The metabolic syndrome is defined as a concurrence of obesity, disturbed glucose and insulin metabolism, hypertension and dyslipidemia, and is associated with increased morbidity and mortality from cardiovascular diseases and type 2 diabetes. With the increasing prevalence of childhood obesity, the prevalence of metabolic syndrome is rising among children and adolescents. Identifying these children is important for early prevention and treatment of different components of the syndrome. The first-line treatment comprises lifestyle modification consisting of diet and exercise. The aim of this article is to provide a overview of the diagnosis and treatment of childhood metabolic syndrome, as well as to present the relationships between metabolic syndrome and its individual components.
Adolescent ; Cardiovascular Diseases ; Child ; Diet ; Dyslipidemias ; Glucose ; Humans ; Hypertension ; Insulin ; Life Style ; Obesity ; Prevalence

Iron and zinc are essential nutrients for growth and development in children. Iron deficient anemia is the most widespread and common nutritional disorder. A deficiency of iron results in fatigue, poor work performance, decreased immunity and possible irreversible effects on the early cognitive development. Oral administration of ferrous salts (most often ferrous sulfate) provides inexpensive and effective therapy. On the other hand, because of low nutritional requirements and plentiful supply, deficiencies of zinc are rare. Children may have apparently asymptomatic deficiencies of zinc, but still benefit from supplementation. Zinc is a crucial micronutrient because it affects various immune mechanisms and modulates host resistance to several pathogens. Zinc supplementation of at-risk children reduces the incidence and severity of diarrhea, pneumonia, and possibly common cold. Early identification of risk factors and nutritional intervention with sufficient iron and zinc supply is much more important than therapeutic supplementation.
Administration, Oral ; Anemia ; Child ; Common Cold ; Diarrhea ; Fatigue ; Growth and Development ; Hand ; Humans ; Incidence ; Iron ; Micronutrients ; Nutrition Disorders ; Nutritional Requirements ; Pneumonia ; Risk Factors ; Salts ; Zinc

Eating disorders impact on both physical and mental health with a profound disruption in the quality of life of adolescent. The prevalence of these disorders has been increasing in East Asia and over 10% of young people have some eating disorder related traits. Cultural changes such as the internalisation of the thin ideal predispose to eating disorders. The core features of eating disorders are the pursuit of weight loss and the resultant low body weight or compensatory behavior. The nutritional compromise of eating disorders, particularly anorexia nervosa, results in disruption in menstrual cycle, increased medical risks, and an eventual increase in mortality. The mortality rate of anorexia nervosa is 12 times the rate of healthy age-matched women. The underlying medical causes of the increased mortality rate were cardiovascular, endocrine, hematopoietic, autoimmune, respiratory, and urogenital in nature. High frequencies of medical complications in eating disorders emphasizes the importance of recognizing eating disorders as a medical risk in adolescent in Korea. Successful approaches to prevention against eating disorders have already been developed for adolescent in Europe. Public health interventions targeted at schools responsible for the care of adolescent (parents, teachers, college tutors) would be useful in Korea.
Adolescent ; Anorexia Nervosa ; Body Weight ; Bulimia Nervosa ; Eating ; Feeding and Eating Disorders ; Europe ; Far East ; Female ; Humans ; Korea ; Menstrual Cycle ; Mental Health ; Prevalence ; Public Health ; Quality of Life ; Weight Loss

Chronic constipation is a very common disease in children. Successful treatment of constipation can be achieved not only with medication but also with lifestyle changes, including a proper diet. Diets including fruits, fluids, and probiotics are good for constipation. Some dietary components are helpful for constipation, and some are harmful. In this study, we present diets related to constipation from the literature, and propose some perspectives regarding diets related to constipation.
Child ; Constipation* ; Diet* ; Fruit ; Humans ; Life Style ; Probiotics

A 4-week-old infant presented with a coagulation disorder resulting from a vitamin K deficiency. The vitamin K deficiency was caused by neonatal cholestasis due to biliary atresia. Jaundice, hepatomegaly and pale stools are the predominant presenting symptoms of biliary atresia, none of which were recognized in our patient before admission. However, the patient presented with bleeding caused by vitamin K deficiency. She was fully breastfed and had received adequate doses of vitamin K at birth and from the age of 1 week. In case of a hemorrhagic diathesis due to neonatal cholestasis, timely identification of treatable underlying disorders, in particular biliary atresia, is important because an early surgical intervention results in a better prognosis. Meticulous history taking and a thorough physical exam can be decisive for an early diagnosis and subsequent intervention.
Biliary Atresia ; Cholestasis* ; Early Diagnosis ; Hemorrhage ; Hemorrhagic Disorders* ; Hepatomegaly ; Humans ; Infant ; Jaundice ; Parturition ; Prognosis ; Vitamin K ; Vitamin K Deficiency

Lymphocytic gastritis (LG) is a rare subtype of chronic gastritis. It is defined as dense proliferation of intraepithelial lymphocytes (IELs) more than 25 lymphocytes per 100 epithelial cells. The known major causes of LG are celiac disease and Helicobacter pylori infection. H. pylori associated LG (HpLG) has more enhanced cytotoxic and apoptotic tendencies than chronic H. pylori gastritis. A 12-year-old girl with postprandial epigastric pain was diagnosed HpLG on endoscopic biopsy. After the 1st eradication therapy, H. pylori bacilli were still found, and urea breathing test was positive. Although the endoscopic finding was partially improved, clinical symptoms and histologic finding were persisted. We could achieve the improvement of clinical symptoms and disappearance of IELs after the 2nd eradication. The discordant of histopathologic and endoscopic improvement occurred after the 1st eradication therapy of HpLG. Therefore the clinical and histopathologic evaluation should be considered as well as endoscopic findings.
Biopsy ; Celiac Disease ; Child* ; Epithelial Cells ; Female ; Gastritis* ; Helicobacter pylori* ; Humans ; Lymphocytes ; Respiration ; Urea

PURPOSE: The use of dietary supplements (DS) has increased in most nations. We investigated the amount of DS intake in the Korean population by analyzing a national survey, to support the preparation of a national institutional strategy regarding DS intake and marketing. METHODS: The data of the fifth Korea National Health and Nutrition Examination Survey (a year between 2010 and 2012) were investigated, analyzing the rate of DS intake, and the characteristics of the intake group and non-intake group in Korean preschool children. RESULTS: The intake rate of DS was 49.0-54.2% (1,313,874-1,491,240) and 19.6-30.3% (250,603-421,922) in children from 1 to 6 years old and in those less than 1 year, respectively, from 2010 to 2012. The highest intake rate was observed in the age group of five. The mean age was significantly higher in the DS intake group than in the non-intake group. Intake of essential nutrients, minerals, and vitamins were also higher in the DS intake group. The level of family income was significantly associated with the intake rate (p<0.001). In children less than 1 year, probiotics accounted for the highest intake of DS. CONCLUSION: Korean preschool children have high consumption of DS. Therefore, problems may arise from the waste of money purchasing unnecessary DS, and from the overuse of DS in preschoolers who do not require DS intake. We hope these results can be used to produce an appropriate national institutional strategy regarding DS intake and marketing.
Child ; Child, Preschool* ; Dietary Supplements* ; Hope ; Humans ; Korea ; Marketing ; Minerals ; Nutrition Surveys* ; Probiotics ; Vitamins

PURPOSE: Choledochal cyst is a cystic dilatation of common bile duct. Although the etiology is presently uncertain, anomalous pancreaticobiliary ductal union (APBDU) is thought to be a major etiology of choledochal cyst. In this study, we analyzed the clinical and anatomical characteristics and pathologies of patients diagnosed with choledochal cyst in a single institute for 25 years. METHODS: A total of 113 patients, diagnosed with choledochal cyst and who received an operation in Severance Children's Hospital from January 1988 to May 2013, were included. Medical records were reviewed, including clinical and demographic data, surgical procedures. Abdominal ultrasonography, magnetic resonance cholangiopancreatography, and intraoperative cholangiography were used as diagnostic tools for evaluation and classification of choledochal cyst and the presence of anomalous pancreaticobiliary ductal union. Todani's classification, and relationship between APBDU and surgical pathology. RESULTS: Among 113 patients, 77 patients (68.1%) presented symptoms such as hepatitis, pancreatitis and/or cholecystitis. Eighty three patients (73.5%) had APBDU, and 94 patients (83.2%) showed inflammatory pathologic changes. APBDU, pathologic inflammation, and serological abnormalities such as hepatitis or pancreatitis showed a statistically significant correlation to one another. CONCLUSION: APBDU is thought to be one of the etiologic factors of choledochal cyst. It is related to the inflammatory changes in bile duct that can lead to the cystic dilatation.
Bile Ducts* ; Child ; Cholangiography ; Cholangiopancreatography, Magnetic Resonance ; Cholecystitis ; Choledochal Cyst* ; Classification ; Common Bile Duct ; Dilatation ; Hepatitis ; Humans ; Inflammation* ; Medical Records ; Pancreatitis ; Pathology ; Pathology, Surgical ; Ultrasonography

PURPOSE: To study temporal pattern of serum liver enzymes levels in newborns with hepatic injury associated with birth asphyxia (BA). METHODS: Singleton term newborns with BA and < or =72 hours of age admitted to neonatal intensive care unit were prospectively enrolled. Term newborns with physiological jaundice and without BA were studied as controls. Serum liver enzymes were measured at <24 hours, 24-72 hours, and at 6-12 days of age for cases and at 1-6 days of age for controls. BA was defined by 1 minute Apgar score <7 or delayed or absent cry with hypoxic ischemic encephalopathy. BA-associated liver injury was defined as serum alanine aminotransferase (ALT) elevation beyond +2 standard deviation (ALT > +2 SD) above the mean of control subjects at any of the three time points. RESULTS: Sixty controls and 62 cases were enrolled. Thirty-five cases (56%) developed BA-associated liver injury (ALT>81 IU/L). They had higher serum levels of ALT, aspartate aminotransferase, lactate dehydrogenase than the control infants, with peak at 24-72 hours. In controls, serum liver enzyme levels were significantly higher in appropriate-for-date (AFD) babies than small-for-date (SFD) babies. Serum enzyme pattern and extent of elevation were comparable between SFD and AFD babies. Degree of serum liver enzyme elevation had no relationship with severity of hypoxic encephalopathy. CONCLUSION: Serum liver enzyme elevation is common in BA; it peaks at 24-72 hours followed by a sharp decline by 6-12 days of age. Pattern and extent of enzyme elevation are comparable between SFD and AFD babies.
Alanine Transaminase ; Apgar Score ; Aspartate Aminotransferases ; Asphyxia Neonatorum ; Asphyxia* ; Hepatitis ; Humans ; Hypoxia, Brain ; Hypoxia-Ischemia, Brain ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Ischemia ; Jaundice ; L-Lactate Dehydrogenase ; Liver* ; Parturition* ; Prospective Studies ; Transaminases

PURPOSE: Constipation is a common pediatric problem worldwide. This study aims to describe the clinical characteristics of pediatric constipation in south Jordan according to gender and age group. METHODS: All patients with constipation managed at our pediatric gastroenterology service between September 2009 and December 2012 were included. Hospital charts were reviewed. Demographic data, clinical characteristics, and final diagnosis were recorded. Data were analyzed according to gender and the following age groups: infants, pre-school, school age, and adolescents. RESULTS: During the study period, 126 patients were enrolled. The number (percentage) of patients according to age were the following infants: 43 (34.1%), pre-school: 55 (43.7%), school age: 25 (19.8%), and adolescents: 3 (2.4%). Males made up 54.8% of the study population. There were no statistical gender differences in any age group. The most common symptom in all age groups was dry, hard stool. Infrequent defecation was found in almost one-half of the patients. Fecal incontinence was more common in school-aged children compared to pre-school-aged children and adolescents. Abdominal pain was seen in almost 40% of the constipated children. Abdominal pain was more prevalent in girls and older children. Fecal mass in the rectum was the most common physical finding, with constipated boys exhibiting higher rates. Functional constipation was the most common etiology. CONCLUSION: Clinical characteristics of constipation in children vary according to age group and gender. Older children had less frequent bowel motions, a longer duration of symptoms, and a higher prevalence of long-standing constipation compilations (fecal incontinence and abdominal pain).
Abdominal Pain ; Adolescent ; Child ; Constipation* ; Defecation ; Diagnosis ; Fecal Incontinence ; Female ; Gastroenterology ; Humans ; Infant ; Jordan* ; Male ; Prevalence ; Rectum