A cross sectional study with healthy obese adolescents aged 13 until 18 years old were conducted during October 2019 to January 2020. Obesity was determined based on body mass index (BMI) for age based on gender \> percentile 95th of CDC growth chart 2000.
Body weight was measured using Seca Robusta 813 digital scale in standing position, by stepping on the scale. While Body height was measured using Seca 206 Body Meter. Height was measured from the vertex of the head to the heel in standing position. Waist circumference and hip circumference were measured using Seca 201 measuring tape. Waist circumference was measured by wrapping the measuring tape around the subject's stomach, at the midpoint between the lowest rib and the endpoint of the iliac crest upon expiration, in line with the navel. Hip circumference was measured by asking the subjects to keep the feet together, then wrapping the measuring tape around the widest part of hips, at the point of the greatest gluteal protuberance. The subjects were measured using light cloth without food wear and other accessories such as belt, hat, or hair accessories, etc.
Blood pressure was measure using Omron Automatic Blood Pressure Monitor HEM-8712 (Omron Health Care Co., Ltd, Japan) by placing the cuff on the right arm, then pull and tighten it according to the size if the arm. After it was installed correctly (fasten and did not move), the power button on the digital tension tool was pressed, and then the microprocessor started to drive air pressure into the cuff, and then the value of blood pressures will appear in the manometer tube column.
Metabolic syndrome criteria were determined using The International Diabetic Federation criteria18:
1. For adolescent aged 10-16 years old: if there was a central obesity (waist circumference \> 90th percentile based on WHO waist circumference table. For boys at the circumference of \> 88 cm, and ≥ 85 cm for girls) accompanied with at least 2 other signs below:
* Blood pressure \> 90th percentile (systole ≥130/diastole ≥ 85 mmHg).
* Hypertriglyceridemia, if the triglyceride levels \> 110 mg/dl.
* Low level HDL-c, if the HDL-c levels \< 40 mg/dl, and \< 50 mg/dl for girls.
* Hyperglycaemia, if fasting blood glucose (FBG) levels was \> 110 mg/dl.
2. For adolescent aged more than 16 years old: if there was a central obesity (waist circumference \> 90th percentile based on WHO waist circumference table. For boys at the circumference of \> 94 cm, and ≥ 80 cm for girls) accompanied with at least 2 other signs below:
* Blood pressure \> 90th percentile (systole ≥130/diastole ≥ 85 mmHg).
* Hypertriglyceridemia, if the triglyceride levels ≥ 150 mg/dl.
* Low level HDL-c, if the HDL-c levels \<40 mg/dl for boys, and \< 50 mg/dl for girls.
* Hyperglycaemia, if fasting blood glucose (FBG) levels was ≥ 100 mg/dl19. Blood samples were withdrawn via vena cubitus as much as 5 ml by the trained analysts, and placed on vacutainer with EDTA. After that, the vacutainer was replaced in icebox to transport to the laboratory. Blood analysis include: lipid profile, fasting blood glucose, fasting insulin and adiponectin using the ELISA method in the laboratory. Intercellular Adhesion Molecule-1 (ICAM-1) was analyzed using Human intercellular adhesion molecule 1 Elisa kit (Bioassay Technology Laboratory). while sVCAM-1 was analysed using Human vascular cell adhesion molecule-1 Elisa kit (Bioassay Technology Laboratory).
Statistical analysis conducted were test of normality and homogeneity test, Anova/ Kruskal-Wallis, Independent sample T-test/Mann-Whitney U test, and Spearman correlation, and determined as significant if p value\<0.05.
