• Clinical and Experimental Pediatrics
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• v.51 no.1
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• pp.42-46
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• 2008

Purpose : Apolipoprotein E (Apo E) plays a major role in lipoprotein metabolism and lipid transport. Many investigators have described that Apo E polymorphisms is one of the most important genetic determinants for cardiovascular disease. The purpose of this study was to evaluate the association between Apo E polymorphisms and serum lipid profiles in obese adolescent. Methods : We measured the serum concentrations of glucose, apolipoprotein (Apo) A1, Apo B, total cholesterol (TC), triglyceride (TG), HDL and LDL-cholesterol after overnight fasting in obese adolescent. Apo E polymorphisms were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results : 86 obese adolescents participated in this study. The body mass index (BMI) of participants were excess of 95 percentile by age and sex. Male to female ratio was 1.7 and mean age of study group was $16.2{\pm}1.8\;years$. Mean BMI was $27.4{\pm}2.5kg/m^2$. The frequency of ${\varepsilon}2$, ${\varepsilon}3$ and ${\varepsilon}4$ allele were 8.1%, 87.2% and 4.7% respectively. Study populations were classified into the following three genotypes 1) Apo E2 group (n=13, 15.1%) carrying either the ${\varepsilon}2/{\varepsilon}2$ or ${\varepsilon}2/{\varepsilon}3$ 2) Apo E3 group (n=65, 75.6%) carrying the most frequent ${\varepsilon}3/{\varepsilon}3$ 3) Apo E4 group (n=8, 9.3%) carrying either the ${\varepsilon}3/{\varepsilon}4$ or ${\varepsilon}4/{\varepsilon}4$. No differences were found among Apo E genotypes concerning age, sex, weight, height and BMI. Apo B and LDL-cholesterol concentrations were significantly higher in the Apo E4 group (P<0.05). No association were found between Apo E genotypes and glucose, Apo A1, TC, TG and HDL. Conclusions : We confirmed that serum concentrations Apo B and LDL-cholesterol were influenced by Apo E genotypes. Apo E polymorphisms seems to influence some alteration of lipid metabolism associated with obesity in adolescent.

• Clinical and Experimental Pediatrics
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• v.49 no.9
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• pp.946-951
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• 2006

Purpose : The purpose of this study was to demonstrate the effectiveness of combined exercise for 12 weeks on the adiponectin and obesity related variables in overweight and obese children. Methods : Eighteen children in 5th grade in a certain elementary school in Busan were recruited. They were all overweight or obese children(more than 85 percentile in body mass index). Nine children in the experimental group were given exercises consisting of walking and band resistant training for 12 weeks. Auxological data(including height, weight and body fat mass) and laboratory data (fasting blood sugar, insulin, adiponectin) were checked at baseline and at the 1 week, and at the 4 weeks and 12 weeks stages of their exercise program. Insulin resistance and sensitivity were evaluated indirectly using HOMA index and QUICKI index. Results : Adiponectin gradually decreased until the 4 weeks point and gradually increased thereafter to the starting level at the 12 weeks stage. Body weight, body mass index(BMI) and HOMA index significantly decreased more at the 1 week, 4 weeks, and 12 weeks stages in the experimental group than in the control group. Body fat mass significantly decreased at 12 weeks. The change of insulin was significantly correlated with changes of body weight and BMI. But there was no correlation between changes of adiponectin and changes of insulin. Conclusion : Exercise seems to effect the adiponectin concentration. And it might be assumed that exercise increases the adiponectin concentration if it is continued for long time(may be more than 12 weeks). More studies may be necessary to draw that conclusion.

• Clinical and Experimental Pediatrics
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• v.48 no.5
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• pp.527-533
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• 2005

Purpose : Long-term administration of anticonvulsants in children with epilepsy may cause short stature, hypocalcemia and low bone mineral density. This study was performed for the early detection of abnormal bone metabolism in children with epilepsy on taking anticonvulsants. Methods : Thirty children aged 5 to 16 years who were diagnosed with epilepsy were enrolled in this study. All had taken anticonvulsants for more than one year. Bone mineral density of lumbar vertebra was measured by dual-energy X-ray absorptiometry. Serum calcium, phosphorous, alkaline phosphatase, 25-hydroxycholecalciferol[$25(OH)D_3$], parathyroid hormone, and urine deoxypyridinoline were measured as biochemical bone markers. Bone age and body mass index were also calculated. Results : Bone minreal density, body mass index, bone age, and height were significantly decreased in two female patients who had taken two antiepileptic drugs for more than four years and they also had chronic diseases such as cerebral palsy with microcephaly, encephalomalacia, and microcephaly with atrial septal defect. Bone mineral density had significant positive correlations with body mass index(P<0.01) and bone age(P<0.01). Conclusion : This study showed chronic medication of anticonvulsants in children may cause low bone mineral density and short stature. Bone age and body mass index could be the important surrogate markers to find the population at risk. More studies, including a large study population and long term cohort study, will be required.

• Clinical and Experimental Pediatrics
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• v.46 no.3
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• pp.217-223
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• 2003

Purpose : Every year, there is a remarkable increase in the prevalence of children with excess body fat. The aim of this study is to find a useful screening method in assessing adolescent, obesity and to specify the predictable risk factors that are related to adult cardiovascular disease according to BMI and obesity index. Methods : From July to November in 2001, a total of 2,814(male : female=2,011 : 803) mid to high school students who were in the obesity range according to obesity index(>20%) were evaluated according to height, weight, body mass index(BMI), obesity index, and serum lipid levels. Results : Among the obese students over 20% by obesity index, 86.6% were over the range of 95 percentile by BMI. Among students defined as obese by BMI, 21.0% of males and 21.4% of females students had hypercholesterolemia; by obesity index, the ratio was 20.7% male and 19.0% female. The frequency of hypertriglyceremia in male students was 15.0% in group I(overweight group, 85P97p); in female students 11.8%, 20.7% and 28.2% respectively. Conclusion : In this study, using BMI alone to test the serum lipid level in adolescent obesity had a limit of 10.0-17.0% omission. Therefore using obesity index as a screening method to find the adult cardiovascular disease would rather reduce the omission rate. The risk factor of cardiovascular disease according to BMI was the increasing level of triglyceride in both male and female students. We think that using the obesity index has more rationale rather than BMI in assessing lipid profiles.

• Clinical and Experimental Pediatrics
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• v.52 no.10
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• pp.1109-1118
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• 2009

Purpose : Metabolic syndrome (MS), characterized by obesity and insulin resistance, elicits risk factors such as hyperlipidemia, hypertension, and glucose intolerance with additive effects on atherosclerosis, leading to cardiovascular diseases. The purposes of this study were to evaluate the prevalence of MS among overweight and obese adolescents and to investigate the impact of obesity on the cardiovascular system. Methods : In all, 684 adolescents were included in the study. Blood pressure, body mass index (BMI), fasting blood glucose, total cholesterol, triglyceride, low-density-lipoprotein (LDL)-cholesterol, high-density-lipoprotein (HDL)-cholesterol, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and high-sensitive C-reactive protein (hs-CRP) were measured in the patients with a BMI of >85 percentile. Brachial-ankle pulse wave velocity (BaPWV) and ankle brachial index were measured using Vascular Profiler (VP)-1000. Results : MS was confirmed in 19.5% of the overweight and obese adolescents and 50.8% of the obese adolescents. The systolic and diastolic blood pressure, height, weight, fat mass, %fat, BMI, obesity index, and waist circumference were higher in the overweight and obese adolescents with MS. Moreover, the triglyceride, AST, ALT, and hs-CRP levels were higher, whereas HDL-cholesterol level was significantly lower in this group. The overweight and obese adolescents with MS showed shorter diastolic and systolic times, higher heart rate and BaPWV, and longer E-wave deceleration time by echocardiography. Conclusion : Overweight and obese adolescents showed characteristic MS features such as hypertension and hyperlipidemia. Thus, obese adolescents predisposed to MS should be provided early treatment for obesity.

• Clinical and Experimental Pediatrics
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• v.45 no.9
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• pp.1126-1133
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• 2002

Purpose : Prader-Willi syndrome(PWS) is a complex disorder affecting multisystems with characteristic clinical features. Its genetic basis is an expression defect in the paternally derived chromosome 15q11-q13. We analyzed the clinical features and genetic basis of PWS patients for early detection and treatment. Methods : We retrospectively studied 24 patients with PWS in Department of Pediatrics, Samsung Medical Center, from September 1997 to September 2001. We performed cytogenetic and molecular genetic techniques using high resolution GTG banding techniques, fluorescent in situ hybridization and methylation-specific PCR for CpG island of SNRPN gene region. Results : The average birth weight of PWS patients was $2.67{\pm}0.47kg$ and median age at diagnosis was 1.3 years. The average height and weight of PWS patients under one year at diagnostic time were located in a 3-10 percentile relatively, and a rapid weight gain was seen between two and six years. Feeding problems in infancy and neonatal hypotonia were the two most consistently positive major criteria in over 95% of the patients. In 18 of the 24 cases(75%), deletion of chromosome 15q11-q13 was demonstrated and one case among 18 had an unbalanced 14;15 translocation. In four cases without any cytogenetic abnormality, it may be considered as maternal uniparental disomy and the rest showed another findings. Conclusion : We suggest diagnostic testing for PWS in all infants/neonates with unexplained feeding problems and hypotonia. It is necessary for clinically suspicious patients to undergo an early genetic test. As the genetic basis of PWS was heterogenous and complex, further study is required.

• Clinical and Experimental Pediatrics
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• v.50 no.2
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• pp.182-189
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• 2007

Purpose : The primary purpose of this study was to evaluate the growth and neuropsychologic function following treatments for pediatric hematologic and oncologic diseases. Healthy monozygotic twins served as ideal controls for comparison to exclude possible confounding factors. Methods : Seven children treated with various hematologic and oncologic diseases were included in the study: acute lymphoblastic leukemia (ALL; n=2), Diamond-Blackfan anemia twins (n=2), and aplastic anemia (n=3). The median age at the diagnosis was 5.2 (0.3-15) years. The median duration of follow-up was 7.2 (4.9-10) years. Controls were healthy monozygotic twins. Growth was measured and the percentile channels were evaluated sequentially for patients. The K-WISC III was applied and compared in 5 pairs of patients and controls. Results : Similar growth profiles were noted for the twins. The percentiles at diagnosis was 3-10 in 3, 25-50 in 2, and 50-75 in 2 cases. All patients stayed in their growth percentiles through follow-up, except for 1 patient who became obese. For IQ tests, the mean behavioral, verbal and full scale IQ scores of patients were 88.0, 93.8, and 89.8, respectively, and those from their corresponding controls were 92.2, 97.0, and 91.7 (P>0.05). However, 2 children who were treated for ALL had lower IQ scores. Conclusion : Similar growth profiles were observed in the monozygotic twins in terms of height and weight. The IQ scores of patients were similar to those of monozygotic twins. However, prophylactic CNS-directed therapy for leukemia might adversely affect the IQ scores. A further prospective study on larger number of twins is warranted.

• Clinical and Experimental Pediatrics
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• v.51 no.12
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• pp.1300-1309
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• 2008

Purpose :This study aimed to estimate age- and gender-specific cut points for metabolic syndrome (MS) components, including body mass index (BMI), blood pressure (BP), triglycerides, high-density lipoprotein (HDL) cholesterol, and glucose. Methods :Data from the 1998, 2001, and 2005 Korean NHANES (National Health and Nutrition Examination Survey) were analyzed (n=4164; 2,139 boys and 2,025 girls, aged 10-19 years). Height, weight, waist circumference (WC), BP, triglycerides, HDL cholesterol, and fasting glucose were measured. Results :BMI over $25kg/m^2$ represents the $85^{th}P$ (percentile) in 17-year-old boys and the $90^{th}P$ in 17-year-old girls. A level of WC higher than that of the cutoff points of Asian adults was found in the $90^{th}P$ of 17-year-old boys and girls. The $90^{th}P$ of boys aged 15 years old and the $95^{th}P$ of 13-year-old were included in the range of systolic BP over 130 mm Hg. Over the $75^{th}P$ of the group showed triglycerides greater than 110 mg/dL, (criterion of MS presented by NCEP-ATP III) and the $90^{th}P$ of the group showed triglycerides greater than 150 mg/dL by IDF. An HDL cholesterol level of 40 mg/dL represents the $25^{th}P$ in boys and the $10^{th}P$ in girls. A glucose level greater than 110 mg/dL represents the $95^{th}P$ and greater than 100 mg/dL represents the $90^{th}P$. Conclusion :Values of the $90^{th}P$ of MS components in late adolescent boys (WC, BP, and triglycerides) and girls (WC and triglycerides) were very high and in close proximity to the diagnostic criteria of adult MS.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.13 no.1
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• pp.51-57
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• 2010

Purpose: It has been reported that children with hypopituitarism have features of metabolic syndrome, including obesity, impaired glucose tolerance, and dyslipidemia. The aim of this study was to investigate the clinical features and liver histology of pediatric non-alcoholic fatty liver disease (NAFLD) associated with hypopituitarism. Methods: We reviewed the clinical data of 11 children diagnosed with NAFLD among patients with hypopituitarism. Results: The mean age at the time of diagnosis of hypopituitarism was 10.4${\pm}$3.2 years, and the mean age at the time of diagnosis of NAFLD was 13.1${\pm}$2.7 years. A craniopharyngioma was the most common cause of pituitary dysfunction. At the time of diagnosis of NAFLD, 9 patients (82%) had a body mass index greater than the 85th percentile, 5 patients (45%) had elevated fasting blood glucose levels, and 9 patients (82%) had hypertriglyceridemia. The mean height SD score was significantly lower at the time of diagnosis of NAFLD than at the time of diagnosis of hypopituitarism. Of the six patients who were biopsied, one had cirrhosis, two had non-alcoholic steatohepatitis (NASH) with bridging fibrosis, two had NASH with mild portal fibrosis, and one had simple steatosis. Conclusion: Children with hypopituitarism are at risk of short stature, obesity, dyslipidemia, and NAFLD. The early diagnosis of NAFLD is important in children with hypopituitarism because advanced fibrosis is common.

• Research in Community and Public Health Nursing
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• v.15 no.4
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• pp.587-599
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• 2004

Purpose: The purpose of this study is to compare abdomen-fat rate, life style and social-support between normal weight women and obese women. Method: 304 women objectives from their 30 to 59 years of age were selected living in Je-chon city, Chung-Buck province and their height and weight were measured from April 1st to June 30th, 2003. Data were classified into low-weight group ($18.5kg/m^2$), normal-weight group ($18.5{\sim}22.9kg/m^2$), over weight group ($23{\sim}24.9kg/m^2$), and obese group ($25kg/m^2$) following the Korean Conference of Obesity, 2001. in which 119 people in the normal weight group and 91 people in the obese group, i.e. total 210 people were analyzed in sequence. Using SPSS Win 10.1 Program, frequency and percentile, and by ANOVA, $X^2-test$ and t-test were treated. Results: The average age of obese women was 46.68 distributing 40.7% of forties and 39.6% of fifties while normal-weight women were average 41.73-year old distributing 53.8% of forties and 34.5% of thirties, which revealed aged in obese women. The body fat rate of obese women averaged $37.52{\pm}4.17%$, in which 98.9% of obese women and 21.0% of normal weight women with a more than 30% of body-fat rate resulted in a higher body-fat rate in obese women. The waists of obese women averaged $88.37{\pm}8.22cm$, in which more than 85cm showed in obese women of 68.2% and normal weight women of 7.6% indicating a higher waist-fat rate in obese women. The abdomen-fat rate of more than 0.85 of waist vs hip-fat showed 74.7% in obese women and 58.4% in normal weight women, indicating a higher abdomen-fat rate in obese women. Obese women and normal weight women showed significant differences in education level, number of children, religion, menstrual status, and mother's weight. Especially, obese women ate hotter or saltier food than normal weight women preferring meat. However, no significant differences appeared in marital status, social economic status. occupation. eating habits. smoking. drinking and physical exercise. Social support levels showed a lower rate in obese women than in normal weight women, indicating a statistically significant difference (p<.05). Observing areas of social support, obese women showed lower rates in attachment/intimacy, social integrity, opportunity of foster and confidence in value except help and instruction, which indicated a statistically significant difference (p<.05). Social support for obese women showed significant differences in age, education level, social hierarchy, religion and menstrual status. Obese women were more negative than normal weight women in health recognition, indicating a statistically significant difference (p<.01). Normal weight women showed higher health recognition when provided high social support and significantly low (p<.01) health recognition when provided low social support. However, there was no significant difference in health recognition in obese women whether high or low social support was given. The health recognition of obese women showed significant differences in age, education level, social hierarchy, number of children, menstrual status, physical exercise, eating habits, eating taste and preference of food. Conclusion: Obese women showed elder than normal-weight women, higher body-fat rate and abdomen-fat rate, lower social support, and a tendency to more negative health recognition. Therefore, providing weight-control programs for the treatment of obesity and prevention of recurrence for obese women to prevent progressing to adult disease and promote a healthy life, we suggest that better eating habits and the encouragement of regular physical exercise should be included, as well as total approachment on change of health recognition and social support would be needed.