteria for children and adolescents limiting their full application to age from 10 to <16 years [2]. Since the prevalence of MetS in children varies widely, its single components should be recognized as early as possible [1]. Early school years between 1st grades and 3rd grades are critical for excess weight gain since children who have MetS do increase their risk of cardiovascular disease (CVD) in adulthood [3, 4]. Because the IDF does not recommend measuring MetS in children who are younger than 10 years old, our aim was to characterize four of the MetS components in terms of absolute values derived from age- and gender-specific growth curves in a large sample of 6-year old first graders. Furthermore, we compared the prevalence of four IDF components as age- and gender-specific values. 2. Subjects and Methods We investigated 2228 German first graders (1116 boys and 1112 girls, median age 6.0 years) who participated in yearly cross-sectional surveys (1994？2003) of the Prevention Education Program (PEP) Family Heart Study. Continuously trained research assistants measured WC, systolic (SBP) and diastolic (DBP) blood pressure, using an oscillometric BP-measuring device, fasting triglycerides (TG), and high-density-cholesterol (HDL-C) as previously
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