• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.16 no.4
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• pp.225-232
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• 2013

Children with abnormal liver function can often be seen in outpatient clinics or inpatients wards. Most of them have respiratory disease, or gastroenteritis by virus infection, accompanying fever. Occasionally, hepatitis by the viruses causing systemic infection may occur, and screening tests are required. In patients with jaundice, the tests for differential diagnosis and appropriate treatment are important. In the case of a child with hepatitis B virus infection vertically from a hepatitis B surface antigen positive mother, the importance of the recognition of immune clearance can't be overstressed, for the decision of time to begin treatment. Early diagnosis changes the fate of a child with Wilson disease. So, screening test for the disease should not be omitted. Non-alcoholic fatty liver disease, which is mainly discovered in obese children, is a new strong candidate triggering abnormal liver function. Muscular dystrophy is a representative disease mimicking liver dysfunction. Although muscular dystrophy is a progressive disorder, and early diagnosis can't change the fate of patients, it will be better to avoid parent's blame for delayed diagnosis.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.sup1
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• pp.118-126
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• 2009

The incidence of childhood obesity has increased dramatically. Childhood obesity is an increasing health problem because of its strong associations with chronic health problems in children and adults. These health problems significantly contribute to the development of common chronic diseases in later life, including hypertension, type2 diabetes, hyperinsulinemia, coronary heart disease, and other psychological disorders. So it is an important issue to prevent and treat obesity during childhood and adolescent. Diet and exercise are the cornerstones of treatment for obesity and related complications. For obese children, some clinical trials have shown improvement with diet, exercise, and /or behavioral interventions. Promising interventions for high-risk individuals, such as bariatric surgery and novel pharmacological agents, also require rigorous assessment with attention to long-term patient important outcomes. There are various pharmacological approaches to the treatment of obesity in the adolescent population some of which have FDA approval. In the article we discuss pharmacological approaches to guide the treatment of obesity in the pediatric population, including risks of treatment, monitoring of potential side effects.

• 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.

• Journal of Nutrition and Health
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• v.34 no.6
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• pp.637-644
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• 2001

The purpose of this study was to examine the effect of exercise and diet control program on nitrogen balance in obese children. The subjects of this study were five obese boys aged from 8 to 12 participating in the control period(C) for 3 days, exercise without energy deficit period(EEN) for one week, and exercise with energy deficit period(EED) far another one week, consecutively. The intensity of the exercise was 60-70% of HRmax and the energy was restricted at 493 kcal/day. Daily mean total energy intake was 2,152 $\pm$ 138kca1, 1,861 $\pm$ 138kca1, and 1,368 $\pm$ 87kca1 for the period C, EEN and EED, respectively. The body weight for EEN and EED decreased compared with the period C by average 1.2 $\pm$ 0.2kg and 1.8 $\pm$ 0.3kg, respectively. Of the body weight loss, the fat mass decreased bur 1.0 $\pm$ 0.3kg and 1.5 $\pm$ 0.5kg and the lean body mass by 0.2 $\pm$ 0.4kg and 0.3 $\pm$ 0.4kg, respectively. Of the daily mean nitrogen consumption was 9.1 $\pm$ 0.7g, 9.1 $\pm$ 0.8g and 7.1 $\pm$ 0.5g, the daily mean nitrogen excretion from feces was 1.3 $\pm$ 0.2g, 0.9 $\pm$ 0.1g and 0.7 $\pm$ 0.1g, and from urine was 6.7 $\pm$ 0.6g, 6.6 $\pm$ 0.5g and 6.7 $\pm$ 0.6g, for the period C, EEN and EED, respectively. Daily mean nitrogen balance excluding nitrogen excretion firm feces and urine indicated + 1.1 $\pm$ 1.0, +1.6 $\pm$ 0.6 and - 0.3 $\pm$ 0.9 for the period C, EEN and EED, respectively. Despite the negative indication during EED, there was no statistical signifiranre. The daily mean creatinine excretion was 0.5 $\pm$ 0.0g, 0.7 $\pm$ 0.1g and 0.6 $\pm$ 0.0g and the creatinine-height index(CHl) was 85.1 $\pm$ 6.7%, 83.8 $\pm$ 6.6% and 81.0 $\pm$ 6.5%, for the period C, EEN and EED, respectively, indicating little significant difference among the periods. Taking above results into consideration, it seems the exercise program conducted for this study did not substantially affect the nitrogen balance of the obese children, and may be used far the body weight control. Howeever, the adequacy of the energy restriction and amount of exercise applied to this study need to be further investigated as the nitrogen balance indicated negative and increasing tendency of the creatinine excretion showed during the EED compared with period C, despite the statistical insignificance.

• 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.

• Korean Journal of Community Nutrition
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• v.2 no.1
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• pp.13-22
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• 1997

The purpose of this survey was to investigate the prevalence of obesity, eating habits and life styles of children. This survey was carried out anthropometry and questionnaires in 180 male and 141 female students of fifth-grade at Dongmak elementary school. The results are summarized as follows : 1)18.2% of the male and 19.3% of female students were obese. Underweight group was 10.5% of the male and 15.0% of the female students. 2) Average height of male and female students were 142.0㎝, 144.0㎝ and weight of those were 35.8㎏ and 37.1㎏ respectively. The height and skinfold thickness of the triceps in female students were significantly higher than those of male students and body fat content in female students was significantly lower than that of male students. There was no difference in BMI, RW and RI between male and female students. The average BMI, RW, RI were 17.7, 25.4, 124.0, respectively. 3) The student's height was positively related to parent's height and moth's weight. There were significantly positive correlation between mother's and subject's weight. BMI, RW and RI were positively related to parent's BMI. 4) 78.3% of male and 51.8% of female students had prejudice for special food, and 45.5% of male and 34.5% of female students had an overeating habit. Male students had significanthy higher rate than female in both cases. Average eating time per meal was 18.9 minutes for male and 21.0 minutes for female students. Experience for taking nutrient supplement in male student was more than that in female. Obese group had prejudice for special food, overeating habit and rapid eating rate more than any other groups. The prevalence of obesity among the children is gradually increasing. Therefore, in order to prevent progress into adulthood obesity, nutrition education including the right perception for obesity and eating behavior modification was needed.

• Journal of Community Nutrition
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• v.6 no.3
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• pp.117-120
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• 2004

Objective : To get a better understanding of obesity and etiological factors of obesity among school children. Methods : We have conducted a questionnaire survey of 4542 (2395male and 2147female) age from 7-15 in Shanghai School District to study their 24h nutrition intakes ; we have asked all our survey participating students to take a physical exam and body mass index measurement to determine the morbidity of obesity. Common statistic method was used in analyzing the data. Results : The result shows an over all morbidity (boys and girls) of $12.3\%$ among the students we have studied. Our research shows that boys have a higher rate of morbidity of obesity $17.1\%$ vs. $7.0\%$ for girls. The morbidity for boys starts under age 10, reaches the peak at age 10 ($24.3\%$), then declines after age 11 ; as for girls the morbidity starts at under age 9, reaches the peak at 9, and then declines after 10. Our study also indicates that the daily nutrition intake of protein, fat and carbohydrate by the students have satisfied Chinese Dietary Reference Intakes (DRIs), while the daily intakes of calcium, iron, zinc, and vitamin C are below the $80\%$ of the DRIs suggested value. For students who are obese, our study shows that their average daily intakes of calories and protein have reached $90\%$ of the suggested value by the RNI while the intakes of calcium, iron, and zinc are far below standards. Furthermore, our research shows that the obese students usually intake more calories, proteins and vitamin $B_1$, but less for iron and calcium compared to the normal students. Some other factors such as the education and occupation of the parents, especially the mother, the family history of obesity and the eating habits are important factors that should be closely watched. Conclusion : The morbidity of obesity among boys is higher than girls. Obesity is closely related to the family history, the diet habits and the life styles.

• The Korean Journal of Food And Nutrition
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• v.24 no.2
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• pp.246-257
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• 2011

The purpose of this study was to identify the effectiveness of a nutrition education program of reducing children's sugar intake based on social cognitive theory. This education program composed of 6 units was conducted in discretional activity class of the $3^{rd}$ and $4^{th}$ grade elementary school students. The results are as follows: First, the rate of correct answers and score of nutrition knowledge significantly increased after nutrition education. The scores of nutrition education in male students, students whose mothers have no job, and students with skinny physiques were much improved after nutrition education(p<0.05, p<0.01, p<0.001, respectively). Second, the dietary attitudes toward reducing sugar intake and checking nutrition labels significantly improved(p<0.05). And also, it tended to decrease in preference and intake of sweet foods. Third, the consumption of candy caramel jelly(p<0.05), yogurt(p<0.05), jam honey(p<0.05), and ice cream(p<0.001) were reduced after nutrition education. Besides, obese students' consumption of isotonic beverages, carbonated beverages, and fruit juice was reduced. Therefore, a positive change in dietary behavior appeared. Based on the above results, we confirmed that the nutrition education program focusing on reducing sugar intake applied with social cognitive theory was effective for improving the nutrition knowledge, dietary attitude and dietary behavior in sugar intake in elementary school students. Especially, this program showed the improvement in nutrition knowledge as well as dietary attitude and behavior in sugar intake among obese children. Since nutrition education during childhood significantly influences lifetime-health and disease prevention, it is necessary to develop theory-based nutrition education program and practice systematic and constant nutrition education in elementary schools.

• Journal of Preventive Medicine and Public Health
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• v.46 no.4
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• pp.192-200
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• 2013

Objectives: To measure the prevalence of behavioural risk factors for obesity among urban adolescent school children in Chennai, India. Methods: This study was performed as a cross-sectional study using a World Health Organization-designed Global School-based Student Health Survey questionnaire (modified for India) among adolescent school children studying in 30 randomly selected secondary and higher secondary schools in Chennai city. 1842 adolescents studying in the VIII to XII standards were randomly selected for the study. Results: In the present study, 40.7% of the students ate fruit one or more times per day and 74.5% of the students ate vegetables one or more times per day. Nearly 20% of the students ate fast food items on 4 to 7 days during the previous week. Among the students, 30.4% watched television for more than two hours per day. Nearly 68% of the girls and 22% of the boys did not participate in outdoor sports activities. When the pattern of physical activity of the students was assessed, it was observed that 15.6% were inactive, 43.4% were minimally active, and the remaining 41.0% belonged to the category of health enhancing physical activity. Among the students, 6.2% were overweight and 5.2% were obese. Conclusions: The prevalence of risk factors for obesity was quite high among the adolescents. This study also showed that a great proportion of overweight/obese adolescents had a correct perception of their body weight and they were making efforts to modify risk factors such as television viewing, computer use, a sedentary lifestyle, and unhealthy dietary habits.

• Journal of Nutrition and Health
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• v.50 no.3
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• pp.217-224
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• 2017

Purpose: Although it is well known thatmortality and morbidity due to cardiovascular diseases are higher in salt-sensitive subjects than in salt-resistant subjects, their underlying mechanisms related to obesity remain unclear. Here, we focused on salt-sensitive gene variants unrelated to monogenic obesity that interacted with sodium intake in humans. Methods: This review was written based on the modified $3^rd$ step of Khans' systematic review. Instead of the literature, subject genes were based on candidate genes screened from our preliminary Genome-Wide Association Study (GWAS). Finally, literature related to five genes strongly associated with salt sensitivity were analyzed to elucidate the mechanism of obesity. Results: Salt sensitivity is a measure of how blood pressure responds to salt intake, and people are either salt-sensitive or salt-resistant. Otherwise, dietary sodium restriction may not be beneficial for everyone since salt sensitivity may be associated with inherited susceptibility. According to our previous GWAS studies, 10 candidate genes and 11 single nucleotide polymorphisms (SNPs) associated with salt sensitivity were suggested, including angiotensin converting enzyme (ACE), ${\alpha}$-adducin1 (ADD1), angiotensinogen (AGT), cytochrome P450 family 11-subfamily ${\beta}$-2 ($CYP11{\beta}$-2), epithelial sodium channel (ENaC), G-protein b3 subunit (GNB3), G protein-coupled receptor kinases type 4 (GRK4 A142V, GRK4 A486V), $11{\beta}$-hydroxysteroid dehydrogenase type-2 (HSD $11{\beta}$-2), neural precursor cell-expressed developmentally down regulated 4 like (NEDD4L),and solute carrier family 12(sodium/chloride transporters)-member 3 (SLC 12A3). We found that polymorphisms of salt-sensitive genes such as ACE, $CYP11{\beta}$-2, GRK4, SLC12A3, and GNB3 may be positively associated with human obesity. Conclusion: Despite gender, ethnic, and age differences in genetics studies, hypertensive obese children and adults who are carriers of specific salt-sensitive genes are recommended to reduce their sodium intake. We believe that our findings can contribute to the prevention of early-onset of chronic diseases in obese children by facilitating personalized diet-management of obesity from childhood to adulthood.