• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제24권2호
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• pp.187-196
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• 2021

Purpose: The rising prevalence of childhood obesity in the past decades has caused non-alcoholic fatty liver disease (NAFLD) to become the most common cause of pediatric chronic liver disease worldwide. This study was aimed at determining the effect of vitamin D (Vit D) on ultrasonography and laboratory indices of NAFLD and some blood biochemical indicators in children. Methods: In this interventional study liver ultrasonography was performed in 200 children with overweight and obesity. A 108 had fatty liver among which 101 were randomly divided into two groups of study (n=51) and control (n=50). The study group was treated with Vit D, 50000 U once a week whereas the control group received placebo with the same dose and package, both for 12 weeks. At the end of the intervention lab tests and ultrasound study was performed once again to evaluate the response to treatment. Results: It was found out that Vit D supplementation improved the fatty liver grade in the study group. The mean changes in hemoglobin (Hb), uric acid, highdensity lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), insulin, albumin and alanine aminotransferase (ALT) was significantly higher in the study group compared to controls (p<0.05). After the intervention and means adjustment, a significant difference was obtained in HDL-C, insulin, LDL-C and homeostasis model assessment of insulin resistance (HOMA-IR) between the two groups. Conclusion: Vit D supplementation in addition to improving the fatty liver grade in ultrasonography and increasing the blood Vit D level, increases the HDL and Hb level besides decreasing uric acid, LDL, HOMA-IR, insulin and ALT levels.

• Clinical and Experimental Pediatrics
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• 제63권12호
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• pp.477-482
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• 2020

The childhood obesity pandemic has emerged as an important public health problem in many countries. Obese children are likely to become obese adults, and adult obesity is associated with an increased risk of morbidity. Therefore, controlling the childhood obesity epidemic has become a top public health priority worldwide. The current coronavirus disease 2019 (COVID-19) pandemic may significantly impede this important mission and constitute an unprecedented tragedy in the global battle against childhood obesity. This manuscript presents evidence that the COVID-19 pandemic will aggravate the childhood obesity epidemic and lead to significant weight gain in school children by creating an unprecedented obesogenic environment. Within the last few months, many countries took uncompromising measures in response to the COVID-19 pandemic, including school closures and quarantine. While these steps are often necessary to ensure infection control, they may have a significant negative effect on children's mental and physical health. Physical, nutritional, and psychosocial factors that promote obesity in children during this special situation complementarily contribute to an unprecedented obesogenic environment. Large-scale quarantine and home confinement will impose new and unfamiliar stressors on children, thereby worsening the childhood obesity epidemic. Most importantly, adverse childhood events resulting from a predicted increase in domestic violence within the next few months will significantly contribute to this concern. The scenario presented in this review is of paramount public health importance and must be considered during future pandemic planning. Involved stakeholders, including governments, schools, and families, must make all possible efforts to minimize the impact of the COVID-19 epidemic on childhood obesity.

• Childhood Kidney Diseases
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• 제14권1호
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• pp.94-99
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• 2010

Obesity-related glomerulopathy (ORG)는 단백뇨를 보이는 비만아에서 신장 조직학적 소견상 사구체 비대, 국소 분절성 사구체 경화 소견이 관찰되고 기저막 비후, 국소 간질조직 증식, 중등도의 발 돌기 소실 등을 보이는 질환으로 정의된다. 특발성 국소분절 사구체경화증과 비교하여 신증후군이 적으며 콜레스테롤 상승이 적고, 병의 진행이 느리다는 점에서 차이가 있다고 알려져 있으며, 체중감소를 통해 신장 기능이 회복될 수 있다고 알려져 있다. 본 증례의 9세된 비만아는 임상증상과 신장 조직검사에서 ORG로 진단되어 치료하였으나, 지속적인 체중 증가와 단백뇨로 말기 신부전으로 진행하여 소아 ORG 환아에서는 드문 경과를 취하여 이를 보고하는 바이다.

• Clinical and Experimental Pediatrics
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• 제52권12호
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• pp.1321-1326
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• 2009

Prevalence of obesity in Korean children and adolescents has dramatically increased since the last 10-20 years. It is important to initiate prevention efforts early in childhood because prevalence of obesity in adolescence is the strongest predictor of its prevalence in adulthood. Intrauterine life, infancy, and preschool years may comprise the critical periods that are essential for the long-term regulation of energy balance therefore, obesity-prevention strategies should be initiated in utero and continued throughout childhood and adolescence. Families with high-risk children should be provided early education about maintaining normal weight. Encouraging physical activity and, especially, avoiding inactivity, are key challenges in the prevention of future obesity. Schools should be primarily involved in educating parents to discourage their children from excessively watching TV or playing computer games and eating unhealthy snacks and food. The involvement of medical practitioners is also important, especially, in the case of obese parents, obesity prevention strategies should be promoted from the first visit of pregnant women to the physicians. Health professionals can also be involved in obesity prevention because they are ideally equipped to identify young children at risk of obesity. Community and nation-wide efforts to increase awareness and promote environments that encourage physical activity and healthy nutrition are required.

• Clinical and Experimental Pediatrics
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• 제51권6호
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• pp.564-568
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• 2008

The prevalence of obesity in Korean children is estimated to be around 10%, and has increased significantly over the past 20 years. Metabolic syndrome, which includes central obesity, glucose intolerance, insulin resistance, dyslipidemia, and hypertension, is a well documented risk factor for cardiovascular diseases, but there is no general consensus concerning its definition for children. In this study, ablut 30-40% of overweight or obese children had metabolic syndrome compared to less than 10% in the general population. Dyslipidemia was the most common component and hyperglycemia was the least common component of metabolic syndrome. If the prevalence of childhood obesity continues to increase, it is highly likely that the prevalence of the metabolic syndrome will also increase. These findings emphasize the importance of preventing obesity in addition to the diagnosis and management of metabolic syndrome in Korean adolescents.

• Clinical and Experimental Pediatrics
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• 제48권2호
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• pp.126-137
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• 2005

New insights in the complex metabolic pathways and its control mechanism for energy homeostasis have refined our understanding of the pathophysiology of obesity. It is now recognized that there are several additional regulatory mechanism such as peripheral signals including leptin, ghrelin, GLP-1 and PYY and cellular signals including uncoupling proteins and ${\beta}$ Adrenergic receptors, which contribute to the regulation of food intake and energy expenditure, respectively. In addition, the function of adipocyte as an endocrine organ in energy homeostasis has been recently emphasized. Recent findings suggest that elevated levels of adipokines, such as leptin, adiponectin, resistin and TNF-${\alpha}$, in addition to increased free fatty acid level could be related to the pathophysiology of insulin resistance in obesity. For effective treatments and prevention of obesity, further studies on the circuits of neural and endocrine interactions in the regulation of energy homeostasis are needed.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제22권4호
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• pp.407-412
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• 2019

Excessive weight gain in children diagnosed with celiac disease (CD) is becoming more common. We describe 2 siblings (9-year and 6 months-old female and 6-year and 9 months-old male) with obesity showing attenuated gastrointestinal and atypical symptoms in which CD was diagnosed in the absence of a known family history of CD. After children's diagnosis, CD in their parents was also investigated. It was detected in their father affected by overweight. The presentation of patients with CD has changed. While patients with overweight and obesity commonly have symptoms such as abdominal pain, reflux, headache, and constipation due to lifestyle factors, CD should also be considered in patients with or without a family history of CD. Careful nutritional status assessment and follow-up monitoring after the diagnosis of CD are mandatory, especially in subjects who are already overweight at the presentation of this disease.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제23권3호
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• pp.189-230
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• 2020

The metabolic syndrome, by definition, is not a disease but is a clustering of individual metabolic risk factors including abdominal obesity, hyperglycemia, hypertriglyceridemia, hypertension, and low high-density lipoprotein cholesterol levels. These risk factors could dramatically increase the prevalence of type 2 diabetes and cardiovascular disease. The reported prevalence of the metabolic syndrome varies, greatly depending on the definition used, gender, age, socioeconomic status, and the ethnic background of study cohorts. Clinical and epidemiological studies have clearly demonstrated that the metabolic syndrome starts with central obesity. Because the prevalence of obesity has doubly increased worldwide over the past 30 years, the prevalence of the metabolic syndrome has markedly boosted in parallel. Therefore, obesity has been recognized as the leading cause for the metabolic syndrome since it is strongly associated with all metabolic risk factors. High prevalence of the metabolic syndrome is not unique to the USA and Europe and it is also increasing in most Asian countries. Insulin resistance has elucidated most, if not all, of the pathophysiology of the metabolic syndrome because it contributes to hyperglycemia. Furthermore, a major contributor to the development of insulin resistance is an overabundance of circulating fatty acids. Plasma fatty acids are derived mainly from the triglycerides stored in adipose tissues, which are released through the action of the cyclic AMP-dependent enzyme, hormone sensitive lipase. This review summarizes the latest concepts in the definition, pathogenesis, pathophysiology, and diagnosis of the metabolic syndrome, as well as its preventive measures and therapeutic strategies in children and adolescents.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제22권3호
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• pp.233-241
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• 2019

Purpose: Vitamin D deficiency is a condition widespread throughout the world. Recent studies have suggested that vitamin D deficiency was associated with obesity and metabolic syndrome. The purpose of the study was to examine the relationship between vitamin D deficiency and nonalcoholic fatty liver disease (NAFLD) in adolescents. Methods: The data were obtained from the Korean National Health and Nutrition Examination Survey from 2008-2014. A total of 3,878 adolescents were included in the study. Vitamin D deficiency was defined as a 25-hydroxyvitamin D concentration <20 ng/mL and suspected NAFLD was defined as an alanine transaminase concentration >30 U/L. Results: Vitamin D deficiency was noted in 78.9% of the studied population. Age, body mass index, waist circumference, and blood pressure, glucose, cholesterol, and triglyceride levels were significantly higher in adolescents with suspected NAFLD than in adolescents without suspected NAFLD, while the mean vitamin D level was significantly lower in adolescents with suspected NAFLD. The multivariate-adjusted odds of suspected NAFLD were higher with increased age, male gender, obesity, and metabolic syndrome. Individuals with vitamin D deficiency were at higher risk of suspected NAFLD (odds ratio, 1.77; 95% confidence interval, 1.07-2.95) after adjusting for age, gender, obesity, and metabolic syndrome. Conclusion: Vitamin D deficiency was associated with suspected NAFLD, independent of obesity and metabolic syndrome, in adolescents.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제15권2호
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• pp.74-78
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• 2012

With a markedly increased prevalence of obesity, non-alcoholic fatty liver disease (NAFLD) now becomes the most common cause of chronic liver disease in both adults and children. The etiology and pathogenesis of NAFLD are multifactorial and remain incompletely understood. According to the "two-hit" theory, inflammatory cytokines and adipokines are activated by oxidative stress and they are involved in insulin resistance, necroinflammatory steatohepatitis and fibrosis. This review discusses the latest updates on the role of some of important inflammatory adipokines and cytokines in the pathogenesis of NAFLD with an emphasis on their potential therapeutic implications.