Table 3 Clinical-based and biochemical screening for cardiometabolic risk factors or comorbidities associated to cardiometabolic risk in children and adolescents with obesity and the relative screening frequency according to age

HTN

Blood pressure from age 3 years

Blood pressure

At every clinic visit

Dyslipidemia

Fasting lipids from age 2 years in presence of familial or medical conditions at risk of cardiovascular disease

Fasting lipids

• After 3 years

(if negative)

• More frequently if rapid weight gain or development of other cardiometabolic comorbidities

• Every 6–12 months (if abnormal)

Prediabetes,

T2D

-

Fasting glucose and HbA1c;

OGTT and HbA1c in presence of pubertal onset plus additional risk factors*

OGTT and HbA1c in presence of additional risk factors*

• After 3 years (if negative)

• More frequently if rapid weight gain or development of other cardiometabolic comorbidities

• Fasting glucose and HbA1c every 3 months (if prediabetes)

MASLD

-

Liver ultrasonography in presence of elevated serum ALT or other CMRFs

• ALT every 2 years (if negative)

• More frequently if rapid weight gain or

development of other cardiometabolic comorbidities

• 3–6 months (if abnormal) to confirm results and guide subsequent laboratory testing

• Ultrasonography every 12 months (steatosis)

PCOS

-

-

Hormonal assessment in presence of persistent irregular menstrual cycles and clinical and/or biochemical signs of hyperandrogenism**

Clinical-based screening at every clinic visit starting 2 years after menarche

OSA

Pediatric Sleep Questionnaire in the presence of suggestive symptoms (snoring, disturbed sleep, daytime sleepiness, headache, attention deficit, hyperactivity)

Diagnosis confirmed by polysomnography

Clinical-based screening at every clinic visit

Physical inactivity

Questionnaire on physical activity/ sedentary time

At every clinic visit

Left ventricular hypertrophy

-

Echocardiography in presence of confirmed HTN

6–12 months if persistent HTN despite treatment, or signs of target organ damage

Preclinical atherosclerosis

-

Carotid–radial pulse wave velocity, flow-mediated dilation and cIMT measurements are not indicated in clinical practice

Not indicated

Kidney disease

-

Microalbuminuria and sCr

• Annually (if negative)

• Semi-annually in presence of microalbuminuria or abnormal values of SCr

• Every 3–6 months in presence of other comorbidities (HTN, prediabetes/T2D, or PCOS)