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Review Article
Association of gut microbiota with obesity in children and adolescents
KY YOUNG CHO
Pediatric obesity is among the most serious global health problems whose prevalence has increased over the past decade. Pediatric obesity increases concomitant health problems, including type 2 diabetes mellitus, hypertension, dyslipidemia, fatty liver disease, and psychological problems, which often progress into adulthood. The gut microbiota is a new factor in the development of obesity, which is affected by renowned risk...
Total energy expenditure measured by doubly labeled water method in children and adolescents: a systematic review
Nahyun Kim, Jonghoon Park
Total energy expenditure (TEE) is essential for understanding children and adolescents' growth, development, and physical activities. This study aimed to summarize the existing evidence on TEE measured using the doubly labeled water (DLW) technique in children and adolescents aged 1–18 years. Furthermore, this review compared TEE between participants with obesity and normal weight. This systematic review was conducted using PubMed,...
Endocrinology
Pediatric hypertension based on Japanese Society of Hypertension Guidelines (JSH 2019) with actual school blood pressure screening data in Japan
Toru Kikuchi
Clin Exp Pediatr. 2022;65(6):283-290.   Published online November 26, 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.
Original Article
Endocrinology
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
Clin Exp Pediatr. 2022;65(6):304-311.   Published online November 11, 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.
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,...
Guideline
Nutrition
Clinical practice guideline for the diagnosis and treatment of pediatric obesity: recommendations from the Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology Hepatology and Nutrition
Dae Yong Yi, Soon Chul Kim, Ji Hyuk Lee, Eun Hye Lee, Jae Young Kim, Yong Joo Kim, Ki Soo Kang, Jeana Hong, Jung Ok Shim, Yoon Lee, Ben Kang, Yeoun Joo Lee, Mi Jin Kim, Jin Soo Moon, Hong Koh, JeongAe You, Young-Sook Kwak, Hyunjung Lim, Hye Ran Yang
Clin Exp Pediatr. 2019;62(1):3-21.   Published online December 27, 2018
The Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition newly developed the first Korean Guideline on the Diagnosis and Treatment of Obesity in Children and Adolescents to deliver an evidence-based systematic approach to childhood obesity in South Korea. The following areas were systematically reviewed, especially on the basis of all available references published in...
Review Article
Endocrinology
The adiposity rebound in the 21st century children: meaning for what?
Min Jae Kang
Clin Exp Pediatr. 2018;61(12):375-380.   Published online December 6, 2018
With the increase in the prevalence of overweight and obesity worldwide, early adiposity rebound, which is known to have a strong association with obesity, has recently been a focus of research. Early adiposity rebound is conventionally known to have a close relationship with non-communicable diseases. However, novel insights into early adiposity rebound have implied an acceleration of growth and puberty,...
Original Article
Endocrinology
Secular change in waist circumference and waist-height ratio and optimal cutoff of waist-height ratio for abdominal obesity among Korean children and adolescents over 10 years
Min Sub Kim, Se Young Kim, Jae Hyun Kim
Clin Exp Pediatr. 2019;62(7):261-268.   Published online December 3, 2018

Purpose: This study aimed to evaluate the time trends of waist circumference (WC) and waist-height ratio (WHR), and to present WC and WHR distributions with optimal WHR cutoff for abdominal obesity in Korean children and adolescents. Methods: We performed a retrospective cross-sectional analysis of data from 13,257 children and adolescents (6,987 boys and 6,270 girls) aged 6–18 years who were included...
Adolescence Medicine
Serum alanine aminotransferase levels are closely associated with metabolic disturbances in apparently healthy young adolescents independent of obesity
Ki Eun Kim, Kyung Suk Baek, Sol Han, Jung Hyun Kim, Youn Ho Shin
Clin Exp Pediatr. 2019;62(2):48-54.   Published online November 23, 2018

Purpose: Liver metabolism plays a pivotal role in the development of metabolic disorders. We aimed to investigate the clinical and laboratory risk factors associated with alanine aminotransferase (ALT) levels in young adolescents from an urban population in Korea. Methods: A population of 120 apparently healthy adolescents aged 12–13 years was included in the cross-sectional design study; 58 were overweight or obese...
Gastroenterology
Nonalcoholic fatty liver disease in obese and nonobese pediatric patients
Eun Jeong Kim, Hyun Jin Kim
Clin Exp Pediatr. 2019;62(1):30-35.   Published online September 17, 2018

Purpose: Obesity is risk factor for nonalcoholic fatty liver disease (NAFLD). However, nonobese patients are also increasingly susceptible to NAFLD. The aim of this study was to compare the clinical characteristics of obese and nonobese pediatric patients with NAFLD. Methods: We retrospectively studied 68 patients who were diagnosed with NAFLD between January 2010 and October 2016 at 10–18 years of age....
Endocrinology
The association of total blood mercury levels and overweight among Korean adolescents: analysis of the Korean National Health and Nutrition Examination Survey (KNHANES) 2010–2013
Yi-Yeon Shin, In-Kyung Ryu, Mi-Jung Park, Shin-Hye Kim
Clin Exp Pediatr. 2018;61(4):121-128.   Published online April 23, 2018
Purpose

Obesity has been associated with higher total blood mercury levels, based on animal studies; however, studies that focus on children and adolescents are lacking. We aimed to assess the association between total blood mercury levels and the incidence of overweight and abdominal obesity in Korean adolescents.

Methods

The study population comprised 1,567 adolescents (793 boys and 774 girls; aged 10–19 years), who...

Developmental and Behavioral Medicine
Mid-upper-arm circumference as a screening measure for identifying children with elevated body mass index: a study for Pakistan
Muhammad Asif, Muhammad Aslam, Saima Altaf
Clin Exp Pediatr. 2018;61(1):6-11.   Published online January 22, 2018
Purpose

Mid-upper-arm circumference (MUAC) is considered an alternative screening method for obesity. The aims of this investigation were to examine the ability of MUAC to correctly identify children with elevated body mass index (BMI) and to determine the best MUAC cutoff point for identification of children with high BMI.

Methods

Anthropometric measurements (height, weight, and MUAC) from a cross-sectional sample of 7,921 Pakistani...

Endocrinology
The influence of gonadotropin-releasing hormone agonists on anthropometric change in girls with central precocious puberty
Jong Wan Yoon, Hyun A Park, Jieun Lee, Jae Hyun Kim
Clin Exp Pediatr. 2017;60(12):395-402.   Published online December 22, 2017
Purpose

The potential effect of gonadotropin-releasing hormone agonist (GnRHa) treatment on the weight of girls with central precocious puberty (CPP) remains a controversy. We investigated anthropometric changes during and after GnRHa treatment among girls with CPP.

Methods

This retrospective study evaluated data from 127 girls with CPP who received GnRHa treatment for ≥2 years. Height, weight, and body mass index (BMI) values were...

Cardiology
Subtle inflammation: a possible mechanism of future cardiovascular risk in obese children
Watchareewan Sontichai, Prapai Dejkhamron, Peraphan Pothacharoen, Prachya Kongtaweelert, Kevalee Unachak, Nuthapong Ukarapol
Clin Exp Pediatr. 2017;60(11):359-364.   Published online November 27, 2017
Purpose

The risk of cardiovascular disease (CVD) has been shown to be associated with systemic inflammation in obese adults with metabolic syndrome (MetS). The aims of this study were to evaluate the prevalence of MetS and its relation to inflammatory markers in obese Thai children.

Methods

A cross-sectional study was conducted. Children with history of endogenous obesity, chronic diseases, drug ingestion, and any...

Review Article
Endocrinology
Waist-to-height ratio as a screening tool for obesity and cardiometabolic risk
Eun-Gyong Yoo
Clin Exp Pediatr. 2016;59(11):425-431.   Published online November 18, 2016

The waist-to-height ratio (WHtR), calculated by dividing the waist circumference (WC) by height, has recently gained attention as an anthropometric index for central adiposity. It is an easy-to-use and less age-dependent index to identify individuals with increased cardiometabolic risk. A WHtR cutoff of 0.5 can be used in different sex and ethnic groups and is generally accepted as a universal...

Original Article
Endocrinology
Lipopolysaccharide-binding protein plasma levels as a biomarker of obesity-related insulin resistance in adolescents
Ki Eun Kim, Young Sun Cho, Kyung Suk Baek, Lan Li, Kwang-Hyun Baek, Jung Hyun Kim, Ho-Seong Kim, Youn Ho Sheen
Clin Exp Pediatr. 2016;59(5):231-238.   Published online May 31, 2016
Purpose

Lipopolysaccharide-binding protein (LBP) is a 65-kDa acute phase protein, derived from the liver, which is present in high concentrations in plasma. Data regarding the association between circulating plasma LBP levels and obesity-related biomarkers in the pediatric population are scarce. We aimed to determine whether there was a difference in plasma LBP levels between overweight/obese and normal-weight adolescents and to assess...

Impact of lifestyle factors on trends in lipid profiles among Korean adolescents: the Korea National Health and Nutrition Examination Surveys study, 1998 and 2010
Shin-Hye Kim, Young-Hwan Song, Sangshin Park, Mi-Jung Park
Clin Exp Pediatr. 2016;59(2):65-73.   Published online February 29, 2016
Purpose

Only a few studies have explored nationwide trends in lipid profiles among Asian adolescents. We aimed to assess trends in lipid profiles and the associated lifestyle factors among Korean children.

Methods

We analyzed data for 2,094 adolescents who were aged 10–18 years and had participated in the Korea National Health and Nutrition Examination Surveys in 1998 and 2010.

Results

During 1998–2010, the prevalence of...

Review Article
Endocrinology
Catch-up growth and catch-up fat in children born small for gestational age
Won Kyoung Cho, Byung-Kyu Suh
Clin Exp Pediatr. 2016;59(1):1-7.   Published online January 22, 2016

Infants born small for gestational age (SGA) are at increased risk of perinatal morbidity, persistent short stature, and metabolic alterations in later life. Recent studies have focused on the association between birth weight (BW) and later body composition. Some reports suggest that fetal nutrition, as reflected by BW, may have an inverse programing effect on abdominal adiposity later in life....

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