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Review Article
Pediatric hypertension based on Japanese Society of Hypertension Guidelines (JSH 2019) with actual school blood pressure screening data in Japan
Toru Kikuchi
Received July 10, 2021  Accepted October 28, 2021  
The prevalence of Japanese pediatric hypertension is 0.9% based on proper measurement protocols. Hypertensive children tend to be hypertensive adults. Pediatric essential hypertension is characterized by an absence of symptoms, obesity, a family history of hypertension, and a low birth weight. The most common causes of pediatric secondary hypertension are renal parenchymal and renovascular diseases. Important factors controlling pediatric hypertension include healthy lifestyle modifications and pharmacotherapy.
DOI: https://doi.org/10.3345/cep.2021.00920    [Epub ahead of print]
Original Article
Effects of probiotics combined with dietary and lifestyle modification on clinical, biochemical, and radiological parameters in obese children with nonalcoholic fatty liver disease/nonalcoholic steatohepatitis: a randomized clinical trial
Thushara Rodrigo, Samaranayake Dulani, Sumudu Nimali Seneviratne, Arjuna P. De Silva, Jerad Fernando, H. Janaka De Silva, Jayasekera , V. Pujitha Wickramasinghe
Received June 4, 2021  Accepted October 23, 2021  
Question: Could probiotics be used as a therapeutic modality in nonalcoholic fatty liver disease/nonalcoholic steatohepatitis?
Finding: There seem no added advantages over lifestyle modifications compared to Probiotics.
Meaning: There does not seem to be an advantage of probiotics over lifestyle modifications in improving obesity-associated metabolic derangement in children.
DOI: https://doi.org/10.3345/cep.2021.00787    [Epub ahead of print]
Review Article
Endocrinology
Endocrine comorbidities of pediatric obesity
Jieun Lee, Jae Hyun Kim
Clin Exp Pediatr. 2021;64(12):619-627.   Published online August 26, 2021
∙ Pediatric obesity can involve endocrine comorbidities such as prediabetes, type 2 diabetes, dyslipidemia, metabolic syndrome, polycystic ovary syndrome, and central precocious puberty.
∙ Prediabetes and type 2 diabetes in youth aged 10–19 years had a prevalence of 25.9% and 0.6% in 2013–2014, respectively.
∙ Dyslipidemia in Korean adolescents aged 10–18 years had a prevalence of 7.64% (total cholesterol ≥200 mg/dL), 6.09% (low-density lipoprotein cholesterol ≥130 mg/dL), 8.69% (triglyceride ≥150 mg/dL), and 12.52% (high-density lipoprotein cholesterol ≤40 mg/dL) in 2007–2018.
∙ Metabolic syndrome in Korean youth has a prevalence of 1.9%–14.7% in males and 1.7%–12.6% in females with wide variation in definitions.
∙ Appropriate comorbidity screening and management and/or specialist referral are necessary for obese children and adolescents.
Nutrition
Changes in health status of North Korean children and emerging health challenges of North Korean refugee children
Seong-Woo Choi
Clin Exp Pediatr. 2021;64(11):552-558.   Published online May 17, 2021
· Among North Korean refugee (NKR) children under 5 years, 61% and 9.3% were underweight in 1998 and 2017, respectively.
· The immunization rate of NKR children exceeded 90% since 2006.
· For NKR children, protein-energy malnutrition was the #1 cause of death in 2009 versus #17 in 2019.
· In 2020, stunting affected 5.4% and 0.9% and obesity affected 10.7% and 2.7% of NKR versus South Korean children, respectively.
Nephrology (Genitourinary)
Obesity and chronic kidney disease: prevalence, mechanism, and management
Hyung Eun Yim, Kee Hwan Yoo
Clin Exp Pediatr. 2021;64(10):511-518.   Published online April 6, 2021
· Obesity is strongly associated with the development and progression of chronic kidney disease.
· Altered renal hemodynamics, metabolic effects, and lipid nephrotoxicity may play a key role in the development of obesity-related kidney disease.
· Children born to obese mothers are at increased risk of developing obesity and chronic kidney disease later in life.
· A multilevel approach is needed to prevent obesity and related chronic diseases.
Original Article
General Pediatrics
Global relationship between parent and child obesity: a systematic review and meta-analysis
Ju Suk Lee, Mi Hyeon Jin, Hae Jeong Lee
Clin Exp Pediatr. 2022;65(1):35-46.   Published online March 29, 2021
Question: Are parent and child obesity correlated worldwide?
Finding: Overweight and obese status of parents and children were significantly associated worldwide. The association between parent and child obesity was stronger in Asia than in Europe and the Middle East, and in high-income than in middle- and low-income countries.
Meaning: Childhood obesity is highly influenced by parental weight status, indicating that parents could play an important role in its prevention.
Review Article
Infection
The COVID-19 pandemic: an unprecedented tragedy in the battle against childhood obesity
Maximilian Andreas Storz
Clin Exp Pediatr. 2020;63(12):477-482.   Published online November 5, 2020
Large-scale quarantine and home confinement during the coronavirus disease 2019 (COVID-19) pandemic will impose new and unfamiliar stressors on children, thereby worsening the childhood obesity epidemic. Physical, nutritional, and psychosocial factors that promote obesity in children during this special situation complementarily contribute to an unprecedented obesogenic environment. Involved stakeholders, including governments, schools, and families, must make all efforts to minimize the impact of the COVID-19 epidemic on childhood obesity.
Adolescence Medicine
The impacts of exercise on pediatric obesity
Ronald J. Headid III, Song-Young Park
Clin Exp Pediatr. 2021;64(5):196-207.   Published online August 4, 2020
Pediatric obesity contributes to the development of vascular dysfunction and metabolic and cardiovascular diseases which have all been shown to track into adulthood, increasing the risk of early mortality. Early exercise intervention is critical for combating obesity-related comorbidities and the optimal exercise prescription has yet to be well documented. Exercise prescriptions to combat pediatric obesity should incorporate both aerobic and muscle-strengthening exercises with an emphasis on long-term adherence.
Endocrinology
Early menarche and its consequence in Korean female: reducing fructose intake could be one solution
Ji Hyun Kim, Jung Sub Lim
Clin Exp Pediatr. 2021;64(1):12-20.   Published online May 14, 2020
In Korea, the average age of menarche has declined sharply. Early menarche is associated with psychosocial and behavioral problems and cardiometabolic disease. Excess fructose intake has been suggested as one cause of early menarche in recent studies, so reducing fructose intake may be one solution.
Air pollution and childhood obesity
Moon Young Seo, Shin-Hye Kim, Mi Jung Park
Clin Exp Pediatr. 2020;63(10):382-388.   Published online March 27, 2020
Questions: What are the possible effects of air pollution on the occurrence of childhood obesity and what are the mechanisms?
Finding: Epidemiologic studies suggest that air pollutants might act as obesogens in the pediatric population, and their possible mechanisms include oxidative stress, physical inactivity, and epigenetic modulation.
Meaning: This paper reviews updated information on air pollution, one of the modifiable environmental factors in childhood obesity.
Original Article
Endocrinology
Influence of subclinical hypothyroidism on metabolic parameters in obese children and adolescents
Ozlem Kara
Clin Exp Pediatr. 2020;63(3):110-114.   Published online March 6, 2020
Question: Does subclinical hypothyroidism in obese children and adolescents affect metabolic parameters?
Finding: Insulin, HOMA-IR, and TG levels were higher and the HDL-C level was lower in patients with SH.
Meaning: A clear association is observed between SH, and insulin resistance and dyslipidemia in obese children. It can be said that the TSH may be evaluated as a metabolic risk factor in obese patients.
Lipid accumulation product is a predictor of nonalcoholic fatty liver disease in childhood obesity
Bahar Özcabı, Salih Demirhan, Mesut Akyol, Hatice Öztürkmen Akay, Ayla Güven
Clin Exp Pediatr. 2019;62(12):450-455.   Published online October 28, 2019
Background: Lipid accumulation product (LAP) is associated with the presence and severity of nonalcoholic fatty liver disease (NAFLD) in adults.
Purpose: Here we evaluated the ability of LAP to predict NAFLD in obese children. Methods: Eighty obese children (38 girls; age 6–18 years) were included. Anthropometric measurements and biochemical values were obtained from the patients’ medical records. LAP was calculated as [waist...
General Pediatrics
Prevalence of hyperuricemia and its association with metabolic syndrome and cardiometabolic risk factors in Korean children and adolescents: analysis based on the 2016–2017 Korea National Health and Nutrition Examination Survey
Jung Hyun Lee
Clin Exp Pediatr. 2019;62(8):317-323.   Published online June 24, 2019

Purpose: Investigating the prevalence of hyperuricemia and its association with metabolic syndrome (MetS) and cardiometabolic risk factors (CMRFs) in Korean children and adolescents. Methods: This cross-sectional survey used data from the 7th Korea National Health and Nutrition Examination Survey (2016–2017); 1,256 males and females aged 10–18 years were included. Hyperuricemia was defined as serum uric acid levels were >6.6 mg/dL at...
Review Article
Endocrinology
Prevalence of obesity and overweight in Iranian children aged less than 5 years: a systematic review and meta-analysis
kamyar mansori, Sorour Khateri, Yousef Moradi, Zaher Khazaei, Hossein Mirzaei, Shiva Mansouri Hanis, Mehran Asadi Aliabadi, Mehdi Ranjbaran, Fatemeh Varse, Serveh Parang
Clin Exp Pediatr. 2019;62(6):206-212.   Published online April 23, 2019

Purpose: The present study aimed to determine the prevalence of childhood obesity and overweight in Iranian children under 5 years of age using a systematic review and meta-analysis. Methods: We searched MEDLINE (PubMed), Web of Science, Google Scholar, Scopus, CINHAL, and the Iranian databases, including Scientific Information Database (www.sid.ir), Iranian Research Institute for Information Science and Technology (Irandoc.ac.ir), Iranmedex (www.iranmedex.com), and...
Original Article
Endocrinology
Prevalence and associates of obesity and overweight among school-age children in a rural community of Thailand
Teechaya Nonboonyawat, Wuttipat Pusanasuwannasri, Nattanon Chanrat, Natta Wongthanavimok, Danutanut Tubngern, Piengkwan Panutrakul, Mathirut Mungthin, Thirapa Nivesvivat, Panadda Hatthachote, Ram Rangsin, Phunlerd Piyaraj
Clin Exp Pediatr. 2019;62(5):179-186.   Published online February 8, 2019

Purpose: Information about overweight and obesity among students in rural areas of Thailand is limited. Therefore, we aimed to determine overweight and obesity prevalences and associated factors among school-aged children in a rural community of Thailand. Methods: We selected 9 public schools through cluster sampling in 2 provinces located in central Thailand in 2016. Anthropometric measurements were measured using standard techniques,...
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