• Clinical and Experimental Pediatrics
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• v.56 no.1
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• pp.19-25
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• 2013

Purpose: Childhood obesity is associated with nonalcoholic fatty liver disease (NAFLD), and it has become one of the most common causes of childhood chronic liver diseases which significant as a cause of liver related mortality and morbidity in children in the United States. The development of simpler and easier clinical indices for medical practice is needed to identify advanced hepatic fibrosis in childhood NAFLD instead of invasive method like liver biopsy. FibroScan and aspartate aminotransferase (AST)-to-platelet ratio index (APRI) have been proposed as a simple and noninvasive predictor to evaluate hepatic fibrosis in several liver diseases. APRI could be a good alternative to detect pathologic change in childhood NAFLD. The purpose of this study is to validate the efficacy of APRI for assessing hepatic fibrosis in childhood NAFLD based on FibroScan. Methods: This study included 23 children with NAFLD who underwent FibroScan. Clinical, laboratory and radiological evaluation including APRI was performed. To confirm the result of this study, 6 patients received liver biopsy. Results: Factors associated with hepatic fibrosis (stiffness measurement >5.9 kPa Fibroscan) were triglyceride, AST, alanine aminotransferase, platelet count, APRI and collagen IV. In multivariate analysis, APRI were correlated with hepatic fibrosis (>5.9 kPa). In receiver operating characteristics curve, APRI of meaningful fibrosis (cutoff value, 0.4669; area under the receiver operating characteristics, 0.875) presented sensitivity of 94%, specificity of 66%, positive predictive value of 94%, and negative predictive value of 64%. Conclusion: APRI might be a noninvasive, simple, and readily available method for medical practice to predict hepatic fibrosis of childhood NAFLD.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.21 no.1
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• pp.59-67
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• 2018

Purpose: to compare cut off points corrected for age and gender (COOP) with fixed cut off points (FCOP) for fasting plasma insulin and Homeostatic model assessment-insulin resistance (HOMA-IR) for the diagnosis of IR in obese children and adolescents and their correlation with dyslipidemia. Methods: A multicenter, cross-sectional study including 383 subjects aged 7 to 18 years, evaluating fasting blood glucose, plasma insulin, and lipid profile. Subjects with high insulin levels and/or HOMA-IR were considered as having IR, based on two defining criteria: FCOP or CCOP. The frequency of metabolic abnormalities, the presence of IR, and the presence of dyslipidemia in relation to FCOP or CCOP were analyzed using Fisher and Mann-Whitney exact tests. Results: Using HOMA-IR, IR was diagnosed in 155 (40.5%) and 215 (56.1%) patients and, using fasting insulin, 150 (39.2%) and 221 (57.7%), respectively applying FCOP and CCOP. The use of CCOP resulted in lower insulin and HOMA-IR values than FCOP. Dyslipidemia was not related to FCOP or CCOP. Blood glucose remained within normal limits in all patients with IR. There was no difference in the frequency of IR identified by plasma insulin or HOMA-IR, both for FCOP and CCOP. Conclusion: The CCOP of plasma insulin or of HOMA-IR detected more cases of IR as compared to the FCOP, but were not associated with the frequency of dyslipidemia. As blood glucose has almost no fluctuation in this age group, even in the presence of IR, fasting plasma insulin detected the same cases of IR that would be detected by HOMA-IR.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.23 no.5
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• pp.430-438
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• 2020

Purpose: We investigated the clinical features and factors affecting the choice of treatment modality and the course of pediatric gallstone (GS) disease. Methods: We retrospectively analyzed the medical records of 65 patients diagnosed with GS using imaging studies between January 2009 and December 2017 were included. Results: This study included 65 patients (33 boys and 32 girls; mean age, 8.5±5.3 years; range, 0.2-18 years) who primarily presented with abdominal pain (34%), jaundice (18%), and vomiting (8%). Idiopathic GS occurred in 36 patients (55.4%). The risk factors for GS included antibiotic use, obesity, hemolytic disease, and chemotherapy in 8 (12.3%), 7 (10.8%), 6 (9.2%), and 4 patients (6.2%), respectively. We observed multiple stones (including sandy stones) in 31 patients (47.7%), a single stone in 17 (26.2%), and several stones in 17 (26.2%). GS with a diameter of <5 mm occurred in 45 patients (69.2%). Comorbidities included hepatitis, choledocholithiasis, cholecystitis, and acute pancreatitis in 20 (30.8%), 11 (16.9%), 11 (16.9%), and 4 patients (6.2%), respectively. Ursodeoxycholic acid (UDCA) was administered to 54 patients (83.1%), leading to stone dissolution in 22 patients (33.8%) within 6 months. Cholecystectomy was performed in 18 patients (27.7%) (mean age, 11.9±5.1 years). Most patients treated surgically had multiple stones (83%) and stones measuring <5 mm in size (89%), and 66.7% of patients had cholesterol stones. Conclusion: Cholecystectomy is feasible in patients with small-sized or large numbers of GS and those with persistent abdominal pain and/or jaundice. UDCA administration with close follow-up is recommended in patients with uncomplicated GS.

• Journal of Food Hygiene and Safety
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• v.23 no.3
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• pp.276-283
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• 2008

To provide the research strategy for protection of children's health from hazardous chemical, we reviewed the hazardous chemicals can be exposed through maternity, children's life style and living environment. Recently, diseases related with children's living condition were focused as asthma, atopy, childhood developmental disability, congenital malformations and obesity. Children can be exposed to hazardous chemicals through an ambient air, water, soil, food, toys and other factors such as floor dust. Also children's health was deeply related with a wrong life style and neglectful caring by a lack of knowledge and information of harmful ones at parents and child care center's nursers. According to the previous study, the chemical risk factor of children's health were identified as inorganic arsenic, bisphenol A, 2,4-D, dichlorvos, methylmercury, PCBs, pesticide, phthalates, PFOA/PFOS, vinyl chloride, et al. Domestic studies for identification of causality between children exposure to chemicals and resulted hazardous effects were not implemented. The confirmation of chemical risk factors through simultaneously performing toxicological analysis, human effect study, environmental/human monitoring, and risk assessment is needed for good risk management. And also, inter-agency collaboration and sharing information can support confirming scientific evidence and good decision making.

• Nutritional Sciences
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• v.8 no.2
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• pp.133-139
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• 2005

Objective: The purpose of this study was to determine serum antioxidant nutrients and the relationship between serum antioxidants and risks of chronic diseases in obese Korean children Methods: Normal weight Korean school children (0=170), mean age of 11.5$\pm$1.5, and obese (body fat mass > $28\%$) children (0=176), mean age of 11.0$\pm$1.8, were recruited Fat mass ($\%$) was determnined by Bioelectrical Impedance (BEI), and body mass index (BMI) was calculated Fasting blood was collected to measure serum antioxidant nutrients, vitamin A, vitamin E and zinc. Serum lipid profiles including total cholesterol (TC), high density cholesterol (HDL) and triglyceride (TG), and blood glucose, glutamic oxaloacetic transaminase (GOT), and glutamic pyruvic transaminase (GPI) were also determined. Differences in serum blood measurements between obese and normal children were assessed by independent t test. Pearson's correlation analysis was used to determine the relationship between variables. Results: Blood glucose, GPT, total cholesterol, and triglycerides concentrations were significantly higher among obese boys, compared to normal boys (p<005). Significantly lower concentrations of serum vitamin E, after adjustment for TG and TC, was shown in obese boys (0.26 mg/mg) and obese girls (0.31 mg/mg), compared to normal boys (0.36 mg/mg) and girls (0.38 mg/mg) (p<0.05). Fat mass ($\%$) was negatively con-elated with serum vitamin A and vitamin E. Conclusion: Obese Korean children showed insufficient serum vitamin E concentration and increased risk for diabetes, atherosclerosis, and liver disease. Since lower vitamin E concentration was negatively con-elated with atherogenic index, improved vitamin E status in children may decrease the risk of atherosclerosis later in life.

• Clinical and Experimental Pediatrics
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• v.53 no.10
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• pp.863-871
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• 2010

The prevalence of pediatric obstructive sleep apnea syndrome (OSAS) is approximately 3% in children. Adenotonsillar hypertrophy is the most common cause of OSAS in children, and obesity, hypotonic neuromuscular diseases, and craniofacial anomalies are other major risk factors. Snoring is the most common presenting complaint in children with OSAS, but the clinical presentation varies according to age. Agitated sleep with frequent postural changes, excessive sweating, or abnormal sleep positions such as hyperextension of neck or abnormal prone position may suggest a sleep-disordered breathing. Night terror, sleepwalking, and enuresis are frequently associated, during slow-wave sleep, with sleep-disordered breathing. Excessive daytime sleepiness becomes apparent in older children, whereas hyperactivity or inattention is usually predominant in younger children. Morning headache and poor appetite may also be present. As the cortical arousal threshold is higher in children, arousals are not easily developed and their sleep architectures are usually more conserved than those of adults. Untreated OSAS in children may result in various problems such as cognitive deficits, attention deficit/hyperactivity disorder, poor academic achievement, and emotional instability. Mild pulmonary hypertension is not uncommon. Rarely, cardiovascular complications such as cor pulmonale, heart failure, and systemic hypertension may develop in untreated cases. Failure to thrive and delayed development are serious problems in younger children with OSAS. Diagnosis of pediatric OSAS should be based on snoring, relevant history of sleep disruption, findings of any narrow or collapsible portions of upper airway, and confirmed by polysomnography. Early diagnosis of pediatric OSAS is critical to prevent complications with appropriate interventions.

• Clinical and Experimental Pediatrics
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• v.54 no.5
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• pp.219-223
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• 2011

McKusick-Kaufman syndrome (MKS) is an autosomal recessive multiple malformation syndrome characterized by hydrometrocolpos (HMC) and postaxial polydactyly (PAP). We report a case of a female child with MKS who was transferred to the neonatal intensive care unit of Seoul National University Children's Hospital on her 15th day of life for further evaluation and management of an abdominal cystic mass. She underwent abdominal sonography, magnetic resonance imaging, genitography and cystoscopy which confirmed HMC with a transverse vaginal septum. X-rays of the hand and foot showed bony fusion of the left third and fourth metacarpal bones, right fourth dysplastic metacarpal bone and phalanx, right PAP and hypoplastic left foot with left fourth and fifth dysplastic metatarsal bones. In addition, she had soft palate cleft, mild hydronephroses of both kidneys, hypoplastic right kidney with ectopic location and mild rotation, uterine didelphys with transverse vaginal septum and low-type imperforated anus. She was temporarily treated with ultrasound-guided transurethral aspiration of the HMC. Our patient with HMC and PAP was diagnosed with MKS because she has two typical abnormality of MKS and she has no definite complications of retinal disease, learning disability, obesity and renal failure that develop in Bardet-Biedl syndrome, but not in MKS until 33 months of age. Here, we describe a case of a Korean patient with MKS.

• Journal of the Korean Dietetic Association
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• v.17 no.2
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• pp.161-175
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• 2011

This study examined students' menu preferences as well as the job satisfaction and specific considerations concerning foodservice operation of dieticians and nutrition teachers at special schools for the disabled. Semi-structured interview questionnaires were sent to all of the 21 special schools with direct school food service in Gyeonggi-do, and 16 dieticians and nutrition teachers agreed to participate in this study. Among the various menu groups, the subjects perceived the meat group as the most preferred and the vegetable group the least preferred. They were generally satisfactory with their job and duty, and had a strong sense of belonging to the school. However, most of them answered that they needed more time for nutritional education and counseling. While most had pride and pleasure in their job, they expressed a desire to change the system to better fit with their roles as professional nutritionists. The content analysis revealed that the subjects mainly focused on safety issues in planning the food menu and were thus limited in selecting menu items. They also felt difficulty in menu planning due to various tastes and preferences, since special schools tend to consist of a wider grade range. However, most subjects reported little trouble in food distribution and food leftovers owing to practical support from teachers and parents. The necessity for education concerning table manners and obesity prevention was generally a shared opinion, and education programs for parents were also perceived as necessary to better understand the special considerations for developing proper eating habits in their child. The study findings provide useful basic data to improve the foodservice system at special schools.

• Journal of the East Asian Society of Dietary Life
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• v.25 no.1
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• pp.20-29
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• 2015

This study investigated the demand of nutrition education programs among preschooler's parents. Focus group interview was conducted four times with 29 parents of preschool children. Most subjects appeared to have interest in nutrition education; 'very interested' (58.6%), 'somewhat interested' (20.7%). Sources of nutrition information were 'internet' (35.1%), 'books' (21.6%), 'newspaper or magazines' (13.5%), 'family or relatives' (13.5%), 'media' (8.1%), 'preschool' (5.4%) and 'hospital or public health center' (2.7%) in order. The most frequently mentioned health problems related to dietary behavior were atopy and obesity. Major concerns for children's dietary behavior was picky eating habits, and having questions for how to deal with this problem. Most subjects had trouble with obtaining an adequate amount of dietary supplements for their children. Nutrition education for parents about food labeling and information on processed foods was in demand. Preferred methods of nutrition education for children were playing games with stickers, gardening vegetables, and participating in cooking. Attitudes toward computer-assisted education materials, one of the methods of nutrition education, appeared to be ambivalent. Some preschool parents showed negative attitudes towards exposing their children to electronic devices at an early age, whereas others showed positive attitudes. Subjects were interested in meal-planning and ways to balance nutrients for their child. Parents preferred attending professional lectures to receive reading materials or searching websites as an adult nutrition education method. Results of this study have implications on providing basic information for developing nutrition education programs for preschoolers and their parents. Future research should focus on developing nutrition education programs for both preschools and the home.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.15 no.1
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• pp.44-51
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• 2012

Purpose: Tumor necrosis factor-${\alpha}$ (TNF-${\alpha}$) polymorphism has been suggested to play an important role in the pathogenesis of non-alcoholic fatty liver disease (NAFLD) in obese adults, and known to be a mediator of insulin resistance. In this study, we evaluated the role of TNF-${\alpha}$ promoter polymorphisms and insulin resistance in the development of NAFLD in obese children. Methods: A total of 111 obese children (M:F=74:37; mean age, $11.1{\pm}2.0$ yrs) were included. The children were divided into 3 groups: controls (group I, n=61), children with simple steatosis (group II, n=17), and children with non-alcoholic steatohepatitis (group III, n=33). Serum TNF-${\alpha}$ levels, homeostasis model assessment of insulin resistance (HOMA-IR), and TNF-${\alpha}$ -308 and -238 polymorphisms were evaluated. Results: There were no differences in TNF-${\alpha}$ polymorphism at the -308 or the -238 loci between group I and group II + III ($p$=0.134 and $p$=0.133). The medians of HOMA-IR were significantly different between group I and group II + III ($p$=0.001), with significant difference between group II and group III ($p$=0.007). No difference was observed in the HOMA-IR among the genotypes at the -308 locus ($p$=0.061) or the -238 locus ($p$=0.207) in obese children. Conclusion: TNF-${\alpha}$ promoter polymorphisms at the -308 and -238 loci were not significantly associated with the development of NAFLD in children; nevertheless, insulin resistance remains a likely essential factor in the pathogenesis of NAFLD in obese children, especially in the progression to NASH.