Childhood obesity prevalence has been increased and known to be related to various diseases and mortality in adult and body mass index (BMI) has been widely used as a screening tool in children with obesity. It is important to understand what BMI is and its limitations. BMI is a measure of weight adjusted for height. Weight scales to height with a power of about 2, is the basis of BMI (weight/height2) as the scaling of body weight to height across adults provides powers rounded to 2. BMI has the advantage of a simple and noninvasive surrogate measure of body fat, but it has limitation in differentiating body fat from lean (fat free) mass and low-moderate sensitivity is problematic for clinical applications. Among overweight children higher BMI levels can be a result of increased either fat or fat-free mass. BMI could be divided into fat-free mass index and fat mass index. Monitoring of the changes in body composition is important as distinguishing changes in each component occur with rapid growth in adolescents as it is occur in concert with changes in the hormonal environment. Reference values for each body composition indexes and chart created with selected percentiles of a normal adolescent population could be helpful in growth assessment and health risk evaluation.
Adipose Tissue ; Adolescent* ; Adult ; Body Composition* ; Body Mass Index* ; Body Weight ; Child* ; Humans ; Mass Screening ; Mortality ; Obesity ; Overweight ; Pediatric Obesity ; Prevalence ; Reference Values ; Weights and Measures

Acute suppurative thyroiditis is an uncommon disease of thyroid, as thyroid gland is remarkably resistant to infection. In children, the most common route of infection is from a pyriform sinus fistula and then the inflammation spreads from the sinus to the perithyroidal space. It is important to differentiate acute suppurative thyroiditis with thyrotoxicosis from subacute thyroiditis. And if left untreated, acute suppurative thyroiditis can lead to thyroid abscess formation. A 11-year-old girl presented with acute illness of fever and tender neck swelling. Thyroid ultrasonogram and ultrasono-guided needle aspirated cytology confirmed acute suppurative thyroiditis. Although on computed tomography (CT) scan suggested acute suppurative thyroiditis due to pyriform sinus fistula, there was no evidence of fistula formation between thyroid and pyriform sinus on barium esophagogram. After treatment with antibiotics, she displayed clinical improvement and was discharged without complication. Here we report a child of acute suppurative thyroiditis with transient thyrotoxicosis controlled with antibiotics with literature review.
Abscess ; Anti-Bacterial Agents ; Barium ; Child* ; Female ; Fever ; Fistula ; Humans ; Inflammation ; Neck ; Needles ; Pyriform Sinus ; Thyroid Gland ; Thyroiditis, Subacute ; Thyroiditis, Suppurative* ; Thyrotoxicosis* ; Ultrasonography

The global epidemic of obesity is an important public health issue, as many serious health problems are associated with severe obesity. It is well known that overweight children and adolescents very often become obese adults. In children and adolescents, obesity is defined as a body mass index (BMI) for age greater than the 95th percentile of a reference population. The criteria of severe obesity (BMI for age greater than the 99th percentile, above 120% of the 95th percentile or above 35 kg/m2) was proposed, however it is not clarified. In this obesogenic environment, the prevalence of severe obesity is increasing at a much faster rate. Medications for childhood obesity and surgical procedures like gastric bypass and gastric banding were introduced as an effective option for the treatment of extremely obese adolescents. However, the basic solution is prevention, even though it is difficult. More efforts are needed to teach pediatricians and other providers how to more effectively initiate behavior change in children and their families, ensuring healthy behavior including eating and physical activity before weight gain occur. Weight gain can occur very early in life, and thus parental teaching and a family approach is necessary. The government should be working together with health providers, industry, and communities to initiate public health approaches.
Child ; Adolescent ; Adult ; Male ; Female ; Humans

Obesity is rapidly increasing and childhood obesity is associated with substantial comorbidity and late sequela. In this article, current information about behaviors related to eating, physical activity and sedentary activity that may affect body weight in children and adolescents were reviewed. The studies of multidisciplinary approach for obesity treatment and more aggressive forms of treatment were presented. Finally recent recommended comprehensive 4-step or staged care approach for weight management was introduced.
Adolescent ; Body Weight ; Child ; Comorbidity ; Eating ; Humans ; Motor Activity ; Obesity ; Overweight

The prevalence of obesity and metabolic syndrome in children and adolescents continues to increase worldwide. Childhood obesity is associated with adulthood obesity and increases the risk of developing adult metabolic syndrome. Metabolic syndrome is a well-documented risk factor for cardiovascular disease and type 2 diabetes mellitus. Thus, to prevent cardiometabolic complications in later life, early detection and early interventions in obese children and adolescents are critical. In this review article, various methods of assessing obesity, including anthropometry and body composition analysis in children and adolescents, are introduced, and clinical predictive risk factors for metabolic syndrome in obese children and adolescents are described. With a comprehensive understanding of each risk factor in pediatric metabolic syndrome, treatment strategies for each component of metabolic syndrome are presented. Finally, the need to establish a school-hospital linkage system for the prevention and treatment of obesity and metabolic syndrome in children and adolescents is discussed.

The prevalence of obesity and metabolic syndrome in children and adolescents continues to increase worldwide. Childhood obesity is associated with adulthood obesity and increases the risk of developing adult metabolic syndrome. Metabolic syndrome is a well-documented risk factor for cardiovascular disease and type 2 diabetes mellitus. Thus, to prevent cardiometabolic complications in later life, early detection and early interventions in obese children and adolescents are critical. In this review article, various methods of assessing obesity, including anthropometry and body composition analysis in children and adolescents, are introduced, and clinical predictive risk factors for metabolic syndrome in obese children and adolescents are described. With a comprehensive understanding of each risk factor in pediatric metabolic syndrome, treatment strategies for each component of metabolic syndrome are presented. Finally, the need to establish a school-hospital linkage system for the prevention and treatment of obesity and metabolic syndrome in children and adolescents is discussed.
Adolescent ; Adult ; Anthropometry ; Body Composition ; Cardiovascular Diseases ; Child ; Diabetes Mellitus, Type 2 ; Early Intervention (Education) ; Humans ; Obesity ; Pediatric Obesity ; Prevalence ; Risk Factors

PURPOSE: This study was performed to investigate the relationship between serum vitamin D and parathyroid hormone (PTH) levels as well as to describe the prevalence and the risk factors of vitamin D deficiency (VDD) in Korean children. METHODS: Participants were 1,212 children aged 4 to 15 years, who visited Bundang CHA Medical Center (located at 37degreesN) between March 2012 and February 2013. Overweight was defined as body mass index> or =85th percentile. Participants were divided into 4 age groups and 2 seasonal groups. VDD was defined by serum 25-hydroxyvitamin D (25OHD) <20 ng/mL. RESULTS: The level of 25OHD was significantly lower in overweight group than in normal weight group (17.1+/-5.1 ng/mL vs. 19.1+/-6.1 ng/mL, P<0.001). Winter-spring season (odds ratio [OR], 4.46; 95% confidence interval [CI], 3.45-5.77), older age group (OR, 1.60; 95% CI, 1.36-1.88), and overweight (OR, 2.21; 95% CI, 1.62-3.01) were independently related with VDD. The PTH levels were significantly higher in VDD group compared to vitamin D insufficiency and sufficiency group (P<0.001). In normal weight children, 25OHD (beta=-0.007, P<0.001) and ionized calcium (beta=-0.594, P=0.007) were independently related with PTH, however, these associations were not significant in overweight children. CONCLUSION: VDD is very common in Korean children and its prevalence increases in winter-spring season, in overweight children and in older age groups. Further investigation on the vitamin D and PTH metabolism according to adiposity is required.
Adiposity ; Body Mass Index ; Calcium ; Child* ; Humans ; Metabolism ; Overweight ; Parathyroid Hormone* ; Prevalence* ; Risk Factors* ; Seasons ; Vitamin D ; Vitamin D Deficiency*

PURPOSE: This study aimed to investigate gender differences in the relationship between fat-free mass index (FFMI) and fat mass index (FMI) by applying body composition chart on Korean elementary students. MATERIALS AND METHODS: Data from 965 healthy Korean children of 8 to 12 years of age (501 boys, 464 girls) were obtained. FFMI and FMI were plotted on the body composition chart, and the differences in the relationships between FFMI and FMI were separately evaluated by gender or grade. RESULTS: Weight was heavier and BMI was higher in 3rd and 4th grade boys compare to girls. The value of FFM was higher in boys, but FM was not different. In subgroup analysis by grade, significant gender by FFMI interaction (p=0.015) was found, indicating that the slope of the lines for FMI vs. FFMI was different between boys and girls (Figure was not shown). In subgroup analysis by gender, grade by FFMI interaction was significant in boys, indicating that FMI vs. FFMI relationship differed according to grade only in boys. CONCLUSION: Boys are leaner than girls, despite having similar BMI. Gender difference in the direction of the change of the FFMI and FMI relationship is evident in children.
Age Factors ; Asian Continental Ancestry Group ; Body Composition/*physiology ; Body Mass Index ; Child ; Female ; Humans ; Korea ; Male ; Obesity/physiopathology ; Sex Factors

PURPOSE: Microalbuminuria is defined as increased urinary albumin excretion (30-300 mg/day) or microalbumin/creatinine ratio (30-300 mg/g) in a spot urine sample. Although microalbuminuria is a predictor of clinical nephropathy and cardiomyopathy, few studies have investigated microalbuminuria in children with urinary tract infection (UTI). METHODS: Therefore, we compared the spot urine microalbumin/creatinine ratio in pediatric UTI patients with that of control subjects. We investigated the correlation between the ratio in children with UTI and age, height, weight, blood pressure, glomerular filtration rate (GFR), hematuria, vesicoureteral reflux, renal parenchymal defect, and renal scar, and its predictability for UTI complications. RESULTS: We studied 66 patients (42 boys, 24 girls) and 52 healthy children (24 boys, 28 girls). The mean microalbumin/creatinine ratio in UTI patients was statistically significantly increased compared to the control group (340.04+/-321.36 mg/g (38.47+/-36.35 mg/mmol) in patient group vs. 225.68+/-154.61 mg/g (25.53+/-17.49 mg/mmol) in control group, P=0.0141). The mean value of spot urine microalbumin/creatinine ratio (384.70+/-342.22 mg/g (43.47+/-37.67 mg/mmol) in patient group vs. 264.92+/-158.13 mg/g (29.94+/-17.86 mg/mmol) in control group, P=0.0341) in 1-23 months age patient group showed statistically significant increase compared to control group. Microalbumin/creatinine ratio showed negative correlation to age (r=-0.29, P=0.0167), body surface area (BSA) (r=-0.29, P=0.0173) and GFR (r=-0.26, P=0.0343). The presence of hematuria (P=0.0169) was found to be correlated. CONCLUSION: The spot urine microalbumin/creatinine ratio in children with UTI was significantly greater than that in normal children, and it was positively correlated with GFR. This ratio is a potential prescreening and prognostic marker in UTI patients. Further studies are required to validate the predictability of microalbuminuria in pediatric UTI patients.
Blood Pressure ; Body Surface Area ; Cardiomyopathies ; Child ; Cicatrix ; Glomerular Filtration Rate ; Hematuria ; Humans ; Urinary Tract ; Urinary Tract Infections ; Vesico-Ureteral Reflux

PURPOSE: Microalbuminuria is defined as increased urinary albumin excretion (30-300 mg/day) or microalbumin/creatinine ratio (30-300 mg/g) in a spot urine sample. Although microalbuminuria is a predictor of clinical nephropathy and cardiomyopathy, few studies have investigated microalbuminuria in children with urinary tract infection (UTI). METHODS: Therefore, we compared the spot urine microalbumin/creatinine ratio in pediatric UTI patients with that of control subjects. We investigated the correlation between the ratio in children with UTI and age, height, weight, blood pressure, glomerular filtration rate (GFR), hematuria, vesicoureteral reflux, renal parenchymal defect, and renal scar, and its predictability for UTI complications. RESULTS: We studied 66 patients (42 boys, 24 girls) and 52 healthy children (24 boys, 28 girls). The mean microalbumin/creatinine ratio in UTI patients was statistically significantly increased compared to the control group (340.04+/-321.36 mg/g (38.47+/-36.35 mg/mmol) in patient group vs. 225.68+/-154.61 mg/g (25.53+/-17.49 mg/mmol) in control group, P=0.0141). The mean value of spot urine microalbumin/creatinine ratio (384.70+/-342.22 mg/g (43.47+/-37.67 mg/mmol) in patient group vs. 264.92+/-158.13 mg/g (29.94+/-17.86 mg/mmol) in control group, P=0.0341) in 1-23 months age patient group showed statistically significant increase compared to control group. Microalbumin/creatinine ratio showed negative correlation to age (r=-0.29, P=0.0167), body surface area (BSA) (r=-0.29, P=0.0173) and GFR (r=-0.26, P=0.0343). The presence of hematuria (P=0.0169) was found to be correlated. CONCLUSION: The spot urine microalbumin/creatinine ratio in children with UTI was significantly greater than that in normal children, and it was positively correlated with GFR. This ratio is a potential prescreening and prognostic marker in UTI patients. Further studies are required to validate the predictability of microalbuminuria in pediatric UTI patients.
Blood Pressure ; Body Surface Area ; Cardiomyopathies ; Child ; Cicatrix ; Glomerular Filtration Rate ; Hematuria ; Humans ; Urinary Tract ; Urinary Tract Infections ; Vesico-Ureteral Reflux