Associação entre Hipovitaminose D e Resistência Insulínica em crianças e adolescentes com excesso de peso / Association between hypovitaminosis d and insulin resistance in children and adolescents with overweight

Introdução: A redução dos níveis séricos de vitamina D também foi associada ao aumento da prevalência de Síndrome Metabólica ou a seus componentes individualmente. Na faixa etária pediátrica, essa relação ainda é controversa. Objetivo: Avaliar a associação entre vitamina D sérica e parâmetros bioquímicos de resistência insulínica (RI) em crianças e adolescentes com excesso de peso. Métodos: Estudo observacional em 122 crianças e adolescentes com excesso de peso acompanhados em serviço de atenção secundária entre agosto de 2014 e dezembro de 2018. As variáveis clínicas foram sexo, idade, IMC (escore-Z), grau de excesso de peso (OMS) e estação do ano. Os parâmetros bioquímicos analisados foram vitamina D, glicemia e insulina de jejum, Modelo de Avaliação da Homeostase para RI (HOMA-IR), relação glicemia/insulina de jejum e Proteína C Reativa (PCR). Utilizaram-se para análise de dados os testes de Kolmogorov- Smirnov, qui-quadrado e de Kruskal-Wallis. O nível de significância estatística adotado foi p < 0,05. Resultados: Houve associação entre hipovitaminose D sérica e parâmetros bioquímicos de RI. O grupo com hipovitaminose D apresentou maior ocorrência de insulina e HOMA-IR elevados e relação G/I baixa. Constatou-se uma alta ocorrência de insuficiência de vitamina D (69,7%). Os adolescentes apresentaram maiores valores de insulina sérica e índice HOMA-IR, compatível com o seu momento biológico. Conclusão: Observou-se associação entre hipovitaminose D sérica e parâmetros bioquímicos de RI de forma que o grupo com hipovitaminose D apresentou maior ocorrência de insulina, HOMA-IR e relação G/I alterados. Verificou-se, ainda, uma alta ocorrência de hipovitaminose D (69,7%).

Introduction: Reduced serum vitamin D levels have also been associated with an increased prevalence of metabolic syndrome or its individual components. This relationship is still controversial in the pediatric age group. Objective: To evaluate the association between serum vitamin D and biochemical parameters of insulin resistance (IR) in children and adolescents with overweight. Methods: This is an observational study performed with 122 children and adolescents with overweight who were followed up in a secondary healthcare center between August 2014 and December 2018. The clinical variables analyzed in this study were sex, age, body mass index (BMI, Z-score), degree of overweight (according to the World Health Organization), and season of the year. The analyzed biochemical parameters were vitamin D, fasting blood sugar and insulin, homeostasis model assessment of insulin resistance (HOMA-IR), fasting glucose/insulin ratio, and C-reactive protein (CRP). Data analysis used Kolmogorov-Smirnov, chi-squared, and Kruskal-Wallis tests. The statistical significance level defined for this study was p < 0.05. Results: An association was observed between serum hypovitaminosis D and biochemical parameters of IR. The group with hypovitaminosis D presented a higher occurrence of increased insulin and HOMA-IR and a low glucose/insulin ratio. We observed a high occurrence of vitamin D insufficiency (69.7%). Adolescents presented higher values of serum insulin and HOMA-IR, which is compatible with their stage of biological development. Conclusions: We observed an association between serum hypovitaminosis D and biochemical parameters of IR in a way that the group with hypovitaminosis D presented a higher occurrence of altered insulin levels, HOMAIR, and glucose/insulin ratios. We also observed a substantial occurrence of hypovitaminosis D (69.7%).

Menstrual cycle among adolescents: girls' awareness and influence of age at menarche and overweight / Ciclo menstrual em adolescentes: percepção das adolescentes e influência da idade de menarca e excesso de peso

Abstract Objective: To characterize the menstrual cycle (regularity and menstrual flow length), the prevalence of dysmenorrhea and self-monitoring of the cycle in students from Lisbon region, and explore the effect of chronological age, age at menarche and body mass index (BMI) on menstrual disorders. Methods: This is a cross-sectional study with 848 girls aged 12-18 years. A questionnaire about the sociodemographic context and characteristics of the menstrual cycle, and weight and height measures were assessed. BMI was classified according to International Obesity Taskforce criteria. A descriptive analysis of the variables was made, and Odds Ratios (ORs) and 95% confidence intervals (95%CIs) were determined. Results: Mean age at menarche was 12.4 years and mean BMI was 22.0kg/m2. Among adolescents, 59% have regular menstrual cycle, 83% have menstrual flow length of ≤6 days. 88% suffered from dysmenorrhea, among which 8,7% declare absenteeism from school and 49% took pain medication, and 65% self-monitor their menstrual cycle. Higher maternal education was associated with a higher self-monitoring of menstrual cycle among the sample (OR 1.60; 95%CI 1.15-2.17). Girls with menarche <12 years-of-age are more likely to have menstrual flow length of >6 days (OR 1.73; 95%CI 1.19-2.51) and dysmenorrhea (OR 1.87; 95%CI 1.11-3.16) than those with menarche ≥12 years-of-age. No significant association between BMI and menstrual cycle variables was observed. Conclusions: The results suggest that menstrual disorders are frequent and may be associated with early menarche, but not with BMI. It is important to encourage self-monitoring of the menstrual cycle to detect menstrual disorders timely and promote health and well-being.

Resumo Objetivo: Caracterizar o ciclo menstrual (regularidade e duração da menstruação), prevalência de dismenorreia e automonitoramento do ciclo em estudantes da região de Lisboa, e explorar o efeito da idade cronológica, idade de menarca e índice de massa corpórea (IMC) nos distúrbios menstruais. Métodos: Este é um estudo transversal com 848 meninas entre 12 e 18 anos. Foi aplicado um questionário sobre contexto sociodemográfico e características menstruais e feita a medição do peso e altura. O IMC foi classificado pelos critérios da International Obesity Taskforce. Fez-se uma análise descritiva das variáveis e determinaram-se Odds Ratio (p<0,005; IC95%). Resultados: A média da idade de menarca foi 12.4 anos e do IMC foi de 22.0kg/m2. Entre as jovens, 59% afirmaram ter ciclo menstrual regular, 83% menstruação com duração ≤6 dias, 88% sofrem de dismenorreia, entre as quais 8,7% faltaram à escola e 49% consumiram analgésicos, e 65% automonitoram o ciclo menstrual. Uma educação materna elevada está associada a maior monitorização do ciclo menstrual entre as jovens (OR 1,60; IC95% 1,15-2,17). Meninas com idade de menarca <12 anos têm maior chance de ter menstruação com duração >6 dias (OR 1,73; IC95% 1,19-2,51) e dismenorreia (OR 1,87; IC95% 1,11-3,16) do que aquelas com menarca ≥12 anos. Não se observou associação entre o IMC e as características menstruais. Conclusões: Os resultados sugerem que os distúrbios menstruais são frequentes nas adolescentes e podem estar associados com a menarca precoce, mas não com o IMC. É importante incentivar a automonitoramento do ciclo menstrual para detectar adequadamente as perturbações menstruais e promover a saúde e bem-estar.

Factors associated with sugar-sweetened beverages consumption among Malaysian adolescents: findings from the Adolescent Nutrition Survey 2017

@#Introduction: Childhood obesity is a public health problem in Malaysia. Intake of sugar-sweetened beverages (SSB) is associated with obesity in children. There is a lack of studies on factors associated with SSB consumption in Malaysia. This study aimed to determine the sociodemographic factors associated with SSB consumption among Malaysian adolescents. Methods: Data of 2,021 students, aged 10-17 years on sociodemographic, SSB intake and anthropometrics were drawn from the school-based Adolescent Nutrition Survey 2017. A multistage stratified cluster sampling was used to obtain a nationally representative sample of primary and secondary school students. Body mass index (BMI)-for-age status was determined based on calculated z-score using the World Health Organization 2007 reference. SSB consumption was obtained from a food frequency questionnaire. Results: The prevalence of overweight and obesity among Malaysian adolescents were 16.6% and 14.7%, respectively. Malaysian adolescents consumed 1.4 cups of SSB per day. Rural children had a significantly higher SSB intake (1.5 cups) than urban (1.3 cups) children, while males (1.5 cups) had a significantly higher intake than females (1.3 cups). There were no significant differences in SSB consumption between thin, normal, overweight and obese adolescents. Conclusion: Almost all Malaysian adolescents consumed SSB during one month prior to the survey and the average amount consumed was 1.4 cups per day. Rural locality and male were associated with higher SSB consumption. There were differences in SSB consumption between Chinese and Malays, between Chinese and Indians, and between Chinese and Bumiputra Sarawak. There were no differences in consumption between the different BMI-for-age categories.

Application of body composition zones in boys with nonalcoholic fatty liver disease

PURPOSE: Screening nonalcoholic fatty liver disease (NAFLD) by body mass index (BMI) as a single surrogate measure for obesity has limitations. We suggest considering body composition zones by drawing a body composition chart composed of body composition indices, including BMI and percent body fat (PBF), to visualize the risk of NAFLD in obese children and adolescents.METHODS: Thirty-eight boys diagnosed with NAFLD were selected retrospectively from patients who visited Konkuk University Medical Center from 2006 to 2015. They had gone through body composition analysis by bioelectrical impedance analysis (BIA), and biochemical analyses, including a liver function test (LFT) and lipid panel, were performed. Fat-free mass index (FFMI) and fat mass index (FMI) were calculated from body composition analysis and height. We plotted FFMI and FMI of patients on a body composition chart and classified the patients into zones A to D. In addition, we analyzed the correlations between LFT, lipid panel, and body composition indices.RESULTS: Thirty-three of 38 boys (86.8%) were located in zone C, corresponding to high BMI and PBF. Four boys (10.5%) were located in zone D, which correlates with sarcopenic obesity. One boy located in zone B was a muscular adolescent. Alanine aminotransferase level was positively correlated with PBF, FMI, and BMI z-score.CONCLUSION: Body composition zones on a body composition chart might be useful in risk assessment in obesity-related diseases such as NAFLD. Zones on a body composition chart could have practical applications, especially in sarcopenic obese children and adolescents.

Laparoscopic sleeve gastrectomy for morbidly obese adolescents in Singapore

INTRODUCTION@#Laparoscopic sleeve gastrectomy (LSG) outcomes among adolescents and factors associated with adolescent obesity in Singapore were evaluated.@*METHODS@#Prospectively collected data of patients aged 16-19 years who underwent LSG was retrospectively reviewed. A lifestyle questionnaire, Berlin and Epworth scores, and Patient Health Questionnaire-9 scores were collected. Preoperative anthropometrics, comorbidities, weight loss and body composition outcomes were recorded.@*RESULTS@#Among 208 LSGs, 13 (6.3%) were performed on obese adolescents. Mean age and body mass index (BMI) at first presentation were 19.1 ± 0.9 (range 16.8-19.8) years and 46.2 ± 6.3 (range 36-57) kg/m, respectively. There was family history of obesity (n = 7) and regular consumption of high-calorie drinks (n = 12). Most patients had comorbidities (n = 12), including hypertension (n = 5), asthma (n = 4), diabetes mellitus (n = 3), hernia (n = 3) and obstructive sleep apnoea requiring continuous positive airway pressure support (n = 3). At one year, excess weight loss was 64.3% ± 34.7% (range 21.8%-101.5%), while BMI and fat mass dropped to 31.2 ± 7.6 (range 23-40) kg/m and 17.4 kg, respectively. Pain score was 2/10 at 24 hours after surgery. Mean postoperative stay was 2.7 days. No complications or readmissions occurred. Remission of diabetes mellitus and hypertension was reported in two of three and four of five adolescents, respectively, within one year of surgery.@*CONCLUSION@#LSG is a safe option for adolescents with good short-term weight loss outcomes and remission of metabolic comorbid conditions.

Clinical Experience of Weight Loss Surgery in Morbidly Obese Korean Adolescents

PURPOSE: Comprehensive multidisciplinary weight management programs encompassing various conservative measures have shown only modest weight loss results in obese children and adolescents; therefore, bariatric surgery for this population has become a matter of discussion. This study aimed to present our experience with and outcomes for laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in morbidly obese Korean adolescents. MATERIALS AND METHODS: The prospectively established database of all patients undergoing bariatric surgery at Soonchunhyang University Seoul Hospital, Korea between January 2011 and January 2013 was retrospectively reviewed. Adolescents aged 14 to 20 years were included in the present analyses. RESULTS: Twenty-two adolescents underwent bariatric surgery during the study period; 14 underwent LSG and 8, LRYGB. Of these, 17 were female and 5 were male. The mean age was 19 years. Their mean body weight and body mass index (BMI) before surgery were 115 kg and 40.1 kg/m2. The only postoperative complication was intraluminal bleeding in 1 patient, which was managed conservatively. The mean BMI decreased to 29.1 kg/m2 after a mean follow-up of 10 months. The percent excess weight loss (%EWL) at 1, 3, 6, and 12 months postoperatively were 19.6, 39.9, 52.6, and 74.2%, respectively. Only 1 patient showed %EWL less than 30% at 12 months after surgery. All patients with diabetes and sleep apnea were cured of their disease, and other comorbidities also improved or resolved after surgery. CONCLUSION: Bariatric surgery leads to significant short-term weight loss along with resolution of obesity-related comorbidities in obese children and adolescents.

Mothers' Working Hours and Children's Obesity: Data from the Korean National Health and Nutrition Examination Survey, 2008-2010

OBJECTIVES: The aim of this study is to find the association between mothers' working hours and obesity of their children according to children's age and gender. METHODS: This study used data from the second and third year of KNHANES IV and the first year in KNHANES V (2008-2010). We calculate odds ratio (OR) and 95% confidence interval (CI) by using survey logistic regression to assess association of mother's working hours with overweight or obesity of her children. The model was adjusted with household income, mothers' education and obesity and mothers' job characteristics. RESULTS: 13-18 aged boys whose mothers worked under 40 hours per week were higher risk for obesity and overweight (including obesity) than 13-18 aged boys whose mothers worked 40-48 hours. 6-12 aged girls whose mothers worked 49-60 hours per week were more overweight (including obesity) than girls whose mothers worked 40-48 hours per week. 13-18 aged girls whose mothers worked over 60 hours were more overweight (including obesity) than the reference. CONCLUSION: This study showed that girls' obesity was associated with mothers' long working hours. Long working hours can influence health of workers' family.

Obesidad: ¿es una realidad en Venezuela?: epidemiología: pandemia del siglo XXI / Obesity: ¿is it a reality in Venezuela?: epidemiology:ç

La obesidad es una de las afeccines metabólicas más frecuentes en la actualidad. Más de mil millones de personas padecen obesidad o sobrepeso en todo el mundo. Además de las acumulación adiposa, su elevada morbi-mortalidad la convierten en uno de los principales problemas de salud a los que enfrenta la sociedad actual. Se estudia la obesidad, su definición. clasificación y el síndrome metabólco. En Venezuela se han publicado cuatro estudios de prevalencia del síndrome metabólico: Estado Zulia (2001), Gran Caracas, incluyendo los Estados Miranday Vargas (2006), Estado Lara (2007) y Estado Mérida (2007). El Estado Zulia tiene el mayor número de sujetos estudiados, 3.018, con cuatro grupos étnicos diferentes, seguidos de Caracas con 658, Lara y Mérida con 339 y 118 respectivamente. La participación de hombres siempre fue menor en todas las investigaciones. En el Estado Zulia se usó el estudio ATP III (2001), mientras que en las otras se utilizó el modificado de 2005 y el de la Federación Internacional de Diabetes. Los hallazgos arrojan unas cifras globales de promedio de 33,7% con LC 95% entre 32,3%-35,2% para adultos. Se encontraron diferencias importantes entre grupos de edad y sexo. En Venezuela, en el Estado Vargas (nivel del mar), en casi 2.500 madres, el sobrepeso alcanzó 31,4% y la obesidad 16,6%, aumentando con la edad; para los 30 años el sobrepeso llegó al 34,1% y la obesidad a 23,4% y los hijos de madres obesas, mostraron un sobre peso en todas las edades de un 23% a 35%. En el Área Metropolitana de Caracas (1000 m sobre nivel del mar), en las mujeres, el sobre-peso alcanzó 31% y la obesidad 14,6%. Los hombres presentaron un 40% de sobrepeso y 6,2% de obesidad aumentando con la edad. Con respecto a la obesidad en los niños y adolescentes en un total de 17.791 entre 7 y 14 años con sobre peso evaluados, se encontró 19,31% por encima del percentil 90. En el Distrito Capital a 23,26% que fue el valor más alto...

Obesity is one of the common metabolic diseases today. More than one billion people suffer from obesity or overweight worldwide. In addition to the fat accumulation, the high morbidity and mortality make it one of the major health problems facing the society. Obesity are studied. Their definition, classification and the metabolic syndrome. Venezuela has published four studies on the prevalence of the metabolic syndrome: state of Zulia (2001). Greater Caracas, including the states of Miranda and Vargas (2006). Lara State (2007) and Mérida (2007). Zulia state has the larges number of subjects studied, 3018. with four different ethnic groups, followed by Caracas with 658, Lara and Mérida with 339 and 118 respectively. The participation of men was always lower in all investigation. In Zulia state will use the ATP III study (2001), while in the other used the modified 2005 and the International Diabetes Federation version was used. The overall prevalence was 33.7% with 95% confidence limits (CL) 32.3% to 35.2% for adults. Important differences were found between age groups and sex. In Venezuela, in Vargas (sea level) in almost 2.500 mothers reached 31.4% overweight and obesity 16.6%, increasing with age, to 30 years., reached a 34.1% overweight and obesity and 23.4% and obese mothers showed an overweight in all age groups from 23% to 35%. In the metropolitan area of Caracas (1000 ms above sea level), in women, overweight reached 31% and obesity 14.6%. In men they had 40.6% of overweight and obesity 6.2% respectively, increasing age. With respect to obesity in children and adolescent in a total of 17.791 between 7 and 14 years evaluated overweight. 19.31% were found above the 90th percentile. In the Capital District amounted to 23.26% which was the highest value. Et the end of the paper we focus on the treatment of obesity and morbid obesity

Obesity in Thai adolescents: lifestyles, health attitudes and psychosocial concerns.

Objective: To determine the dietary pattern, lifestyle factors, and psychosocial concerns in Thai obese adolescents. Methods: Students’ school health records under the Siriraj School Health Network was reviewed during the academic year of 2005. Those with body mass indices (BMI) ³25 kg/m2 were asked to complete a self-administered questionnaire divided into three parts; 1) health attitudes and psychosocial concerns; 2) dieting lifestyle; 3) physical activity lifestyle. Results: The prevalence of overweight and obesity among 718 from 5,071 students from Siriraj School Health Network was different between genders (7.7% and 2.5 % in male vs. 2.9% and 1% in female). Of those, 403 voluntarily answered the self-administered questionnaires. The majority of students (87.9%) were not satisfied with their actual weight, and tried to lose weight (94.2%). Concerning their lifestyles, 79.4% and 49.6% had taken high calorie food mostly fast food and dined buffet-style at least once a week respectively, while half disliked fruits and vegetables, and 15.4% skipped breakfast. Also, the majority of students exercised less than the standard recommendation of at least three days a week, with more than two thirds, excusing not having enough time to practice while 48% spending at least three hours a day watching television and playing computer. Importantly, more than half of them had weight- related psychosocial problems presenting as poor self image, low self esteem and self confidence. Conclusion: Unhealthy lifestyles, poor health attitudes and negative psychosocial concerns were reported among Thai obese adolescents. Strategies for successful obesity prevention are discussed in this article.

Alterações ortopédicas em crianças e adolescentes obesos / Orthopedic alterations in obese children and adolescents

INTRODUÇÃO: A obesidade infanto-juvenil é um problema muito frequente e implica complicações que podem estar presentes precocemente, como as alterações ortopédicas. OBJETIVO: descrever as alterações que atingem o aparelho locomotor em crianças e adolescentes com sobrepeso e obesidade. METODOLOGIA: Foram consultadas as bases de dados MEDLINE, SciELO, LILACS, ISI e base de dados da Universidade de Standford, com a combinação dos seguintes descritores: "obesidade", "complicações", "criança", "dores músculo-esqueléticas", "postura", "alterações ortopédicas", "marcha" e seus respectivos sinônimos em inglês. RESULTADOS: Pôde-se observar que as crianças e adolescentes obesos são mais predispostos a apresentar essas complicações ortopédicas que os indivíduos eutróficos, e os principais problemas relatados foram as alterações posturais, como hiperlordose lombar e joelhos valgos, e dores músculo-esqueléticas, principalmente na coluna lombar e membros inferiores. Os principais fatores que causam esses problemas não são bem definidos, mas incluem aumento da sobrecarga articular associado à fragilidade óssea em fase de crescimento e à diminuição da estabilidade postural, o que conduz ao aumento das necessidades mecânicas regionais. CONCLUSÃO: A identificação precoce dessas disfunções é fundamental para que essas crianças recebam tratamento multidisciplinar adequado.

INTRODUCION: Childhood obesity is a very recurrent problem that causes some complications which can be present in early stage of life, like orthopedic alterations. OBJECTIVE: To describe the locomotor system alterations in obese children and adolescents. METHODS: Articles were found in MEDLINE, SciELO, LILACS, ISI and Standford databases. The follow key-words were used: "children obesity", "orthopedic disorders", "posture", "gait" and "musculoskeletal pain", in Portuguese and English. RESULTS: This review could observe that obese children and adolescents are more predispose to have these complications than the eutrofic ones and the main problems are the postural alterations, like lumbar hiperlordosis and genu valgum. Musculoskeletal pains are also a common complaint, mainly back pain and knee pain. The main factors that can cause these problems are not well defined, but include an increase in body fat mass and in weight-bearing forces associated to a weaker bone in growth phase and the decrease in postural stability, which leads to a higher mechanical regional needs are some hypothesis. CONCLUSION: The early identification of these problems is essential for these children to receive the adequate multi-professional care.

Prevalence Rates and Risk Factors of Overweight and Obesity in Children and Adolescents: Using Korean National Health and Nutrition Examination Survey 2005 Data / 한국역학회지

PURPOSE: To investigate the prevalence rates of overweight and obesty, and their associations in children and adolescents(12-18years) who were defined as normal weight, overweight , and obese. METHODS: Korean National Health and Nutrition Examination Survey 2005 raw data was utilized. The data on the 669 subjects aged 12-18 consisted of variables from the health interview survey, health examination and nutrition survey, and health consciousness behavior survey. Overweight and obesity was evaluated by established body mass index criteria. Chi-squire and Fisher exact test were performed to analyze differences among normal, overweight and obese groups according to basic characteristics and health consciousness behavior. Logistic regression was used to analyze risk factors for the overweight and obese groups. RESULTS: Overweight and obesity prevalence rates were 11.7% and 8.1%, respectively. Of the subjects from urban regions, 20% were overweight and 12.2% were obese. Of those from semi-urban regions, 10.2% were overweight and 3.8% were obese. Of those from rural regions, 9.0% were overweight and 10.1% were obese. The obesity rate in semi-urban regions were 0.38% times lower than the rural rate. CONCLUSIONS: Geographical location constitutes a risk factor for overweight and obesity, which may influence preventative and education programs aimed at schools and the general community.

Effects of a School-based Obesity Prevention Program in Adolescents

BACKGROUND: We aimed to evaluate the effect of school- based obesity prevention and management program applied to adolescents in a middle school on body mass index (BMI), weight-related attitude, eating behavior and physical activity of adolescents. METHODS: A total of 664 adolescents (14.7+/-0.9 years old) in a middle school located in Busan were study subjects. The obesity prevention and management program was conducted for 6 months, from March to September, 2005. Their weight and height were measured and their weight-related attitude, eating habit and physical activity were assessed using a questionnaire at baseline and after 6 months. Their weight status was classified into under-, normal-, and overweight according to their BMI at baseline. RESULTS: The prevalence of underweight and overweight was 6.2% and 19.3%, respectively. Among the adolescents with overweight, the BMI significantly decreased after 6 months compared to the BMI at baseline (P < 0.05), while the BMI was not significantly changed over 6 months among the under- and normal weight groups. The adolescents were more likely to become highly concerned about obesity-related problems (P=0.002) and actively participating in obesity prevention program (P=0.007) after 6 months compared to those attitude at baseline. The BMI significantly decreased in the adolescents whose eating behavior or physical activity were improved compared to their counterparts (P < 0.05). CONCLUSION: The 6-months program for obesity prevention and management seemed to reduce BMI in overweight adolescents and raise concern about obesity related problems and promote participation in obesity prevention program in adolescents as a whole. Further long-term intervention studies need to be implemented.

Evaluation of School-based Obesity Prevention and Management Program in Korean Children

BACKGROUND: Childhood and adolescent obesity are major health concern impacting on short and long-term health. Prevention programs for obesity through school channel are essential. With the increasing prevalence of obesity and overweight among children and adolescence since 1990's, obesity prevention and management have been pursued in Korea. Schools, where students spend much of their daytime, are in a unique position to play a pivotal role in performing obesity prevention and management programs. The objective of this study was to assess the effectiveness of school-based interventions designed to prevent or manage obesity among elementary, middle, and high school students in Korea. METHODS: Electronic database were searched using the following key words; obesity, obesity prevention, obesity prevention program, child, adolescence, and effectiveness. In this systematic review, school-based programs were evaluated with the assessment items. RESULTS: Thirteen studies were included in the study. Most programs include at least one of the following components: dietary changes, physical activity, behavioral modifications, and parental participation. Studies that involved multidisciplinary measures including dietary education, increased physical activity, parental involvement and behavioral modification and studies focused on increased physical activity among subjects showed positive results. But the majority of studies were short-term and secondary prevention among children, not adolescents, not randomized, and without control. Few studies used validated questionnaires and process evaluation. CONCLUSION: The development and application of evidence-based and feasible strategies in support of communities and families to the school-centered obesity prevention program are needed in the near future.

Affecting Factors of Insulin Resistance in Obese Children and Adolescents / 소아과

PURPOSE: Insulin resistance is the most important risk factor linked to the development of impaired glucose tolerance (IGT), diabetes mellitus and cardiovascular diseases in childhood and adolescent obesity, The purpose of this study was to see whether insulin resistance of obese adolescent is higher than that of obese children. and to analyze gender difference and affecting factors of insulin resistance. METHODS: Of the 9, 837 school children from 5 to 16 tears old, 92 obese children and 187 adolescent, underwent a two-hour oral glucose tolerance test and plasma glucose, insulin, lipid profiles, leptin and high sensitive C-reactive protein (hs-CRP) were measure. RESULTS: Plasma insulin levels of female were higher compared to those of males during oral glucose tolerance test (P< 0.05). Four (4.3%) in obese children and twenty five (13.3%) in obese adolescents met the criteria of IGT. Female, leptin, adiponectin and triglyceride concentrations were strongly correlated with homeostatic model assessment insulin-resistance (HOMA-IR) by multiple linear regression analysis (P< 0.05). CONCLUSION: Obese adolescents might have higher insulin concentrations compared to obese children and obese girls higher insulin concentrations than obese boys. Obese boys and children with impaired glucose tolerance have higher insulin concentrations than those with normal glucose tolerance. HOMA-IR was significantly correlated with female, plasma leptin, adiponectin and triglyceride concentrations.

Evaluation of Web Sites on Treatment of Childhood and Adolescent Obesity / 대한소아소화기영양학회지

PURPOSE: The purpose of this study was to evaluate the quality and problems of Web sites for management of childhood and adolescent obesity. METHODS: We evaluated 203 Web sites identified from the search engine, Korean Yahoo, using the word of 'childhood and adolescent obesity'. 203 Web sites were classified according to medical institutions, health information Web sites, beauty shops. etc. We surveyed whether childhood and adolescent obesity distinguished with adult obesity was considered, or not. and researched the unique managements of childhood and adolescent obesity including the cardinal treatment. RESULTS: Of the 203 Web sites, 157(77.3%) provided detailed information about treatment of obesity, 46(22.7%) provided only simple information about one. The sites providing detailed information were composed of 52.2% of oriental medicine clinics, 35.0% of clinic and hospitals including pediatric hospitals. Distribution of the sites about management of childhood and adolescent obesity distinguished with adult's one was only 23% of oriental medicine clinics, but 93% of childrens hospitals. CONCLUSION: Without considering the speciality of childhood obesity, inaccurate information are distributing on internet web sites. It is necessary for concern and development of advertizing system on the internet distributing accurate information about treatment of childhood obesity.

Prevalence of Insulin Resistance and Impaired Glucose Tolerance among Children and Adolescents with Obesity / 대한소아내분비학회지

Pupose:Recently childhood obesity is increasing and has been accompanied by an increase in the prevalence of type 2 diabetes mellitus(DM) among children and adolescents. We evaluated insulin resistance and impaired glucose tolerance(IGT) in 48 obese children and adolescents. METHODS:All subjects underwent a two-hour oral glucose tolerance test(1.75 g of glucose per kg of body weight) and then glucose and insulin levels were measured. Insulin resistance was estimated by homeostatic model assessment, and betacell function was estimated by calculating the ratio between the changes in the insulin level and glucose level during the first 30 minutes after the ingestion of glucose. RESULTS:IGT was detected in 4.2% of the 24 obese children(4-10 years of age) and 20.8% of the 24 obese adolescents(11 to 18 years of age). Type 2 DM was identified in 8.3% in children and 29.2% in adolescent obesity. Insulin levels were markedly elevated after the glucose tolerance test in subjects with IGT but a little decreased in cases with DM. Those changes of insulin levels were not significant statistically. The insulinogenic index was decreased in IGT and DM group of childhood and adolescent obesity compared to normal glucose tolerance(NGT) but it was not significant statistically. Insulin resistance, which was evaluated with fasting insulin, QUICKI and HOMA-IR, was increased in childhood obesity compared with adolescent obesity and the HOMA-IR of adolescent IGT group was significantly higher compared with NGT group(P<0.05). CONCLUSION: IGT is highly prevalent among children and adolescents with obesity. IGT was associated with insulin resistance and hyperinsulinemia, while beta-cell function was still relatively preserved. Overt type 2 diabetes was linked to insulin resistance and to beta cell failure.

Prevalence of Insulin Resistance and Impaired Glucose Tolerance among Children and Adolescents with Obesity / 대한소아내분비학회지

Pupose:Recently childhood obesity is increasing and has been accompanied by an increase in the prevalence of type 2 diabetes mellitus(DM) among children and adolescents. We evaluated insulin resistance and impaired glucose tolerance(IGT) in 48 obese children and adolescents. METHODS:All subjects underwent a two-hour oral glucose tolerance test(1.75 g of glucose per kg of body weight) and then glucose and insulin levels were measured. Insulin resistance was estimated by homeostatic model assessment, and betacell function was estimated by calculating the ratio between the changes in the insulin level and glucose level during the first 30 minutes after the ingestion of glucose. RESULTS:IGT was detected in 4.2% of the 24 obese children(4-10 years of age) and 20.8% of the 24 obese adolescents(11 to 18 years of age). Type 2 DM was identified in 8.3% in children and 29.2% in adolescent obesity. Insulin levels were markedly elevated after the glucose tolerance test in subjects with IGT but a little decreased in cases with DM. Those changes of insulin levels were not significant statistically. The insulinogenic index was decreased in IGT and DM group of childhood and adolescent obesity compared to normal glucose tolerance(NGT) but it was not significant statistically. Insulin resistance, which was evaluated with fasting insulin, QUICKI and HOMA-IR, was increased in childhood obesity compared with adolescent obesity and the HOMA-IR of adolescent IGT group was significantly higher compared with NGT group(P<0.05). CONCLUSION: IGT is highly prevalent among children and adolescents with obesity. IGT was associated with insulin resistance and hyperinsulinemia, while beta-cell function was still relatively preserved. Overt type 2 diabetes was linked to insulin resistance and to beta cell failure.

The Effect of Overweight to Cardiovascular Risk Factors among Korean Adolescents

BACKGROUND: Cardiovascular complications develop over a long time, and childhood and adolescent obesity often do not present clinical diseases. We evaluated the effect of overweight to cardiovascular risk factor profiles to clustering in Korean adolescents. METHODS: Nationwide population based surveys and health examinations were done in 1998. Among the subjects, adolescents aged 10 to 18 were included for this study. Age and gender specific BMI percentile was calculated by Korean reference. Cardiovascular risk factors were defined as values above 95th percentile (specific for age, gender) for the group as a whole. RESULTS: The prevalence of obesity over 95th percentile was 5.5% among 1,634 adolescents. Obesity increased with adverse levels of risk factors. Adolescents with a BMI above 95th percentile were 6.3, 4.8, 9.8, 5.1, and 4.9 times more likely to have adverse levels of systolic blood pressure, total cholesterol, LDL-cholesterol, triglycerides, and HDL-cholesterol, respectively, than normal weight subjects. Obese boys had higher prevalence of hypertension than obese girls. The number of risk factor profiles increased with obesity, but not in linear pattern. Sixty percent of overweight above 95th percentile had risk factors, while 23% of normal weight group did. CONCLUSIONS: Adolescent obesity in Korea was highly associated with cardiovascular disease risk factors, and clustering. The prevalence of risk factors increased substantially above 75th percentile, and even among overweight above 95th percentile adolescents. The risk of clustering increased BMI above 85th percentile.

Psychosocial Factors and Familial Environments in Adolescent Obesity

BACKGROUND: Adolescent obesity has a high risk of developing into adult obesity and may cause many physical and psychological problems. The purpose of this study was to investigate familial environment and psychosocial factors of adolescent obesity. METHODS: A total of 1,153 students from one middle school located in suburban area were chosen as subjects. In this study, the obese group was defined to have an obesity index higher than 85 pecentile, compared to the normal weight group which ranged between 25 and 75 percentile. The questionnaires included items on familial environment and psychosocial factors, their parents' BMI, physical activity, self esteem inventory, depression self rating scale, and FACES III (family cohesion and adaptability scale III). RESULTS: Maternal BMI of the obese group was significantly higher than that of the normal weight group. The mean self esteem score of the obese group was significantly lower than that of the normal weight group. Depression self-rating score of the female obese group was significantly higher than that of the normal weight group. There was no difference in family functioning between the obese group and the normal weight group. CONCLUSION: In multivariate analysis, there were significant correlations among adolescent obesity and higher maternal BMI and lower self-esteem. It will be necessary to evaluate and support the psychosocial factors in the management of adolescent obesity.

Weight control behaviors of obese adolescents

BACKGROUND: As childhood-onset obesity has been known to have a poor prognosis, and its prevalence is rapidly increasing, many children and adolescents are becoming concerned about obesity and try various weight control methods. This study assessed the experience and behaviors of weight control in obese adolescents. METHODS: A total of 732 among 840 obese students from 28 schools in Seoul metropolitan area were assessed with a self-administered questionnaire. RESULTS: Middle school students showed the highest trial rate of weight control. Elementary and high school girls showed significantly higher trial rates of weight control than boys(P<0.05). The methods more frequently used were physical exercise, and diet, drugs and other methods, and visits to obesity clinics in that order. Elementary school girls most frequently tried physical exercise while high school girls went on a diet most frequently. All groups of girls were dieting significantly more often than boys(P<0.05). High school girls were the most frequent users of drugs and other methods while elementary school boys and middle schoolgirls visited obesity clinics most frequently. Unhealthy weight control methods observed were monodiet(2.7%), fasting(1.9%), dieting pills(1.4%), and vomiting(0.1%). The mean number of weight control methods was decreased with increasing age. The possibility of overall weight control was significantly higher in girls, having higher weight dissatisfaction levels. The possibility of physical exercise was significantly higher in younger ages, having mother with a career and a family history of obesity. The possibility of dieting was significantly higher in girls, older ages, having higher obesity index. The possibility of using drugs and other methods was significantly higher if they had higher weight dissatisfaction levels and a family history of obesity. The possibility of visiting obesity clinics was significantly higher if they had higher obesity index. CONCLUSION: Although, exercise and diet were frequently chosen by obese adolescents for weight control, the munber unhealthy methods chosen were found to be higher and physical exercise decreased with increasing age. Therefore, an appropriate weight control program that is not detrimental to normal growth and development is called for in early adolescence.