• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.2
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• pp.150-159
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• 2008

Purpose: To assess the relationship between lifestyle and metabolic syndrome in obese children and adolescents. Methods: We retrospectively reviewed the medical records and laboratory results of 109 subjects (7~15 years of age) who visited our pediatric obesity clinic between January 2004 and December 2007. They completed the parent- and self-report questionnaire developed by the Committee on Nutrition of the Korean Pediatric Society to assess lifestyle. The metabolic syndrome was defined as having 3 or more of the following metabolic risk factors: obesity, hypertension, serum triglycerides ${\geq}$110 mg/dL, HDL-cholesterol ${\leq}$40 mg/dL, fasting glucose ${\geq}$110 mg/dL, and insulin ${\geq}20{\mu}IU/mL$. Results: All subjects had at least 1 risk factor (obesity). Sixty-three percent of subjects had 2 or more risk factors, 32% of subjects had 3 or more risk factors, and 10% had 4 or more metabolic risk factors. Hypertriglyceridemia (36%), hypertension (32%), hyperinsulinemia (24%), and HDL-hypocholesterolemia (20%) were observed. Fasting blood glucose levels were normal in all subjects. Hypertension was significantly associated with an unbalanced diet and hyperinsulinemia was significantly associated with parental obesity (p<0.05). Those who ate after 8 PM were at a risk of hypertension (odds ratio, 2.5; 95% CI, 1.0~6.1). Those who did not have a preference for exercise were at a risk of hyperinsulinemia (odds ratio, 10.4; 95% CI, 2~54.1). Those who watched TV for ${\geq}$3 hours/day were at a risk of metabolic syndrome (odds ratio, 4.8; 95% CI, 1.2∼18.8). Conclusion: Lifestyle, such as eating late, no preference for exercise, and TV watching ${\geq}$3 hours/day, were related to metabolic syndrome in obese children and adolescents.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.2
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• pp.160-168
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• 2008

Purpose: This study was designed to characterize the nutritional status and assess obesity to determine the relationship between obesity and serum lipid profiles in 6~7 year old children. Methods: In 2007, we surveyed 483 children (233 boys and 250 girls) aged 6~7 years. The total cholesterol, triglyceride levels and HDL-cholesterol were measured in the fasting state. Dietary information was obtained by a questionnaire. Results: The prevalence of obesity was 9.9%. There was no significant difference between genders. The mean caloric intake was 1,781 kcal in boys and 1,640 kcal in girls. The prevalence of excessive calories was 33% in boys and 30% in girls. The prevalence of a total cholesterol ${\geq}$200 mg/dL was 8.4%, TG ${\geq}$130 mg/dL was 5.0%, LDL-cholesterol ${\geq}$130 mg/dL was 3.1%, and HDL-cholesterol <35 mg/dL was 4.4%. The prevalence of hypertension was 2.1%. There was no significant difference between genders. The systolic blood pressure, triglyceride levels and LDL-cholesterol were significantly related to an increased obesity index (p<0.05). The mean caloric intake and nutritive component were not related to the obesity index. The obesity group was compared to the control group: for triglycerides ${\geq}$130 mg/dL the odds ratio was 4.08; for LDL-cholesterol ${\geq}$130 mg the odds ratio was 2.85; for a TC/HDL-cholesterol ${\geq}$4.0 the odds ratio was 1.16. The BMI and triglyceride levels in the group with hypertension were higher than control group (p<0.05). There were significant positive correlations between the BMI and blood pressure as well as the LDL-cholesterol and triglycerides (p<0.05). The BMI was not correlated with the mean caloric intake or nutrition. Conclusion: The prevalence of hypertension and hyperlipidemia in 6~7 year old children was significantly related to an increased obesity index. The management of obesity in 6~7 year old children should include a reduction in the risk for hyperlipidemia and hypertension.

• Clinical and Experimental Pediatrics
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• v.49 no.7
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• pp.757-762
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• 2006

Purpose : Pneumonia is one of the most common infections in children who visit emergency departments(ED), but standard clinical guidelines for children with pneumonia in Korea have not been studied. This study was performed to collect and evaluate a data-base of children with pneumonia for establishing clinical guidelines in ED. Methods : This study reviewed 304 children who were diagnosed and treated for pneumonia in the ED at one tertiary hospital between January 2003 and December 2003 retrospectively by reviewing the charts and analyzing the clinical characteristics, laboratory findings, and radiologic findings between an admission group and a discharge group. Results : The 2 year-5 year age group was the top of age distribution and the peak incidence of monthly distribution was December. Two hundred forty seven(81.3 percent) children were hospitalized(admission group), and the mean length of hospitalization was $7.24{\pm}3.24$ days. The most common indications of admission were fever, tachypnea and an age of less than three months. There was statistical differences in the outpatient department follow-up between the two groups(85.8 percent in admission group vs 35.1 percent in discharge group). Conclusion : More prospective studies are needed to establish clinical standard guidelines for children with pneumonia. This will be helpful in ED management and will aid the prevention of pneumonia.

• Clinical and Experimental Pediatrics
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• v.45 no.12
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• pp.1484-1490
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• 2002

Purpose : The purpose of this study was to look at prevalences of abnormal serum aminotransferase levels and abnormal serum total cholesterol levels among adolescents with obesity in Seoul area. Methods : Body mass index[$BMI(kg/m^2)$], serum aspartate aminotransferase(AST) alanine aminotransferase( ALT), and total cholesterol levels were measured in 26,876 adolescents(male : 13,287, female : 13,589) of first grade of high school in Seoul between the ages of 15 and 16 years, enrolled in a large health examination survey by Seoul School Health Center(SSHC) in 2001. Obesity was defined as BMI more than 95th percentile for age and sex and normal weight was defined as BMI between 25th percentile and 75th percentile for age and sex. Abnormal levels of AST, ALT and total cholesterol were defined as more than 95th percentile for age and sex. Results : The BMI at 95th percentile was 28.7 in males and 26.9 in females. The prevalence of abnormal AST levels was higher in obesity group than in normal weight group. In males, those were 23.7% and 3.7%, respectively(P<0.01, $x^2-value$ : 529.2). In females, those were 11.8% and 4.9 %, respectively(P<0.01, $x^2-value$ : 56.3). The prevalence of abnormal ALT levels was significantly higher in the obesity group compared with the normal weight group. In males, those were 33.9% and 1.7%, respectively(P<0.01, $x^2-value$ : 1,693.4). In females, those were 22.3% and 3.9%, repectively(P<0.01, $x^2-value$ : 397.6). The prevalence of abnormal total cholesterol levels was higher in the obesity group than in the normal weight group. In males, those were 16.8% and 3.5%, respectively(P<0.01, $x^2-value$ : 268.3). In females, those were 9.0% and 5.4%, respectively(P<0.01, $x^2-value$ : 14.2). Conclusion : This study revealed that the prevalences of abnormal AST, ALT and total cholesterol level were higher in the obese group than in the normal weight group.

• Journal of radiological science and technology
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• v.30 no.3
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• pp.213-219
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• 2007

The purpose of this study is to evaluate shielding effect of radiation protector for interventional radiologists in procedures by measuring inside and outside of radiation protector. In this study, we measured the radiation dose of 4 interventional radiologists during TACE and PTBD procedure for 4 month(2005.05-2005.09). Absorbed dose were measured by TLD placed underneath and over radiation protector such as Goggle, Thyroid protector, Apron and placed on the 4th finger of Hand. In addition, we measured background radiation dose in the control room using TLD. During TACE procedure, using 0.07 mmPb Goggle decreased average 53.8% of radiation dose rate in continuous fluoroscopic mode and decreased average 77.6% of radiation dose rate in pulse fluoroscopic mode. Using 0.5 mmPb Thyroid protector decreased average 88.9% of radiation dose rate in continuous fluoroscopic mode and decreased average 92.8% in pulse fluoroscopic mode. During PTBD procedure, using 0.07 mmPb Goggle decreased radiation dose rate average 62.7%, 87.9% by 0.5 mmPb Thyroid protector, 90.5% by 0.5 mmPb Apron. The average fluoroscopic time of PTBD was 6.14 min. shorter than TACE procedure, but radiation exposure dose rate of PTBD was 3 times higher in total body dose, and 40 times higher in hand dose rate than TACE. Interventional radiologists must wear thicker protector recommended over 0.5 mmPb. Also, they must use lead Goggle during interventional procedure. Abdomen dose decreased average 38.4% by drawing a lead curtain under the patient's table, therefore, they must draw a lead curtain to shield scattering ray. Radiation exposure dose decreased average 59.0% by using pulse fluoroscopic mode. So radiologists would better use pulse fluoroscopic mode than continuous fluoroscopic mode to decrease exposure dose.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.8 no.1
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• pp.41-48
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• 2005

Purpose: Non-A, B, C viral hepatitis is the name given to the disease with clinical viral hepatitis, but in which serologic evidence of A, B, C hepatitis has not been found. Little is known about the etiology and clinical features of non-A, B, C viral hepatitis in children. Methods: A clinical analysis of 45 cases with non-A, B, C viral hepatitis who were admitted to the Department of Pediatrics, Pusan National University Hospital, from January 2001 to June 2004 was carried out retrospectively. Patients who were positive for HBsAg, anti-HAV and anti-HCV and had toxic, metabolic, autoimmune, or neonatal hepatitis were excluded in this study. Results: Among 45 cases of non-A, B, C viral hepatitis, the etiology was unknown in 26 (57.8%), CMV (cytomegalovirus) in 14 (31.1%), EBV (Epstein Barr virus) in 2 (4.4%), HSV (herpes simplex virus) in 2 (4.4%) and RV (rubella virus) in 1 (2.2%). Twenty seven out of 45 (60.0%) patients were under 1 year of age. Sixteen (33.3%) patients had no specific clinical symptoms and were diagnosed incidentally. On physical examination, twenty seven out of 45 patients (60.0%) had no abnormal findings. Forty three out of 45 patients (95.6%) showed classic clinical course of acute viral hepatitis, whereas fulminant hepatitis developed in two patients. Mean serum ALT (alanine aminotransferase) level was $448.7{\pm}771.9IU/L$. Serum ALT level was normalized in 31 out of 45 patients (81.6%) within 6 months and all patients within 18 months. Aplastic anemia was complicated in a case. Conclusion: Although most patients with non-A, B, C viral hepatitis showed a good prognosis, a careful follow-up would be necessary because some of them had a clinical course of chronic hepatitis, fulminant hepatitis and severe complication such as aplastic anemia.

• Sleep Medicine and Psychophysiology
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• v.18 no.2
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• pp.76-81
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• 2011

Objectives: This study aims to analyze the association between the severity of sleep apnea, sleep and mood related scales, and activity during sleep in obstructive sleep apnea syndrome (OSAS) patients. Methods: 176 drug-free male patients confirmed as OSAS (average age=$43{\pm}11$ years) were selected through nocturnal polysomnography (NPSG). OSAS was diagnosed with apnea-hypopnea index (AHI) >5, mean AHI was $39.6{\pm}26.0$. Sleep related scales were Stanford Sleepiness Scale (SSS), Epworth Sleepiness Scale (ESS), Pittsburg Sleep Quality Index (PSQI) and Morningness-Eveningness Scale (MES). Mood related scales were Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), State-Trait Anxiety Inventory (STAI) I, II and Profile of Mood States (POMS). NPSG was performed overnight with both wrist actigraphy (WATG). Parameters produced from WATG were total activity score, mean activity score and fragmentation index. We analyzed the correlation between each scale, AHI scored from NPSG and activity score analyzed from WATG. Results: ESS showed significant positive correlation with PSQI, BDI, BAI and STAI I, II, respectively (p<0.01). SSS showed significant positive correlation with PSQI and BAI (p<0.05, p<0.01). BAI showed significant positive correlation with total activity score, mean activity score and fragmentation index (p<0.05, p<0.01, p<0.05).Total activity score showed significant positive correlation with ESS and BAI, respectively (p<0.05). Fragmentation index showed significant positive correlation with ESS, PSQI and BAI (p<0.05, p<0.01, p<0.05). AHI, indicator of sleep apnea is showed no significant correlation with each sleep and mood related scale. Conclusion: The degree of daytime sleepiness tends to be associated with night sleep satisfaction, depression and anxiety, and the activity during sleep rather than the severity of sleep apnea.

• Tuberculosis and Respiratory Diseases
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• v.46 no.6
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• pp.836-845
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• 1999

Background : Obesity is present in the majority of adult patients with obstructive sleep apnea(OSA) and is considered to be a major risk factor for its development. A reduction in body weight has been associated with substantial improvement in the severity of apnea. However, a variety of treatment strategies for obesity have yielded limited sucess. This study was done to determine resting energy expenditure(REE) in patients with obstructive sleep apnea and the correlation between the severity of sleep apnea and REE, and to investigate whether leptin influences REE and correlated with the severity of sleep apnea in 39 patients with OSA and 45 controls matched for obesity. Method : Overnight polysomnography was performed on all subjects using standard techniques. Measurements of REE were made using a Sensormedic Vmax 229 and a canopy system. Serum leptin concentration was measured by human leptin RIA kit of LINCO Research INC. Results : REE was greater in patients with OSA compared with controls, but there was no difference between the two groups on REE%. And also there was no significant correlation between anthropometric data, polysomnographic data and REE%. Serum leptin was linearly related to body mass index(BMI), apnea index, apnea hypopnea index and lowest arterial oxygen saturation($SaO_2$) but not related to REE%. Conclusion : This study suggests the followings. Firstly patients patients with sleep apnea have a pattern of obesity characterized by energy homeostasis at an elevated body weight set-point. In order to achieve a lower body weight in these patients, it may be necessary to increase energy expenditure by increasing physical activity. Secondly leptin level was not correlated with REE, suggesting that leptin may predominantly regulate body fat by altering eating behavior rather than calorigenesis. Lastly leptin level was significantly correlated with the severity of sleep apnea. These elevated level of leptin in patients of sleep apnea may be related to the obesity, however it needs further studies to determine the relationship between the severity of sleep apnea and serum leptin.

• Clinical and Experimental Pediatrics
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• v.45 no.5
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• pp.646-653
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• 2002

Purpose : The incidence of type 2 diabetes mellitus in children has been increasing worldwide recently, which is thought to be related to the increasing prevalence of obesity. We investigated to evaluate the incidence and the characteristics of type 2 diabetes mellitus in children and also analysed the relationship between intrauterine growth retardation and type 2 diabetes mellitus. Methods : We investigated 25 children diagnosed as type 2 diabetes mellitus between March 1990 and December 2000. The analysis was performed retrospectively with medical records based on the clinical characteristics and laborotory findings. Results : Incidence of type 1 and type 2 diabetes mellitus in children has been increasing since 1990. We demonstrated an increase in the percentage of type 2 diabetes mellitus children from 5.3% in 1990 to 21.0% in 2000. Sixty eight percent of patients(17/25) were classified as obese group. Initial symptoms at first visit were polyuria, polydipsia and polyphagia 48%(12/25), asymptomatic glycosuria 40% (10/25), weight loss 8%(2/25) and obesity 4%(1/25). The mean age at diagnosis was $12.9{\pm}1.8$ years. 64%(16/25) of patients had positive family history of type 2 diabetes mellitus. Autoanti-bodies were positive in 18.1%(4/22) of patients. Twenty eight percent (7/25) of patients had an associated disease and two patients had fatty liver in association with obesity. Treatment consisted of diet, exercise, education and oral hypoglycemic agents. Three patients were treated with insulin as well as oral hypoglycemic agents because of poor blood glucose control. Long-term diabetic complications occurred in 4 patients. Intrauterine growth retardtion was found in 34.6%(9/25); 88.9% (8/9) of these patients were non-obese group. Conclusion : The increase in the incidence of type 2 diabetes mellitus in children is thought to be related to the increasing prevalence of obesity. The non-obese group of patients might be associated with intrauterine growth retardation.

• Sleep Medicine and Psychophysiology
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• v.12 no.1
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• pp.39-44
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• 2005

Objectives: Much attention has been paid to sleep apnea syndrome (SAS) in the elderly because of its high prevalence. It is expected that SAS in the elderly has both similarities and differences compared to SAS in the young or middle-aged populations. The aim of this study was to elucidate the characteristics and consequences of SAS in the elderly. Methods: In this study we included 210 young or middle-aged adults between 23 and 59 years (20 women and 190 men) and 65 older adults between 60 and 83 years of age (16 women and 49 men). Respiratory disturbance indices (RDIs) of the study subjects were more than 5 in an overnight polysomnography. They completed the Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). Informations about body mass index (BMI), neck, waist, and hip measurements, and blood pressure were obtained. Results: No difference was observed between older adults with SAS (older SAS) and adults aged under 60 with SAS (SAS aged under 60) in RDI, apnea index, % time of oxygen saturation less than 90%, and PSQI. Obstructive apnea index and oxygen desaturation index (ODI) were lower in older SAS. Compared to SAS aged under 60, lowest oxygen saturation and central apnea index were higher in older SAS, but they were statistically not significant. BMI and neck circumference were significantly lower in older SAS compared to SAS aged under 60. Diastolic blood pressure was lower in older SAS compared to SAS aged under 60 with no difference in systolic blood pressure. Older SAS showed lower scores in ESS than SAS aged under 60. Significant correlation was observed between RDI and BMI in SAS aged under 60, but not in the case of older SAS. The relationships between RDI and neck circumference, systolic and diastolic pressure, and ESS were similar. Conclusions: The elderly with SAS were not over-weight and there was no relationship between body weight and the severity of SAS. Also, the behavioral and cardiovascular effects of SAS were not marked in the elderly, which might be partly explained by decreased ODI and relatively higher lowest oxygen saturation in older SAS. The normal aging process, aside from increased body weight, might contribute to the development of SAS in the elderly with modest complications.