• The Journal of Pediatrics of Korean Medicine
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• v.27 no.4
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• pp.57-67
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• 2013

Objectives The purpose of this study is to investigate the safety and effect of Biman-tang (BMT) on two different administration periods in the treatment of childhood overweight and obesity. Methods In retrospective study, 39 overweight and obese ($85^{th}$ percentile ${\leq}$ Body Mass Index (BMI)) children were treated with BMT from January 2006 to April 2013 at Korean Medical Clinic in Suwon, Korea. The primary outcomes were the changes in BMI and Obesity Index (OI) from baseline to the treatment groups. Secondary outcomes included the changes in height, weight and safety of the medicine. Comparisons of BMI, OI, height and weight between the short-period (SP) treatment group and the long-period (LP) treatment group were done by using ANCOVA. Results The change of the mean of BMI ($-0.5{\pm}0.6kg/m^2$ vs $-1.4{\pm}0.8kg/m^2$, respectively; p=0.003) and OI ($-3.6{\pm}3.9%$ vs $-9.7{\pm}4.7%$, respectively; p<0.001) showed significant reduction both in SP (n=16) and LP treatment group (n=23). The mean height showed no significant difference in both groups. The mean weight of LP treatment group showed significant reduction compared to SP treatment group ($-0.2{\pm}1.3kg$ vs $-1.6{\pm}1.6kg$, respectively; p=0.006). Most of the children were compliant to the medication and no serious adverse events were found in two groups. Conclusions These findings emphasize that BMT is effective in the treatment of childhood obesity and it requires at least 45 days of treatment for the best result.

• Clinical and Experimental Pediatrics
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• v.62 no.5
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• pp.179-186
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• 2019

Purpose: Information about overweight and obesity among students in rural areas of Thailand is limited. Therefore, we aimed to determine overweight and obesity prevalences and associated factors among school-aged children in a rural community of Thailand. Methods: We selected 9 public schools through cluster sampling in 2 provinces located in central Thailand in 2016. Anthropometric measurements were measured using standard techniques, classified as overweight (>1 standard deviation [SD]) and obese (>2 SD) with respect to their age and sex using 2007 World Health Organization reference charts. Standardized questionnaires on risk factors were sent to parents to be completed together with their child. Results: Among 1,749 students, 8.98% had overweight and 7.26% had obesity. Mean age (range) was 11.5 years (5-18 years). Independent factors associated with overweight and obesity included primary school student (reference as secondary school) (adjusted odds ratio [aOR], 2.25; 95% confidence interval [CI], 1.24-4.08; P=0.07), mother's body mass index (aOR, 1.07; 95% CI, 1.02-1.12; P=0.001), self-employed father (aOR, 1.99; 95% CI, 1.12-3.55; P=0.018), number of siblings (aOR, 0.61; 95% CI, 0.47-0.81; P=0.001), having sibling(s) with obesity (aOR, 1.82; 95% CI, 1.20-2.77; P=0.005), more than one (aOR, 7.16; 95% CI, 2.40-21.32; P<0.001), consuming 2-3 ladles of rice/meal (aOR, 2.14; 95% CI, 1.38-3.32; P=0.001), consuming >3 ladles of rice/meal (aOR, 2.69; 95% CI, 1.11-6.46; P=0.27), watching <2 hours of television/day (aOR, 2.18; 95% CI, 1.19-4.01; P=0.012), and watching >2 hours of television/day (aOR, 2.60; 95% CI, 1.36-4.96; P=0.004). Conclusion: Many sociodemographic, dietary, and behavioral factors were related to overweight and obesity among school-aged children not only in urban but also rural communities of Thailand.

• Journal of the Korean Society of Food Science and Nutrition
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• v.25 no.2
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• pp.214-224
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• 1996

본 연구는 비만아동을 위한 효과적인 운동 및 식이 요법에 관한 자료를 얻기 위하여 실시하였다. 대상자는 8~12세의 비만아동(체지방 $36.1\pm1.3%)과$ $정상아동(18.9\pm1.3%)$ 각각 5명이었으며 3일간 실험환경에 적응하기 위한 대조기간(Control : C)을 거친후 1주간은 운동은 부하하되 에너지는 제한하지 않는 운동기간(Exercise without energy deficit : EEN)와 다음 1주간은 비만아동만을 대상으로 운동부하와 동시에 에너지를 제한하는 에너지 제한 운동기간(Exercise with energy deficit : EED)으로 나누어 실시하였다. 운동강도는 60~75%HRmax이었으며 에너지 제한량은 493kcal/day이었다. 각 실험 조건별 대사에너지 섭취량, 체중, 체성분, 체내 보유 에너지, 에너지 소비량의 변화를 측정하였다. 체지방량은 생체 전기저항 지방측정기를 이용하여 측정하였다. 대변 및 소변으로의 에너지 손실량으로부터 측정한 1일 평균 대사 에너지량(ME)은 정상아동이 대조기간(C) 및 운동기간(EEN)별로 각각 $1802\pm50kcal$ 및 $1771\pm72kcal이었고$ 비만아동이 대조기간(C) 및 운동기간(EEN) 및 에너지 제한 운동기간(EED)별로 각각 $2152\pm138kcal,$ $1861\pm138kcal$ 및 $1368\pm87kcal이었다.$ 대조기간(C)에 비만 아동은 정상아동에 비해 대사에너지량(ME)이 높았으나 무지방조직(LBM) kg당 섭취량은 정상아동이 79kcal이며 비만아동이 70kcal로 오히려 비만아동의 경우가 낮았다. 대체로 운동에 의해 에너지 섭취량은 감소되었다. 동일한 운동 부하로 정상아동 및 비만아동의 체중은 각각 $1.00\pm0.20kg$ 및 $1.24\pm0.22kg씩$ 감소되어 정상아동에 비하여 비만아동의 체중감소가 더 많았다. 비만아동에서 에너지 제한(493kcal)으로 인한 체중감소량은 0.52kg이었고 체지방조직량(FM)은 0.46kg이었다. 운동기간(EEN)중 체성분 변동량으로부터 산출한 1일 1인당 체내 에너지 변동량은 정상아동이 1092kcal, 비만아동이 1270kcal 감소디어 비만아동의 에너지 소모량이 더 많았다. 비만아동에 있어 에너지제한 운동기간(EEN)에 정상아동이 $2863\pm58kcal,$ 비만아동이 $3131\pm158kcal이었으며,$ 에너지 제한 운동기간(EED)에 비만아동은 $3153\pm151kcal이었다.$ 이상의 성적으로 보아 본 실험에 적용한 운동 프로그램은 체중 감소에 효과적으로 작용하나 일부 부지방조직(LBM)의 감소를 동반하는 것으로 보아 다소 운동 부하량이 과도한 것으로 생각된다. 그러나 에너지 제한량(500kcal)은 체중감소에 매우 효율적인 것으로 평가되어 이후 비만아동의 체중조절에 본 실험의 에너지제한 운동 프로그램중 운동 부하량만을 다소 줄여 적용하면 매우 효과적일 것이라 생각된다.

• Clinical and Experimental Pediatrics
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• v.57 no.12
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• pp.520-525
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• 2014

Purpose: Childhood obesity is an increasing public health issue worldwide. We examined dietary patterns among adolescents in a dormitory school, identified obese adolescents and tried to intervene to improve food habits and physical activity. Methods: We conducted an experimental prospective longitudinal study based on 36 obese (body mass index $[BMI]{\geq}95th$ percentile) adolescents (aged 12-18 years) compared with controls (healthy children: normal age-appropriate BMI ($BMI{\leq}85th$ percentile). Six months' intervention included lifestyle-modification counseling (once a week by a clinical dietician), and an exercise regimen twice a week, 60 minutes each time, instructed by a professional pediatric trainer). Both groups underwent baseline measurements at the beginning of the study and 6 months later (arterial stiffness, blood pressure, pulse, weight and height, hemoglobin, creatinine, liver enzymes, highly sensitive C-reactive protein and complete lipid profile). Results: Twenty-one participants completed the study. Low compliance from participants, school staff and parents was observed (participation in planned meetings; 71%-83%). BMI significantly decreased from $32.46{\pm}3.93kg/m^2$ to $30.32{\pm}3.4kg/m^2$ (P=0.002) in the study group. Arterial stiffness was not significantly different between the 2 groups and did not change significantly after 6 months' intervention (P=0.494). No significant changes in CRP and lipid profile were observed after the intervention. Conclusion: Making lifestyle modifications among adolescents in a dormitory school is a complex task. Active intervention indeed ameliorates BMI parameters. However, in order to maximize the beneficial effects, a multidisciplinary well-trained team is needed, with emphasis on integrating parents and the school environment.

• Korean Journal of Community Nutrition
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• v.18 no.6
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• pp.644-651
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• 2013

Although there has been a significant increase in breast-feeding (BF) rate in Korea, it is plateaued since 2008 and still low compared with that of other countries. Because BF has been related to lower obesity prevalence in many studies and the increase in childhood obesity became evident in Korea, we wondered if a relatively lower BF rate has anything to do with this increase. Therefore, we looked into the relationship between mode & duration of BF during infancy and weight status of toddlers using the data from Korea National Health and Nutrition Examination Survey 2008 through 2011. Number of 2-3 year old toddlers with complete information on BF, anthropometry and normal birth weight was 674. While 87% of them were ever-breastfed, 6.2% each of them were either obese or overweight based on the Standard Growth Chart for Korean Children. Not only the obesity prevalence was different among groups of different mode of feeding, but also the mean duration of BF was significantly longer in normal weight group (9.2 mo.) compared with obese group (5.5 mo.). Accordingly, overweight and obesity prevalence of the toddlers breast-fed for 12 months or longer was significantly lower than that of the toddlers breast-fed for less than 12 months (OR 0.53, 95% CI 0.32-0.87). This study revealed that both BF and duration of BF affect the childhood obesity and, BF for 12 months or longer should be encouraged more aggressively as one of the main strategies to prevent and/or decrease childhood obesity in Korea.

• Journal of the Korean Society of Food Science and Nutrition
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• v.42 no.10
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• pp.1592-1599
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• 2013

Despite numerous studies regarding overweight or obese children, only a limited number of studies have investigated the effect of underweight. The purpose of this study is to investigate the determinants of underweight among school-aged children. A total of 493 students (86 underweight and 407 normal weight students) aged 11 to 13 years were included in our study. Socio-demographic characteristics, eating habits, health information, self-perception of weight, weight-control efforts and birth-related information were collected by using survey questionnaires for children and parents. Dietary information was obtained by two 24-hour food records, which were completed by both children and their parents. The prevalence of underweight was significantly higher in girls than boys, and the frequency of medical treatment and flu symptoms were higher in underweight children than normal ones. Overall, girls tended to overestimate their own weight; this misclassification was greater among underweight girls. Birthweight was positively correlated with current weight (P<0.05) and height (P<0.01) in girls, but these correlations were not seen in boys. In conclusion, underweight girls had inappropriate self-perception of weight, and underweight in girls may be related with birthweight and inadequate dietary intakes. Therefore, it is important to build a well-designed framework that integrates efforts of home, school, and community to maintain a healthy weight with balanced diet and exercise throughout the lifetime.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.13 no.2
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• pp.180-192
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• 2010

Purpose: To evaluate the feasibility and usefulness of the waist circumference-to-height ratio (WHTR) in screening for obesity in Korean children and adolescents. Methods: Data, including body mass index (BMI), waist circumference (WC), and height, were obtained from the national growth surveys for children and adolescents in 2005. The WHTR was calculated dividing WC by height in subjects 2~18 years of age. Overweight and obese were defined by BMI percentiles for age and gender. The receiver operating characteristic (ROC) analysis was performed to find out the optimal cutoff values of WHTR that matched BMI-determined overweight and obesity using the STATA program. The area under the curve (AUC), a measure of diagnostic power, of WHTR was compared to WC. The influence of age on WHTR was analyzed by the SAS program. Results: The WHTR significantly decreased with age, and had less correlation with age in the 6~18-year-old age group than the 2~5-year-old age group. Furthermore, the WHTR also had less correlation with age than WC in the 6~18-year-old age group. The AUC of WHTR in identifying overweight and obesity was significantly higher than the AUC of WC in the 6~18-year-old age group. The optimal cutoff values were 0.51 in boys and 0.49 in girls for obesity, and 0.48 in boys and 0.47 in girls for overweight, with all having the AUC>0.9. The optimal cutoff values of WHTR had a higher sensitivity for diagnosing obesity than WC${\geq}$90th percentiles. Conclusion: The WHTR is an easy, accurate, and less age-dependent index with high applicability in screening for obesity in children and adolescents.

• Clinical and Experimental Pediatrics
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• v.45 no.6
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• pp.764-772
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• 2002

Purpose : Obesity is closely related to insulin resistance, compensatory hyperinsulinemia and dyslipidemia in adults. We identified the effect of obesity measured by BMI and insulin resistance on dyslipidemia in children and adolescents. Methods : The fasting serum insulin, glucose, total cholesterol, triglyceride, HDL- and LDL-cholesterol were measured and insulin resistance(HOMA-IR) was calculated in 35 children with simple obesity(age :$10.6{\pm}2.8$ years; male 20, female 15; BMI : $27.1{\pm}5.4kg/m^2$). Results : The hypertriglyceridemia(37%), hyperinsulinemia(54%) and HDL-hypocholesterolemia(5.7%) were observed. HOMA-IR was well expressed by fasting insulin. As BMI increased, there was a statistically significant increase in insulin resistance and insulin level in both sexes. BMI was not related with lipid profile in both sexes. Triglyceride was correlated with only insulin level and insulin resistance index in boys. In girls, there was no correlation between triglyceride, HDL-cholesterol and insulin(insulin resistance). Conclusion : These results suggest that hypertriglyceridemia was dependent on insulin resistance in pre-adult males. Monitoring of insulin resistance and those risk factors known to become a part of insulin resistance syndrome should become part of routine medical care for obese children.

• 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.

• Journal of Nutrition and Health
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• v.56 no.1
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• pp.54-69
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• 2023

Purpose: Proteins are major components of the body and essential nutrients for proper growth and development. However, studies on protein intake in children and adolescents are insufficient. A few previous studies have reported the relationship with growth indicators, but results vary depending on the source of protein. Therefore, the current study investigates the relationship between protein intake and overweight and obesity among children and adolescents in Korea. Methods: Based on the 2014-2019 Korea National Health and Nutrition Examination Survey, 5,567 children and adolescents aged 6-18 years, who participated in a 24-hour dietary recall with information on height and weight, were included in this study. Protein intake was estimated as percentage of total energy (% of energy) and was classified into animal and plant protein according to the food source. Overweight and obesity were defined using the 2017 pediatric and adolescent growth chart. Results: Total protein intake of the subjects was estimated as 14.5% of total energy (animal protein 8.3% and plant protein 6.3%). The group with the highest total protein intake had a higher odds ratio (OR) of overweight/obesity than those with the least protein intake (OR, 1.36, 95% confidence interval (CI), 1.10-1.67, p for trend = 0.003). When classified by food source, the group with the highest animal protein intake had a significantly higher OR of overweight/obesity than subjects with the lowest intake (OR, 1.30, 95% CI, 1.05-1.61, p for trend = 0.016). However, plant protein was not significantly associated with overweight/obesity. Conclusions: These findings suggest that a high intake of animal protein in children and adolescents increases the risk of being overweight and obese. In order to develop normal growth and prevent obesity in the future, it is necessary to determine an appropriate protein intake level through nutrition education programs and prospective studies on balanced protein intake.