To assess :

Compare predictive value of waist to-height ratio and bio-electrical impedance analysis versus BMI in early detection of metabolic syndrome parameters and complication of obesity.

Childhood Obesity is defined as a body mass index (BMI) above the 95th percentile for sex and age.It is Labelled as a national epidemic and affects one in three adults and one in six children in the United States of America.Worldwide several countries have witnessed a double or triple escalation in the prevalence of obesity in the last three decades probably due to urbanization, sedentary lifestyle, and increase consumption of high-Calorie processed food.Based upon the World Population Review 2020, Egypt ranked as the highest 19th country in the world and the 7th highest country in the Arab region, with a 32% obesity rate. In Qena government study was conducted on 1000 students were chosen randomly from all grades of primary schools the overall prevalence of obesity and Overweight was 13.9% and 16.2% respectively. Girls were more obese than boys.

The alarming increase in childhood obesity foreshows a tremendous burden of chronic disease prevention in the future public healthcare systems worldwide. Obesity prevention is a critical factor in controlling Obesity-related Non-communicable diseases (OR-NCDs), including insulin resistance/ metabolic syndrome, coronary artery Disease ,cancer and psychological problems.

Metabolic syndrome is a clustering of abdominal obesity-associated factors including elevated waist Circumference(WC), elevated blood pressure (BP), elevated glucose, elevated triglycerides (TGs) or reduced high-Density lipoprotein cholesterol (HDL-C).two key components of metabolic syndrome glucose and triglycerides are overproduced by the fatty liver. So liver is therefore a key determinant of metabolic abnormalities and prevalence of both metabolic syndrome and Non-alcoholic fatty liver (NAFLD) increases with obesity.

There are various diagnostic methods for metabolic syndrome in children and adolescents. Based on the world Health organization(WHO) criteria it diagnosed when three or more of the following features are found: body Mass index (BMI):>95th percentile, hyperinsulinemia or impaired fasting glucose or impaired glucose tolerance, BP>95th percentile, triglycerides (TG)>105/136 mg/dL (1.2/1.5 mmol/L) for children aged<10 and>10 years Respectively ,high density lipoprotein (HDL)-C<35 mg/dL (0.9 mmol/L).

While BMI is a simple measure calculated by dividing the body weight by the squared height, it does not fully Reflect adiposity or body composition. So a better anthropometric measures than BMI to screen for central obesity are needed. . Among the anthropometric measures used to evaluate adiposity, the waist circumference and waist-To-height ratio (WHtR) can be easily measured in clinical settings and can act as an indicator of central obesity and cardio metabolic risk.

In this study we will Compare predictive value of waist to-height ratio and bio-electrical impedance analysis versus BMI in early detection of metabolic syndrome.

Inclusion Criteria:

• Obese children (Body mass index >95th percentile) aged 6-12 years old

Exclusion Criteria:

Patient who aged <6 or>12 years Presence of chronic illness (diabetes, asthma, endocrine disease) Presence of obesity as a part of genetic syndrome Presence of history of long term drug intake (corticosteroids )

Obese children (Body mass index >95th percentile) aged 6-12 years old