Clinical Nutrition Therapy of Metabolic Syndrome in Adolescents / 대한소아소화기영양학회지

Metabolic syndrome (MetS) is characterized by the clustering of obesity, impaired glucose metabolism, hypertension, and dyslipidemia, and is predictive for development of cardiovascular disease and type 2 diabetes. The high prevalence of MetS is a serious health problem, especially among obese adolescents. Because insulin resistance and obesity play a central role in MetS, treatment of MetS should be primarily focused on improving insulin sensitivity and weight reduction. Nutritional therapy of MetS aims to reduce the intakes of saturated fat and free fructose, and increasing the intakes of dietary fiber, unsaturated fat, and antioxidant nutrients may also be beneficial.

Review on Revised Nutrition Guidelines of the Korea National Health Screening Program for Infants and Children / 대한소아소화기영양학회지

Infancy and childhood are marked by rapid physical growth and development, and infant's and child's health and development depends on good nutrition. Any disruption in appropriate nutrient intake may have lasting effects on growth potential and development achievement. Nutrition needs and feeding patterns vary significantly in each stage of growth and development. This article summarized the key nutritional issues in the Korea national health screening program for infants and children as followings: encouraging breastfeeding, healthier complementary feeding, healthy foods selection, healthy eating habits, coping with feeding problem (picky eating), and overweight prevention with an emphasis on physical activity.

Association between Genotypes and Gastric Mucosal Lymphocytes in Helicobacter pylori-infected Children / 대한소아소화기영양학회지

PURPOSE: Helicobacter pylori infection is probably acquired in childhood and persists as an asymptomatic infection for decades in most individuals. It is unclear why only a minority of those infected develop a clinical manifestation, even in childhood, such as peptic ulcer disease. H. pylori infection activates local immune responses and causes lymphocyte infiltration in the gastric mucosa. We have previously reported that both T and B cells in the lamina propria play important roles in the local immune response of H. pylori-infected children. The aim of this study was to investigate the association between H. pylori genotypes and gastric mucosal lymphocytes. METHODS: Twenty-five H. pylori-infected children (10 with peptic ulcer disease and 15 with gastritis) were enrolled in this study. We investigated the genotypes (cagA, cagE, vacA, and babA2) and evaluated the association with clinical manifestations, histopathology, and gastric mucosal lymphocytes. RESULTS: The prevalence of cagA, cagE, vacA s1m1, and babA2 was 80%, 60%, 84%, and 88%, respectively. The most prevalent (68%) combination of cagA, vacA, and babA2 genotypes was cagA+/ vacA s1m1+/babA2+. H. pylori genotypes were not associated with clinical manifestations, histopathology, or gastric mucosal lymphocytes. CONCLUSION: There was no association between the cagA, cagE, vacA, or babA2 status and gastric mucosal lymphocytes. The role of the host immune response in relation to H. pylori genotypes and disease potential in children needs further studies.

The Rational Use of Drugs in the Management of Diarrhea in Children / 대한소아소화기영양학회지

Worldwide, diarrhea remains one of the most common illnesses among children. Oral rehydration therapy (ORT) is the cornerstone of diarrhea treatment. Yet, the rates at which ORT is used are still disappointingly low. Additional treatment interventions include antimotility drugs, antisecretary drugs, adsorbents, probiotics, antibiotics, oral immunoglobulin, micronutrient supplementation. Drugs are generally not necessary. However, selected probiotics may reduce the duration and intensity of diarrhea. Zinc is beneficial especially to malnourished children with diarrhea. Antibiotic treatment is effective mainly in shigella and cholera infection. Other drugs may be effective but require further investigations.

The Rational Use of Drugs in the Management of Diarrhea in Children / 대한소아소화기영양학회지

Worldwide, diarrhea remains one of the most common illnesses among children. Oral rehydration therapy (ORT) is the cornerstone of diarrhea treatment. Yet, the rates at which ORT is used are still disappointingly low. Additional treatment interventions include antimotility drugs, antisecretary drugs, adsorbents, probiotics, antibiotics, oral immunoglobulin, micronutrient supplementation. Drugs are generally not necessary. However, selected probiotics may reduce the duration and intensity of diarrhea. Zinc is beneficial especially to malnourished children with diarrhea. Antibiotic treatment is effective mainly in shigella and cholera infection. Other drugs may be effective but require further investigations.

Recent concepts on vitamin D in children and adolescents / 소아과

Vitamin D is an important fat-soluble vitamin that functions as a prohormone and affects bone mineralization and calcium homeostasis. Vitamin D deficiency causesboth musculoskeletal manifestations, including rickets, and extra-musculoskeletal symptoms. Because vitamin D is naturally present in only some foods, intake of daily foods cannot meet the dietary reference intake for vitamin D. Sunlight is the main source of vitamin D in humans therefore, the lack of sunlight can easily cause vitamin D deficiency in children and adolescents. Vitamin D deficiency can be diagnosed on the basis ofits typical clinical manifestation, laboratory tests, and radiologic findings. Detection of vitamin D deficiency in children or adolescents necessitates the simultaneous administration of vitamin D and calcium supplements. To prevent vitamin D deficiency, 200 IU of daily vitamin D intake is recommended in infants, and 400 IU of daily vitamin D intake is recommended in Korean children and adolescents.

Current feeding practices and maternal nutritional knowledge on complementary feeding in Korea / 소아과

PURPOSE: To evaluate current feeding practices and maternal nutritional knowledge on complementary feeding. METHODS: Mothers of babies aged 9-15 months who visited pediatric clinics of 14 general hospitals between September and December 2008 were asked to fill questionnaires. Data from 1,078 questionnaires were analyzed. RESULTS: Complementary food was introduced at 4-7 months in 89% of babies. Home-made rice gruel was the first complementary food in 93% cases. Spoons were used for initial feeding in 97% cases. At 6-7 months, <50% of babies were fed meat (beef, 43%). Less than 12-month-old babies were fed salty foods such as salted laver (35%) or bean-paste soup (51%) and cow's milk (11%). The following were the maternal sources of information on complementary feeding: books/magazines (58%), friends (30%), internet web sites (29%), relatives (14%), and hospitals (4%). Compared to the 1993 survey, the incidence of complementary food introduction before 4 months (0.4% vs. 21%) and initial use of commercial food (7% vs. 39%) had decreased. Moreover, spoons were increasingly used for initial feeding (97% vs. 57%). The average maternal nutritional knowledge score was 7.5/10. Less percentage of mothers agreed with the following suggestions: bottle formula weaning before 15-18 months (68%), no commercial baby drinks as complementary food (67%), considering formula (or cow's milk) better than soy milk (65%), and feeding minced meat from 6-7 months (57%). CONCLUSION: Complementary feeding practices have considerably improved since the last decade. Pediatricians should advise timely introduction of appropriate complementary foods and monitor diverse information sources on complementary feeding.

Gastric mucosal immune response of Helicobacter pylori-infected children / 소아과

Purpose: Helicobacter pylori infection is one of the most common gastrointestinal infections worldwide; it almost invariably causes chronic gastritis. Pediatric studies may provide important insights into the mucosal immune response of H. pylori-infection, as children are not submitted to environmental factors such as alcohol, tobacco and anti-inflammatory medication. The aim of the present study was to investigate the mucosal immune response against H. pylori in clinically well-defined groups: H. pylori-positive (divided into peptic ulcer disease and gastritis) and H. pylori-negative control. Methods: Antral biopsies were obtained from 45 children undergoing an upper GI endoscopy for dyspeptic symptoms. T cells (CD3+, CD4+, CD8+) and B cells (CD20+) were analyzed by quantitative immunohistochemistry. The correlation of lymphocyte subsets of gastric mucosa with histology was evaluated. Results: T cells (CD3+, CD4+, CD8+) and B cells (CD20+) were significantly increased in the lamina propria of H. pylori-positive group (p<0.01). CD8+ T cells were significantly increased in the lamina propria of the H. pylori-positive peptic ulcer disease (p<0.01). Within the epithelium, only CD4+ T cells were significantly increased in the H. pylori-positive group (p<0.01). Gastric histological parameters had a closer correlation with lymphocytes in the lamina propria than intraepithelial lymphocytes. Conclusion: This study suggests that both T cells and B cells in the lamina propria play important roles in the local immune response of H. pylori-infected children. Furthermore, it remains to be elucidated whether CD8+ T cells in the lamina propria may contribute to peptic ulcer formation in H. pylori-infected children.

Serum Zinc Concentration in Children with Acute Gasrtoenteritis / 대한소아소화기영양학회지

PURPOSE: To identify factors that influence serum zinc concentrations in children with acute gastroenteritis. METHODS: Thirty-two children under 5 years of age (15 boys and 17 girls) were selected randomly among those who visited to an pediatric emergency room of Ehwa Womans University Mokdong Hospital with acute gastroenteritis from May to August 2005. This study estimated the association between serum zinc concentrations and clinical, biochemical variables in patients with acute gastroenteritis. RESULTS: Serum zinc concentration was lower in febrile patients than afebrile patients with acute gastroenteritis (67.0+/-25.3 vs 85.5+/-14.2, p or =70 microgram/dL (91.7% vs 55%, p<0.05; 91.7% vs 40%, p<0.05, respectively). CONCLUSION: In patients with acute gastroenteritis, serum zinc concentration was influenced by various factors such as fever, CRP, and biochemical factors. For evaluating zinc status in the body. factors.

Revision of a Questionnaire to Assess Health Behaviors in Obese Children / 대한소아소화기영양학회지

PURPOSE: The prevalence of childhood obesity has increased dramatically. It is important to know about life style and dietary habits of the obese children because the treatment of childhood obesity focuses on using behavioral modification techniques. We aimed to develop a questionnaire for the purpose of providing convenient and useful guidance to pediatricians who evaluate and treat obese children. METHODS: Previously developed questionnaire was given to 94 obese children and their parents who had visited clinic for obese children and adolescents. We analyzed response rates on questions and reliability between children and their parents. RESULTS: The response rates on questions were somewhat high. Agreement of paired questions of both parents and children was also moderately high (63~92%). It is acceptable to complete questions by either parents or children alone. Items for hours of playing video games or computer, maternal job, kind of consuming beverage and food outside home were added. CONCLUSION: We concluded that some questions are not needed to be given to both parents and their children. It would be better to have parents record life style of their children and to have children record their food intake with physical activity outside home.

The Metabolic Syndrome in Obese Children / 대한소아소화기영양학회지

PURPOSE: Obesity is rapidly increasing in Korean children. Obesity is a risk factor for cardiovascular morbidity and is frequently associated with hypertension, diabetes mellitus and coronary artery disease. This study was designed to evaluate risk factors of the metabolic syndrome in obese children. METHODS: From February 2000 to June 2004, eighty eight obese (body mass index > or =95th percentile) children aged 4 to 15 years were included. We measured serum lipid levels (total cholesterol, triglyceride, HDL cholesterol, LDL cholesterol), fasting sugar levels and insulin levels. Insulin resistance was determined by homeostasis model assessment, fasting insulin/glucose ratio and quantitative insulin sensitivity check index. RESULTS: Clustering of risk factors for the metabolic syndrome in obese children demonstrated that 60.2% had more than one risk factors. Hypertension (14.8%), hypertriglyceridemia (14.8%), HDL-hypocholesterolemia (14.8%), LDL-hypercholesterolemia (12.5%) and hyperinsulinemia (12.5%) were observed. As BMI increased, there was statistically significant increase in systolic blood pressure, insulin and insulin resistance values. Insulin resistance was correlated to systolic blood pressure, serum lipid and insulin levels. The more risk factors for the metabolic syndrome obese children had, the higher was their insulin resistance. CONCLUSION: The increase in insulin resistance and clustering of risk factors for the metabolic syndrome are already apparent in obese children. Monitoring these risk factors for the metabolic syndrome should become a part of routine medical care for obese children.

Change of Cerebral Blood Flow during Tilt Tests in Children with Vasovagal Syncope

PURPOSE: Syncope appears to be common. However, the mechanism of syncope is not clear. Increased vagal activity and withdrawal of sympathetic stimulation cause hypotension, bradycardia and finally loss of consciousness. The purpose of this study was to evaluate changes of cerebral blood flow velocity, blood pressure, and heart rate during tilt test in children with vasovagal syncope. METHODS: Sixty four children with a past history of syncope were evaluated. The stand up test was performed for 15 minutes after a rest at supine position for 10 minutes, followed by an 80 degrees tilt test lasting 45 minutes. If presyncope(lightheadedness, nausea, blurred vision, or sweating) or syncope occurred, the study was discontinued. 12-lead electrocardiography, echocardiography, and electroencephalography were performed. Transcranial Doppler study was performed at the middle cerebral artery with 2 MHz continuous Doppler probe in 10 children with positive tilt test. Systolic, diastolic, mean cerebral blood flow velocity, integral, and pulsatility index were measured with blood pressure, heart rate, and O2 saturation. RESULTS: The positive rate of tilt test was 31.3%(20/64). Systolic, diastolic, and mean cerebral blood flow velocity decreased significantly in absence of hypotension or bradycardia during presyncope. Time velocity integral of cerebral artery also decreased significantly. CONCLUSION: Decreased cerebral blood flow velocity can predict the presyncope manifestation. Impairment of autoregulation of cerebral blood flow might play an important role in the pathophysiology of vasovagal syncope.

Correlation between Body Fat Percent Estimated by Bioelectrical Impedance Analysis and Other Variable Methods

PURPOSE: Obesity is a significant health problem with medical and psychological consequences for children and adolescents. The purpose of this study was to assess the correlation between body fat percent using bioelectrical impedance(BI) and other variable methods. METHODS: We measured height, weight, body mass index(BMI) and body fat percent by skinfold thickness(ST) and BI in 1,035(496 male; 539 female) children from seven to 18 years of age. The correlation coefficients between BI and each of the other different methods were obtained. The sensitivity and specificity to predict obesity by these several methods were studied. RESULTS: Fat percent estimated by BI analysis and BMI showed a strong correlation(r=0.749). Fat percent estimated by BI analysis and ST showed a very strong correlation(r=0.835). At the 95th percentile cut-off point for BI, ST showed a sensitivity of 57.7%, and a specificity of 97.6% for estimating body fat. At the 95th percentile cut-off point for BI, BMI showed a sensitivity of 84.9%, and a specificity of 99.3% for estimating body fat. CONCLUSION: The fat percent estimated by BI analysis correlated strongly with ST or BMI. BI analysis is an objective and accurate method for estimating body fat in childhood obesity.

A Case of Juvenile Dermatomyositis

Juvenile dermatomyositis is an uncommon autoimmune disease with classic heliotrope discoloration of eyelids, erythematous skin rash of joints and proximal muscle weakness. Quite different from adults, malignancy is rarely accompanied in juvenile dermatomyositis. However vasculitis, muscle atrophy, calcification and gastrointestinal involvement are often observed in juvenile dermatomyositis. A six year old boy was admitted with chief complaints of general weakness and skin rash. Muscle biopsy was performed which was consistent with dermatomyositis. The patient was treated with intravenous immunoglobulin, steroid, methotrexate and physiotherapy. We report a case of juvenile dermatomyositis.