TNF and metabolic syndrome: Concerning our secondary aim to assess the endothelial functions and their surrogate markers of immune-inflammatory endpoints in the tested groups, we found that metabolic syndrome in pediatrics is characterized by a low grade inflammatory state and is associated with an increase in immune-inflammatory mediators; hs-CRP and cytokines; TNF-α, IL-6 and IL-23, markers that are progressively elevated with increased stage of hypertension.