However, the risk of metabolic syndrome in sumo athletes during childhood is unclear. The prevalence of dyslipidemia and hypertension is significantly higher among sumo wrestlers compared with healthy male individuals in the general population13. Weight is correlated with health problems. Given the long span of positive energy balance, high energy intake may lead to the accumulation of visceral fat and metabolic syndrome despite high energy expenditure. Sumo wrestlers have a high resting energy expenditure because of large organ and tissue masses hence, to compensate for their large body size, their energy intake is more than their energy expenditure. Professional adult sumo wrestlers are a unique group of athletes because they have high physical activity levels despite being overweight however, they are at risk for hypertension, hyperlipidemia, and glucose intolerance because of obesity. However, sumo wrestlers follow a diet to increase the body size from childhood, putting them at risk for lifestyle-related diseases such as type 2 diabetes mellitus and dyslipidemia. Thus, bodybuilding is directly linked to the prevention of trauma and improved performance. Moreover, these athletes require body fat to cushion the impact of tackling and to prevent trauma. It is advantageous to have heavy body weight to increase the difficulty of being pushed out of the circle. Sumo wrestling, a competitive sport performed in an circle of 4.55 m diameter, has been practiced in Japan since ancient times. According to Oguri et al., compared with children who do not exercise, children who exercise continuously have a significantly lower risk of metabolic syndrome and lower visceral fat even if they are obese, which indicates the effectiveness of exercise. In particular, exercise habits are strongly correlated with metabolic syndrome. In addition to promoting lipolysis, exercise is associated with improved insulin sensitivity, improved cardiopulmonary function, decreased risk of NAFLD, and improved chronic inflammatory status. Therefore, it is important to address the problem of pediatric obesity from an early stage hence, preventive measures against lifestyle-related diseases are being undertaken during health checkups. In addition, pediatric obesity is a risk factor for metabolic syndrome and other health problems such as hypertension, type 2 diabetes mellitus, non-alcoholic fatty liver disease (NAFLD), dyslipidemia, and accelerated atherosclerosis. Pediatric obesity has a high probability of transitioning to adult obesity. Although the total number of children with obesity has decreased since 2006 because of obesity prevention measures, children with obesity constitute approximately 10% of the pediatric population and the percentage of children with high obesity rate has not decreased. In Japan, the incidence of pediatric obesity increased two–three times within 30 years until 2000. The World Health Organization estimated that the global incidence of pediatric obesity is expected to increase from 42 million cases in 2013 to 70 million cases by 2025. Pediatric obesity has become a global public health problem because of its increasing prevalence.
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