Moon Bae Ahn

Relationships of physical fitness and obesity with metabolic risk factors in children and adolescents: Chungju city cohort study.

Purpose The purpose of this study was to investigate the relationships of physical fitness and obesity with metabolic risk factors in children and adolescents. Methods This cohort study was conducted in Chungju city, South Korea. Total 843 subjects were enrolled, including 193 elementary school 4th grade male (E4M), 189 elementary school 4th grade female (E4F) and 461 male-middle school students (M1M). The subjects were also classified into 2 groups by body mass index; normal weight (NW) group and overweight included obesity (OW/OB) group. Physical fitness was measured by shuttle run (cardiorespiratory fitness, CRF), sit and reach (flexibility), handgrip strength (muscular strength) and stand long jump (agility). Results The prevalence of OW/OB was respectively 33.7% (65 of 193) among E4M, 28.6% (54 of 189) among E4F, and 28.0% (129 of 461) among M1M. Hematocrit, white blood cell, triglyceride, low-density lipoprotein, insulin, homeostasis model assessment of insulin resistance, systolic and diastolic blood pressure were higher, while high-density lipoprotein were lower in the OW/OB group than in the NW group. The OW/OB group presented significantly lower CRF (P<0.01) and lower agility, but higher muscular strength compared with NW group. CRF was negatively correlated with obesity indices and metabolic risk factors. After adjustments for potential confounders, odds ratios for 4th–5th grade CRF of OW/OB compared NW in the E4M, E4F, M1M, were 7.38 (95 % CI, 3.24–16.83), 4.10 (95% CI, 1.83–9.18), 16.06 (95% CI, 8.23–31.00) (P<0.01). Conclusion Our study has shown that CRF has negative correlation with OW/OB in children and adolescents of Chungju city. We suggest that improvement of CRF through regular physical activity would be an important method for reducing the metabolic risks of childhood obesity.

Growth without growth hormone in combined pituitary hormone deficiency caused by pituitary stalk interruption syndrome

Growth hormone (GH) is an essential element for normal growth. However, reports of normal growth without GH have been made in patients who have undergone brain surgery for craniopharyngioma. Normal growth without GH can be explained by hyperinsulinemia, hyperprolactinemia, elevated leptin levels, and GH variants; however, its exact mechanism has not been elucidated yet. We diagnosed a female patient aged 13 with combined pituitary hormone deficiency (CPHD) caused by pituitary stalk interruption syndrome (PSIS). The patient has experienced recurrent hypoglycemic seizures since birth, but reached the height of 160 cm at the age of 13, showing normal growth. She grew another 8 cm for 3 years after the diagnosis, and she reached her final adult height of 168 cm which was greater than the midparental height, at the age of 16. The patients blood GH and insulin-like growth factor-I levels were consistently subnormal, although her insulin levels were normal. Her physical examination conducted at the age of 15 showed truncal obesity, dyslipidemia, and osteoporosis, which are metabolic features of GH deficiency (GHD). Herein, we report a case in which a PSIS-induced CPHD patient attained her final height above mid parental height despite a severe GHD.

Association between serum alanine aminotransferase level and obesity indices in Korean adolescents

Purpose To analyze the correlation between serum alanine aminotransferase (ALT) and obesity indices including body mass index (BMI), body fat percentage (BFP), total fat mass (FM), truncal fat mass (TFM), waist circumference (WC), and waist-to-height ratio (WHtR) in Korean adolescents. Methods This was a cross-sectional study based on data derived from the 2010-2011 Korean National Health and Nutrition Examination Surveys (KNHANES). Subjects were Korean adolescents aged 10-18 years (871 total; 475 boys and 396 girls) who participated in KNHANES. Results In both sexes, BMI, FM, TFM, WC, and WHtR were higher when ALT levels were in the 4th quartile. In boys, there was a significant positive correlation between ALT level and BMI, BFP, FM, TFM, WC, and WHtR (r=0.55, P<0.0001 for BMI; r=0.52, P<0.0001 for BFP; r=0.58, P<0.0001 for FM; r=0.61, P<0.0001 for TFM; and r=0.56, P<0.0001 for WC; r=0.62, P<0.0001 for WHtR), and the correlation coefficient was higher than that in girls. Conclusion Our results suggest a significant positive association between serum ALT level and obesity indices in male adolescents.

The association between skeletal maturation and adrenal androgen levels in obese children and adolescents

Purpose This study aimed to investigate the association between skeletal maturation and adrenal androgen levels in obese children and adolescents. Methods Fifty-three children and adolescents (aged 7–15 years) diagnosed as obese or overweight were investigated. Anthropometric measurements, bone age (BA) determination, serum biochemical analyses, and hormonal measurements were performed. The difference between BA and chronological age (BA–CA, dBACA) was calculated and used to represent the degree of advanced skeletal maturation. Results Thirty-one subjects were classified into the obese group and 22 subjects into the overweight group. Insulin resistance as calculated by the homeostasis model assessment of insulin resistance (HOMA-IR) was significantly higher in the obese group than in the overweight group (4.03±2.20 vs. 2.86±1.11, P=0.026). The skeletal maturation of the obese group was advanced, but the dBACA did not differ between the obese and overweight groups statistically (1.43±1.35 vs. 0.91±1.15, P=0.141). Serum dehydroepiandrosterone sulfate (DHEA-S) levels were significantly higher in subjects with dBACA>1 compared to those with dBACA≤1 (104.3±62.2 vs. 59.6±61.0, P=0.014). Correlation analyses demonstrated that dBACA was positively correlated with body mass index standard deviation scores (r=0.35, P=0.010), fasting insulin (r=0.36, P=0.009), HOMA-IR (r=0.30, P=0.031), and insulin-like growth factor-binding protein-3 (r=0.331, P=0.028). In multivariate linear regression analysis, HOMA-IR (P=0.026) and serum DHEA-S (P=0.032) were positively correlated with the degree of advanced skeletal maturation. Conclusion Advanced skeletal maturation is associated with increased insulin resistance and elevated DHEA-S levels in obese children and adolescents.

Thyroid dysfunction in children with leukemia over the first year after hematopoietic stem cell transplantation

Abstract Background Thyroid function in children with leukemia during the first year after hematopoietic stem cell transplantation (HSCT) was investigated. Methods The medical records of 186 subjects [111 boys and 75 girls; lymphoid=75, myeloid=111; median age at HSCT was 10.7 (0.8–21.8) years old] were reviewed retrospectively. Results In children with leukemia, T3 decreased at 1 month (p<0.001) and recovered 9 months to the levels before HSCT. TSH decreased at 1 month (p<0.001), recovered at 3 months and increased at 12 months (p<0.001) to the levels before HSCT. The incidence of euthyroid sick syndrome (ESS, 23.2%, 15.5%, 5.9%, 5.2%, 3.9%, p for trend <0.001) decreased and subclinical hypothyroidism (SH, 0%, 3.9%, 14.8%, 22.1%, 21.3%, p for trend <0.001) increased at 1, 3, 6, 9 and 12 months after HSCT. Out of 55 patients developing ESS during 3 months after HSCT, 54 recovered to normal thyroid function within 5 months without medication. Among the total 186 subjects, 21 patients have been treated with levothyroxine. Both height and weight standard deviation scores continued to decrease over 1 year after HSCT. Conclusions In children with leukemia, one-quarter had ESS at 1 month and one-fifth had SH at 12 months and continued growth impairments were observed during 1 year after HSCT. Most of the ESS patients recovered to normal within 5 months without medication. More long-term follow-up of thyroid function and growth in children with leukemia after HSCT is crucial.

Metabolic risk factors in Korean adolescents with severe obesity: Results from the Korea National Health and Nutrition Examination Surveys (K-NHANES) 2007-2014

AIMS To investigate the metabolic risk factors according to the degree of obesity in Korean adolescents. METHODS Among 7197 subjects aged 10-18 years who participated in the 2007-2014 K-NHANES, 1326 adolescents (M = 744, F = 582) with age and sex specific body mass index (BMI) ≥85th percentile were included. These adolescents with obesity were classified as: overweight, obesity, severe obesity, and extreme severe obesity. For assessing central obesity, the subjects were further-classified as: normal waist obese, abdominal obesity I, abdominal obesity II and abdominal obesity III. RESULTS The prevalence of overweight, obesity, severe obesity and extreme severe obesity were 5.6%, 6.2%, 5.9% and 0.9% in Korean adolescents. With increasing levels of obese category, the incidence of metabolic risk factors such as HDL-C < 40 mg/dL or <50 mg/dL in girls older than 16 years-old (20.2%, 18.5%, 34.4%, 43.6%, P < .0001), TG ≥ 150 mg/dL (15.3%, 16.7%, 26.5%, 30.9%, P < .003), HbA1C ≥ 5.8% (12.8%, 13.5%, 21.9%, 42.2%, P < .006), SBP ≥ 130 mg/dL (3.5%, 6.4%, 8.1%, 19.5%, P < .003) significantly increased. With increasing levels of central obese category, the incidence of metabolic risk factors such as HDL-C < 40 mg/dL or <50 mg/dL in girls older than 16 years-old (20.2%, 26.2%, 37.9%, 35.7%, P < .0007), TG ≥ 150 mg/dL (16.1%, 21.2%, 25.8%, 29.8%, P < .004), glucose ≥ 100 mg/dL (7.7%, 7.3%, 11.7%, 17.4%, P < .009) and SBP ≥ 130 mg/dL (5.1%, 7.1%, 3.0%, 13.9%, P < .002) significantly increased. CONCLUSION Adolescents with severe obesity have more metabolic risk factors compared to adolescents with less severe degree of obesity.

Factors affecting height velocity in normal prepubertal children

Purpose To analyze the effects of clinical and laboratory factors, including insulin-like growth factor (IGF) levels, on the height velocity of normal prepubertal children. Methods Ninety-five healthy prepubertal children (33 boys, 62 girls) were enrolled. The mean chronological age was 6.3±1.4 years, with a height standard deviation score (SDS) of -0.88±0.70. IGF-1, IGF binding protein-3 (IGFBP-3), SDS for anthropometric measurements, and changes in SDS for anthropometric measurements were analyzed for 1 year, and their associations with 1-year height velocity were investigated. Results The group of children with a 1-year height velocity of ≥6 cm were chronologically younger than the group with a 1-year height velocity of <6 cm (5.9±1.3 years vs. 6.7±1.3 years, P=0.004), with a lesser increase of SDS for body mass index (BMI) over 1 year (-0.18±0.68 vs. 0.13±0.53, P=0.014). There were no differences between the 2 groups in IGF-1 SDS and IGFBP-3 SDS. Multiple linear regression showed that baseline chronological age (r=0.243, P=0.026) and height SDS (r=0.236, P=0.030) were positively associated with IGF-1 SDS. Binomial logistic regression showed that an older chronologic age at referral (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.47–0.99) and an increase of BMI SDS over 1 year (OR, 0.41; 95% CI, 0.18–0.89) were associated with a decreased growth possibility of an above-average height velocity (≥6 cm/yr). Conclusions Height velocity of normal prepubertal children is affected by an increase of BMI SDS and chronological age. Prepubertal IGF-1 SDS reflects height SDS at the time of measurement but is not associated with subsequent height velocity.