• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.27 no.4
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• pp.236-245
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• 2024

Purpose: The prevalence of nonalcoholic steatohepatitis (NASH) is increasing with the increasing prevalence of childhood obesity. Although NASH has a high risk of progression to liver fibrosis and cirrhosis, few studies have reported noninvasive markers for predicting hepatic fibrosis in children. This study aimed to evaluate and compare the diagnostic accuracies of serologic biomarkers and scoring systems for hepatic fibrosis in obese children with NASH. Methods: A total of 96 children were diagnosed with NASH based on liver biopsy findings and divided into two groups according to the degree of liver fibrosis: mild (stage 0-1) or advanced (stage 2-4). Clinical and laboratory parameters and serum levels of hyaluronic acid and type IV collagen were measured. The aspartate aminotransferase/platelet ratio index (APRI) and fibrosis-4 (FIB-4) score were calculated. Results: Among the noninvasive markers, only serum type IV collagen level and FIB-4 were significantly different between the two groups. The area under the receiver operating curve of each biomarker and scoring system was 0.80 (95% confidence interval [CI]: 0.70-0.90) for type IV collagen at an optimal cutoff of 148 ng/mL (sensitivity 69.8%, specificity 84.6%), followed by 0.69 (95% CI: 0.57-0.83) for APRI, 0.68 (95% CI: 0.56-0.80) for FIB-4, and 0.65 (95% CI: 0.53-0.77) for hyaluronic acid. Conclusion: Type IV collagen as a single noninvasive serologic biomarker for hepatic fibrosis and FIB-4 as a hepatic fibrosis score are beneficial in predicting advanced hepatic fibrosis and determining proper diagnosis and treatment strategies before fibrosis progresses in obese children with NASH.

• Clinical and Experimental Pediatrics
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• v.48 no.10
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• pp.1082-1089
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• 2005

Purpose : Abdominal obesity is encountered as a risk factor for cardiovascular diseases. However, the anthropometric cut-off value to estimate the cardiovascular risk, has not been suggested. This study was designed to find the relationship between the abdominal fat and various parameters of obesity to find the cardiovascular risk factors related to abdominal obesity and to establish practical methods to measure them. Methods : Twenty seven obese Korean adolescents of moderate to severe degree and 22 healthy adolescents were enrolled. The body mass index(BMI), arm circumference and skinfold thickness were measured. Furthermore, blood lipid, sugar, insulin and four different cytokines' levels were checked and the distribution of body composition was measured by bioelectrical impedance analysis. The subcutaneous and intra-abdominal fat thickness by abdominal ultrasonography(US) and the total and intra-abdominal fat area by abdominal computerized tomography(CT) were measured in the obese group. Results : The most accurate method to measure abdominal fat in children is abdominal CT and the fat mass measured by bioelectrical impedance was strongly correlated with it(r=0.954). It was also correlated with arm circumference, fat thickness measured by abdominal US, BMI, aspartate aminotransferase(AST), alanine aminotransferase(ALT) and triglyceride level. Conclusion : Abdominal CT is the most accurate method to measure intra-abdominal fat, and it can be replaced by abdominal US for cost effectiveness. The screening methods that can be used at school or in outpatient basis include bioelectrical impedance, waist/hip ratio, and arm circumference. The cardiovascular risk factors include leptin, triglyceride and insulin level.

• Research in Community and Public Health Nursing
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• v.9 no.2
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• pp.502-517
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• 1998

This research intends to survey family environment, health behavior and health status of the students in urban-rural elementary schools and analyze those factors comparatively, and use the result as basic material for school health teacher to teach health education in connection with family and regional areas. It also intends to improve a pupil's self-abilitiy in health care. The subjects involve 2,774 students of urban elementary schools and 583 student in rural ones, who were selected by means of a multi -stage probability sampling. Using the questionnaire and school documents, we collected data on family environment, health behavior and health status for 19 days. Feb. 2nd 1998 through Feb. 20th 1998. The R -form of Family Environment Scale (Moos, 1974) was used in the analysis of family environment(Cronbach's Alpha =0.80). Questionnaires of Health Behavior in School-aged children used by the WHO in Europe(Aaro et al., 1986) and the ones developed by the Health Promotion Committee of the Western Pacific(WHO, 1995)(adapted by long Young-suk and Moon Young-hee(1996)) were used in the analysis of health behavior, as well documents on absences due to sickness, school health room-visits, levels of physical strength, height, weight and degree of obesity were used to determine health status. In next step, We used them with an $X^2$-test, t-test, Odds Ratio, and a 95% Confidence Interval. 1. In two dimensions of three, family-relationship (t=3.41, p=0.001) and system -maintenances(t= 2.41, p=0.0l6) the mean score of urban children were significantly higher than those of rural ones. In the personal development dimension however, there was little significant difference. Assorting family environment into 10 sub-fields and analyzing them, we recognized that urban children were superior to rural children in the sub-fields of expressiveness (t =3.47, p=0.001), conflict (t=0.48, p=0.001), active-recreational orientation (t = 1.97, p=0.049) and organization (t=4.33, p=0.000). 2. Referring to the Odds Ratios of urban-rural children's health behaviors, urban children set up more desirable behavior than rural children wear ing safety belts (Odds Ratio =0.32, p=0.000), washing hands after meals(Odds Ratio = 0.43, p= 0.000), washing hands after excreting (Odds Ratio = 0.39, p=O.OOO), washing hands after coming - home ( Odds Ratio = 0.75, p = 0.003), brushing teeth before sleeping(Odds Ratio =0.45, p=0.000), brushing teeth more than once a day (Odds Ratio =0.73, p=0.0l2), drinking boiled water (Odds Ratio = 0.49, p=0.000), collecting garbage at home(Odds Ratio=0.31, p=0.000) and in the school(Odds Ratio =0. 67, p=0.000). All these led to significant differences. As to taking milk(Odds Ratio = 1.50, p=0.000), taking care of eyesight(Odds Ratio=1.41, p=0.001) and getting physical exercise in(Odds Ratio = 1.33, p=0.0l9) and outside the school(Odds Ratio = 1.32, p=0.005), rural children had more desirable behavior which also revealed a significant difference. There was little significant difference in smoking, but the smoking rate of rural children(5.5%) was larger than that of urban children(3.9%). 3. Health status was analyzed in terms of absences, school health room-visits, levels of physical strength, and the degree of obesity, height and weight. Considering Odds Ratios of the health status of urban-rural children, the health status of rural children was significantly better than that of the urban ones in the level of physical strength(t=1.51, p=0.000) and the degree of obesity(t=1.84, p=0.000). The mean height of urban children ($150.4{\pm}7.5cm$) is taller than that of their counterparts($149.5{\pm}7.9$), which revealed a significant difference (t =2.47, p=0.0l4). The mean weight of urban children($42.9{\pm}8.6kg$) is larger than that of their counterparts($41.8{\pm}9.0kg$), which was also a significant difference(t=2.81, p=0.005). Considering the results above, we can recognize that there are significant differences in family environment, health behavior, and health status in urban-rural children. These results also suggestion ideas for health education. What we would suggest for the health program of elementary schools is that school health teachers should play an active role in promoting the need and importance of health education, develop the appropriate programs which correspond to the regional characteristics, and incorporate them into schools to improve children's ability to manage their own health management.

• Clinical and Experimental Pediatrics
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• v.51 no.3
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• pp.256-261
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• 2008

Purpose : Leptin and adiponectin are two representative adipocytokines. Leptin increases, but adiponectin decreases, with obesity and insulin resistance. We aimed to study the relationship between the leptin/adiponectin ratio and insulin resistance in healthy children. Methods : Seventy-seven healthy children (36 boys and 41 girls) were enrolled in this study. Anthropometric measurements were performed, and the percentage of weight for height (%WFH) was calculated in each subject. Fasting plasma levels of glucose, insulin, leptin, adiponectin, testosterone, estradiol, and sex-hormone binding globulin (SHBG) were measured. The free androgen index (FAI) was used as a representative of testosterone bioactivity. The homeostasis model assessment was used to estimate the degree of insulin resistance (HOMA-IR). Results : In the boys, HOMA-IR was significantly correlated with age, pubertal stage, free androgen index (FAI), leptin, and the leptin/adiponectin ratio. HOMA-IR was also significantly related to age, percentage of weight for height (%WFH), pubertal stage, estradiol, leptin, and the leptin/adiponectin ratio in girls. The leptin/adiponectin ratio was independently related to HOMA-IR after adjusting for age, %WFH, and FAI in the boys (P<0.05). The leptin/adiponectin ratio was not independently related to HOMA-IR after adjusting for age, %WFH, and estradiol in girls. Conclusion : In non-obese healthy children, the leptin/adiponectin ratio was significantly correlated with insulin resistance. The leptin/adiponectin ratio was independently related to insulin resistance even after adjusting for age, degree of obesity, and androgen levels in healthy boys.

• Journal of the Korean Society of School Health
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• v.16 no.1
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• pp.9-21
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• 2003

The present study was designed to evaluate the factors influential on stress and subjective fatigue symptoms based on school life environments and daily life styles among high school students. The self-administered questionnaires were delivered to 2,381 high school students of both sexes in Taejon Metropolitan city during the period from Mar. 1st to Jun. 30th, 2000. The analysis of study results revealed the following findings: 1. According to the magnitude of stress, the normal subjects were 3.1%, the groups with potential stress were 64.7%, and the groups at high risk for stress were 32.2%. Higher level of stress existed in the female than the male students, and in the third grader than the 1st and 2nd graders. According to the classification of typical constitutional symptoms of fatigue, category III (group with bodily projection of fatigue) was the most frequent and it was followed by category II (group with difficulty in concentration) and category I (group with dullness and sleepiness) in a decreasing order of frequency, which showed that the predominant pattern of fatigue arose from the body parts. 2. With regard to the school life characteristics and stress scores, the higher scores of stress were shown in the groups with the lower grades, with worse friend's relation and with the lower satisfaction with the school life. The scores for the subjective fatigue symptoms were higher in the male, in the low graders, in the better friend's relation, and in the satisfactory group than the respective counterparts. 3. Concerning home life characteristics, the higher scores of stress were associated with the students characterized by the recognized poor economic conditions, lower interests of parents, lack of satisfaction with the home life, the poor subjective health status. On the other hand, the scores for the subjective fatigue symptoms were higher in the student groups with good economic conditions, higher interests of parents, presence of satisfaction with the home life, and good subjective health status. 4. Concerning daily life styles, the higher scores of stress were in the students who had inappropriate sleep hours, skipped breakfasts, daily consumption of intermeal snacks, lack of exercise, daily smoking, normal indices of obesity, and lower indices of health habit. Conversely, the scores of subjective fatigue symptoms were higher in the groups who had daily breakfasts, no intermeal snacks, daily exercise, no smoking than their counterparts. 5. The factors exerting influence upon the stress included the satisfaction with school life, friend's relation, satisfaction with the home life, exercise, school grades, interests of parents, school year, sex, scores of health habit, degree of obesity, economic conditions of home. Those influencing on the degree os stress included stress, intermeal snacks, smoking, friend's relation and satisfaction with the home life.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.10 no.11
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• pp.3458-3464
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• 2009

This study was conducted to investigate the relationship between maximum oxygen uptake and its related factors including body measurement and vascular compliance. The subjects of our study were 43 males and 53 females aged 40 to 59 who were visited in military health center. The main results were that 1.the degree of obesity had significantly negative correlation to vascular compliance in male, and waist-hip ratio in female. 2. The degree of obesity, body mass index, waist-hip ratio and body fat percent had significantly negative correlation to maximum oxygen uptake in male, and waist-hip ratio & body fat percent in female. 3. Maximum heart rate had significantly positive correlation to maximum oxygen uptake in male, and vascular compliance & maximum heart rate in female. 4. In multiple regression analysis which maximum oxygen uptake was as dependent variable, body fat percent, vascular compliance and maximum heart rate were significant variables for both male and female. In conclusion, Maximum oxygen uptake of some rural people age 40 to 59 were affected by various factors such as body fat percent, vascular compliance, and maximum heart rate.

• The Journal of Korean Society for School & Community Health Education
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• v.6
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• pp.49-63
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• 2005

The purpose of this study was to investigate the weight control behaviors, the degree of fatness and dance major on behalf of finding the effects of eating disorders. 779 female high school students, 283 dance major students and 496 general major students, were participated in the study. A self-reporting type of questionnaire survey was conducted during the period from $6^{th}$ May to $18^{th}$ April of 2005. Collected data were processed using SPSSW in 12.0; they were analysed through frequencies, percentages, means and standard deviation, and stepwise multiple regression analysis. The results of this study are as follows : 1. With regard to the level of eating disorders(EAT-26), 33.9% of risk group of eating disorder female dance students, and 13.7% of risk group of eating disorder female general major students. Weight-control behaviors in this research were 1) weight control concerns, 2) weight control trial, 3) weight control methods (prescription of M.D., ways of weight control), 4) eating habits. First, 56.6% of subjects had high concerns about weight control, and 92% of subjects had tried weight control. Second, only 5.1% of subjects were prescribed by M.D. Third, subjects had been using wrong methods(25.7%) of weigh control such as fasting, using drugs, vomiting, wearing laps etc. Fourth, 42.7% of the subjects had bad eating habits. The degree of fatness was as follows: 1) BMI(Body Mass Index), 2) self report about weight 3) distorted body image. Depending upon the BMI, the subjects with obesity were not found in female dance students; Comparatively, 36.9% of dance students were fat and 1.4% of the students were very fat. In terms of distorted body image, only 14.9% of all subjects were the same between the subjective degree of fatness and the objective degree of fatness. 2. As a result of multiple regression, six variables were found significant($R^2=11.6%$, P < 0.01). Concerns about the weight control significantly influenced on eating disorders(EAT-26). At the same time, major(dance), wrong methods of weight control, distorted body image, prescription of M.D, and eating habits had significantly influenced on eating disorders. This results indicates that the risk of eating disorders among female dancer students was very high. Therefore, professional intervention is needed for female dance students to prevent the eating disorders.

• The Journal of Internal Korean Medicine
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• v.30 no.3
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• pp.550-557
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• 2009

Objectives : The purpose of this study was to investigate the possibility of Bi-Su as a pattern identification (PI) index in stroke patients. Methods : The subjects were 424 hospitalized stroke patients within 1 month from onset and diagnosed with the same PI subtypes (dampness & phlegm, qi deficiency, fire & heat, eum deficiency, and blood stasis) by agreement of two clinical experts. Bi-Su type is a kind of body shape (Bi : fat, Su : lean). Bi-Su type and degree (Bi-Su score) were decided by clinical expert. Body mass index (BMI) and waist-hip ratio (WHR) were used as an obesity index. Correlation analysis between Bi-Su score and obesity index (Spearman) and variance analysis for Bi-Su score, BMI, and WHR among PI subtypes (ANOVA) and sex were carried out. Results : While there was partial correlation between Bi-Su type and BMI($r^2$=0.634, p<0.001), the distribution of the BMI group based on the Bi-Su group showed the broadest range. The Bi-Su score in the dampness & phlegm group was higher than in the other groups (p<0.001). BMI in the dampness & phlegm groups was also higher but the BMI differences among PI subtypes was low (p=0.002). The Bi-Su score in the dampness & phlegm group was similar in both sexes, although the hand score in the eum deficiency group was the lowest, especially in males. Conclusions : Although BMI is not an objective enough tool for evaluating Bi-Su type, Bi-Su type is more appropriate than BMI as PI index. Therefore Bi-Su type could be used as one of the PI indices for dampness & phlegm or eum deficiency group in stroke patients.

• Annals of Pediatric Endocrinology and Metabolism
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• v.23 no.4
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• pp.196-203
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• 2018

Purpose: The hemoglobin glycation index (HGI) represents the degree of nonenzymatic glycation and has been positively associated with cardiometabolic risk factors (CMRFs) and cardiovascular disease in adults. This study aimed to investigate the association between HGI, components of metabolic syndrome (MS), and alanine aminotransferase (ALT) in a pediatric nondiabetic population. Methods: Data from 3,885 subjects aged 10-18 years from the Korea National Health and Nutrition Examination Survey (2011-2016) were included. HGI was defined as subtraction of predicted glycated hemoglobin ($HbA1_c$) from measured $HbA1_c$. Participants were divided into 3 groups according to HGI tertile. Components of MS (abdominal obesity, fasting glucose, triglycerides, high-density lipoprotein cholesterol, and blood pressure), and proportion of MS, CMRF clustering (${\geq}2$ of MS components), and elevated ALT were compared among the groups. Results: Body mass index (BMI) z-score, obesity, total cholesterol, ALT, abdominal obesity, elevated triglycerides, and CMRF clustering showed increasing HGI trends from lower-to-higher tertiles. Multiple logistic regression analysis showed the upper HGI tertile was associated with elevated triglycerides (odds ratio, 1.65; 95% confidence interval, 1.18-2.30). Multiple linear regression analysis showed HGI level was significantly associated with BMI z-score, $HbA1_c$, triglycerides, and ALT. When stratified by sex, age group, and BMI category, overweight/obese subjects showed linear HGI trends for presence of CMRF clustering and ALT elevation. Conclusion: HGI was associated with CMRFs in a Korean pediatric population. High HGI might be an independent risk factor for CMRF clustering and ALT elevation in overweight/obese youth. Further studies are required to establish the clinical relevance of HGI for cardiometabolic health in youth.

• Clinical and Experimental Pediatrics
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• v.48 no.7
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• pp.745-752
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• 2005

Purpose : Adolescent obesity is known to be associated with complications such as hypertension, coronary artery disease and insulin resistance. We measured the common carotid artery by ultrasound as a predictor of atherosclerosis, and investigated the relationship between carotid artery parameters and serum cytokines in obese adolescents. Methods : Twenty-nine obese adolescents(16-17 years old, obesity index>130 percent) and twentyseven normal controls were included. Obesity index and body mass index were calculated from their height and weight. Skin fold thickness was measured at the triceps, and fat mass and fat distribution by bioelectrical impedence analysis. Blood pressure was measured at resting state and serum lipid, insulin, and homocysteine levels after a 12-hour fasting period. Intimal wall thickness, systolic and diastolic diameters of the common carotid artery were measured by ultrasound, and compliance and distensibility calculated by equation. Results : Systolic and diastolic diameters of the carotid artery significantly correlated with arm circumference, body mass index, fat distribution and fat mass. The higher systolic blood pressure was, the larger systolic and diastolic diameter. The higher diastolic blood pressure was, the larger carotid intimal thickness. Insulin levels had positive correlations with systolic, diastolic diameters and serum homocysteine level with intimal thickness. Conclusion : The carotid artery diameter significantly increased with the degree of obesity and blood pressure. The carotid intimal wall thickness significantly correlated with diastolic blood pressure. Measurement of carotid artery thickness, insulin and homocysteine levels might be useful to predict the development of coronary artery disease.