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

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

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.
Adolescent ; Adult ; Anthropometry ; Body Composition ; Cardiovascular Diseases ; Child ; Diabetes Mellitus, Type 2 ; Early Intervention (Education) ; Humans ; Obesity ; Pediatric Obesity ; Prevalence ; Risk Factors

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.

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: The objective of this study was to determine the type differences of diabetes by analyzing the growth status and body composition of newly diagnosed diabetic adolescent girls. METHODS: The study included 6 type 1 diabetic adolescent girls (age 11.7 +/- 1.9 years) and 6 type 2 diabetic adolescent girls (age 14.4 +/- 2.6 years). The height, weight and body composition of fat mass and fat-free mass were measured in each patient. Body mass index (BMI), fat mass index (FMI), fat free mass index (FFMI) and percent body fat (PBF) were calculated and each component was plotted on a body composition chart. RESULTS: Type 2 diabetic adolescent girls seemed to be taller and heavier compared to type 1 diabetic girls, but the differences in height and weight z-score were not significant. BMI, FFMI, FMI, PBF were also higher in type 2 diabetic girls. The body composition chart revealed that type 2 diabetic girls had significantly higher FMI and PBF. In type 1 diabetic girls, FFMI was lower compared to type 2 diabetic girls. The BMI difference between diabetes types was explained with the difference in FFMI as well as FMI. CONCLUSION: The components of body composition differ according to diabetes type in adolescent girls. Measuring the body composition of diabetic girls might help to promote growth and adequate FFM gain during childhood. In diabetes control, diet and exercise should be emphasized along with insulin treatment.
Adipose Tissue ; Adolescent ; Body Composition ; Body Mass Index ; Diabetes Mellitus ; Diet ; Female ; Humans ; Insulin

Spinal muscular atrophy (SMA) is an autosomal recessive disease characterized by diffuse proximal and distal weakness due to deletion of the survival motor neuron (SMN) gene localized on chromosome 5 (5 q1 1 .2 -1 3 .3 ). SMA has been considered as a pure lower motor neuron disorder, and a definitive diagnosis can be established by molecular genetic testing. Here, we describe two patients with severe hypotonia and frequent aspirations at early infancy. Nerve conduction studies showed more extensive sensory involvement in these patients diagnosed to have SMA by genetic study than in classical cases of SMA. To the best of our knowledge, this is the first report of SMA Type 1 with sensory nerve involvement in Korea.
Aspirations (Psychology) ; Chromosomes, Human, Pair 5 ; Humans ; Korea ; Molecular Biology ; Motor Neurons ; Muscle Hypotonia ; Muscular Atrophy, Spinal ; Neural Conduction

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