Diagnosis
6
Prehypertension
and hypertension
3–11 y: (standardized according to sex, age, and height percentile)
• BP >90th percentile to <95th percentile = prehypertension
• BP ≥95th percentile to <99th percentile + 5 mm Hg = stage 1
HTN
• BP ≥99th percentile + 5 mm Hg = stage 2 HTN
12–17 y: (standardized according to sex, age, and height
percentile)
• BP of >90th percentile to <95th percentile or >120/80 =
prehypertension
• BP ≥95th percentile to <99th percentile + 5 mm Hg = stage 1
HTN
• BP ≥99th percentile + 5 mm Hg = stage 2 HTN
18–21 y:
• BP ≥120/80 to 139/89 mm Hg = prehypertension
• BP ≥140/90 to 159/99 mm Hg = stage 1 HTN
• BP ≥160/100 to 179/109 mm Hg = stage 2 HTN
• BP >180/110 mm Hg = stage 3 HTN
NAFLD • ALT >25 U/L (boys) and >22 U/L (girls)
PCOS • Free and total testosterone and SHBG, per Endocrine Society
PCOS guidelines
c
Obstructive sleep
apnea
• If positive history, refer to pulmonary for nocturnal
polysomnography and, if not available, overnight oximetry
Psychiatric • If positive history, refer to mental health specialist
a
e test should be performed in a laboratory using a method that is NGSP certified and
standardized to the DCCT assay.
b
In the absence of unequivocal hyperglycemia, should be confirmed by repeat testing.
c
Given variability in testosterone levels and the poor standardization of assays, it is difficult
to define an absolute level that is diagnostic of PCOS or other causes of hyperandrogenism
(familiarity with local assays recommended). e preferred assay is HPLC tandem mass
spectroscopy.
Derived from (a) American Diabetes Association. Diabetes Care 2014;37(Suppl 1):S14–S80; (b)
Expert Panel. Pediatrics 2011;128(Suppl 5): S213–S256; (c) Schwimmer JB et al. Gastroenterolog y
2010;138:1357–1364. e1–2; (d) Legro RS et al. J Clin Endocrinol Metab. 2013;98:4565–4592;
(e) Wise MS et al. Sleep 2011;34:389–398; (f )Zametkin AJ. J Am Acad Child Adolesc Psychiatry
2004;43:134–150.
Table 2. Screening for Comorbidities of Pediatric
Overweight or Obesity (cont'd)
Comorbidity
Tests and Interpretation
(To convert mg/dL to mmol/L, multiply by 0.0555 for glucose,
0.0259 for cholesterol, and 0.0113 for triglycerides.)
