• Clinical and Experimental Pediatrics
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• v.59 no.3
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• pp.114-119
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• 2016

Purpose: This study aimed to assess the reference values and factors influencing blood lead levels among Korean adolescents. Methods: The study population consisted of 1,585 adolescents (801 males, 784 females; aged 10-19 years) who participated in the Korea National Health and Nutrition Examination Survey 2010-2013. We analyzed blood lead concentrations in relation to demographic/lifestyle characteristics for all participants. "Reference values" of blood lead levels were calculated as the upper limit of the 95% confidence interval of the 95th percentile. Results: The average "reference value" for blood lead concentrations among Korean adolescents was $2.25{\mu}g/dL$ ($2.49{\mu}g/dL$ for males, $2.07{\mu}g/dL$ for females), and the geometric mean of the blood lead concentrations was $1.34{\mu}g/dL$. Males had higher blood lead concentrations than females (male, $1.48{\mu}g/dL$; female, $1.19{\mu}g/dL$; P<0.001). Elementary school students had higher blood lead concentrations than junior and senior high school students ($1.44{\mu}g/dL$ vs. $1.31{\mu}g/dL$, P<0.001). Participants living in detached houses had higher blood lead concentrations than those living in apartments (P<0.001) and current smokers had higher concentrations than nonsmokers or participants with secondhand smoke exposure (P<0.05). Additionally, participants with excessive alcohol consumption had higher levels than non-drinkers (P<0.001). Conclusion: This study provides national reference data on blood lead concentrations stratified by demographic and lifestyle factors among Korean adolescents. Further studies are needed to elucidate the relationship between increased lead exposure and demographic factors including type of housing.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.21 no.1
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• pp.59-67
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• 2018

Purpose: to compare cut off points corrected for age and gender (COOP) with fixed cut off points (FCOP) for fasting plasma insulin and Homeostatic model assessment-insulin resistance (HOMA-IR) for the diagnosis of IR in obese children and adolescents and their correlation with dyslipidemia. Methods: A multicenter, cross-sectional study including 383 subjects aged 7 to 18 years, evaluating fasting blood glucose, plasma insulin, and lipid profile. Subjects with high insulin levels and/or HOMA-IR were considered as having IR, based on two defining criteria: FCOP or CCOP. The frequency of metabolic abnormalities, the presence of IR, and the presence of dyslipidemia in relation to FCOP or CCOP were analyzed using Fisher and Mann-Whitney exact tests. Results: Using HOMA-IR, IR was diagnosed in 155 (40.5%) and 215 (56.1%) patients and, using fasting insulin, 150 (39.2%) and 221 (57.7%), respectively applying FCOP and CCOP. The use of CCOP resulted in lower insulin and HOMA-IR values than FCOP. Dyslipidemia was not related to FCOP or CCOP. Blood glucose remained within normal limits in all patients with IR. There was no difference in the frequency of IR identified by plasma insulin or HOMA-IR, both for FCOP and CCOP. Conclusion: The CCOP of plasma insulin or of HOMA-IR detected more cases of IR as compared to the FCOP, but were not associated with the frequency of dyslipidemia. As blood glucose has almost no fluctuation in this age group, even in the presence of IR, fasting plasma insulin detected the same cases of IR that would be detected by HOMA-IR.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.21 no.1
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• pp.34-42
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• 2018

Purpose: Monogenic inflammatory bowel disease (IBD) patients do not respond to conventional therapy and are associated with a higher morbidity. We summarized the clinical characteristics of monogenic IBD patients and compared their clinical outcomes to that of non-monogenic IBD patients. Methods: We performed a retrospective cohort study of all children <18 years old who were diagnosed with IBD between 2005 and 2016. A total of 230 children were enrolled. Monogenic IBD was defined as a presentation age less than 6 years old with confirmation of a genetic disorder. We subdivided the groups into monogenic IBD (n=18), non-monogenic very early-onset IBD (defined as patients with a presentation age <6 years old without a confirmed genetic disorder, n=12), non-monogenic IBD (defined as all patients under 18 years old excluding monogenic IBD, n=212), and severe IBD (defined as patients treated with an anti-tumor necrosis factor excluding monogenic IBD, n=92). We compared demographic data, initial pediatric Crohn disease activity index/pediatric ulcerative colitis activity index (PCDAI/PUCAI) score, frequency of hospitalizations, surgical experiences, and height and weight under 3rd percentile among the patients enrolled. Results: The initial PCDAI/PUCAI score (p<0.05), incidence of surgery per year (p<0.05), and hospitalization per year (p<0.05) were higher in the monogenic IBD group than in the other IBD groups. Additionally, the proportion of children whose weight and height were less than the 3rd percentile (p<0.05 and p<0.05, respectively) was also higher in the monogenic IBD group. Conclusion: Monogenic IBD showed more severe clinical manifestations than the other groups.

• Clinical and Experimental Pediatrics
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• v.61 no.4
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• pp.121-128
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• 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 participated in the Korea National Health and Nutrition Examination Survey 2010-2013. We analyzed total blood mercury levels according to obesity status in all participants. Results: The geometric mean of total blood mercury levels was $1.93{\mu}g/L$. Participants with overweight ($2.20{\mu}g/L$) and obesity ($2.17{\mu}g/L$) had higher levels than those with normal weight ($1.86{\mu}g/L$, P<0.0001). The prevalence of overweight significantly increased with elevation of the total blood mercury quartile in both sexes. Increased incidence of abdominal obesity corresponding to increased total blood mercury level was observed in boys. After adjusting for covariates, those in the highest total blood mercury quartile were found to be at higher risk of overweight/obesity than those in the lowest quartile in both sexes (odds ratio [95% confidence interval]: boys, 3.27 [1.66-6.41]; girls, 1.90 [1.03-3.49]). The association between total blood mercury quartile and abdominal obesity was significant after controlling for covariates in boys (2.35 [1.05-5.24]). Conclusion: Our results suggest an association between total blood mercury levels and overweight in Korean adolescents.

• Clinical and Experimental Pediatrics
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• v.59 no.2
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• pp.65-73
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• 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 obesity significantly increased in boys, but no changes were observed in girls. Over this period, there was a small but significant decrease in the mean lowdensity lipoprotein (LDL)-cholesterol level in boys (1998, 87.5 mg/dL; 2010, 83.6 mg/dL; P=0.019) and mean triglyceride levels in girls (1998, 90.8 mg/dL; 2010, 85.8 mg/dL; P=0.020). There were no significant changes in the prevalence of dyslipidemia in boys, but a modest decrease was noted in girls (1998, 25.1%; 2010, 18.3%; P=0.052). During the study period, the prevalence of breakfast skipping decreased, whereas that of regular exercise increased in both groups. Daily total energy intake did not change between these years. In multivariable logistic regression analyses, breakfast skipping was associated with increased risk of hyper-LDL-cholesterolemia in boys (odds ratio [OR], 5.77) and hypertriglyceridemia (OR, 2.27) in girls. Regular exercise was associated with decreased risk of hypo-HDL-cholesterolemia (OR, 0.40) in boys. Conclusion: Although the prevalence of obesity in boys increased, favorable or constant trends in lipid profiles were observed among Korean adolescents during 1998-2010. Decrease in breakfast skipping and increase in regular exercise may have contributed to these trends.

• Child Health Nursing Research
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• v.24 no.2
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• pp.157-165
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• 2018

Purpose: The purpose of this study was to examine differences in the prevalence of vitamin D deficiency between male and female Korean adolescents and to investigate gender-specific factors associated with vitamin D deficiency. Methods: This cross-sectional descriptive study included 975 adolescents aged 12-18 years who participated in the fifth Korean National Health and Nutrition Examination Survey (2010~2011). Multiple logistic regression using complex sample analysis was performed to examine gender-specific factors associated with vitamin D deficiency with adjustments for covariates. Results: Among the participants, 82.9% had vitamin D deficiency. The prevalence of vitamin D deficiency was higher among female adolescents (88.4%) than their male counterparts (78.4%). A rural place of residence (OR, 0.40; 95% CI, 0.19~0.87; p=.021) and daily milk intake (OR, 0.23; 95% CI, 0.07~0.75; p=.015) were significant factors significantly associated with vitamin D deficiency in males, while body mass index (OR, 8.40; 95% CI, 1.05~67.04, p=.045) and having breakfast (OR, 0.22; 95% CI, 0.10~0.49; p<.001) showed significant relationships in females. Conclusion: The results of this study provide preliminary evidence for developing effective strategies to prevent vitamin D deficiency in Korean adolescents. The different factors influencing vitamin D deficiency in males and females should be considered when providing interventions.

• The Korean Journal of Community Living Science
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• v.17 no.2
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• pp.89-103
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• 2006

This study was performed to provide sources of nutrition education for female adolescents by identifying eating disorder patterns and their relationships with self-body image, weight control, and eating behavior. A total of 329 female middle school students were recruited and completed a general characteristics survey, the Eating Attitudes Test(EAT-26), a perception of self-body image survey, a concern for weight control survey, an eating behavior survey, and the Mini Dietary Assessment Index(MDA). Eating disorder patterns were identified to be obesity stress and weight control(OW), risk of binge eating(RB), and dietary restraint(DR) by factor analysis. OW pattern was related with stout body shape, body dissatisfaction, experience of weight control, skipping of dinner, and low MDA score. RB pattern was associated with lean body shape, body satisfaction, indiscreet snack behavior, and the eating time of snacks. The DR pattern was associated with normal body shape, regular meal times, desirable snack behavior, and high MDA scores. The results indicated that the eating patterns of adolescent were not identical to existing diagnostic categories. Furthermore, each eating pattern displayed different characteristics of perception on self-body image, concern for weight control, and eating behavior. In conclusion, nutrition education for female middle school students could reflect the different characteristics of each eating disorder pattern.

• Korean Journal of Community Nutrition
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• v.6 no.4
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• pp.592-603
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• 2001

Seasonal variations of nutrient intake ware evaluated through a 3-day dietary records in 196 Korean adolescents(86 males, 108 females) aged 13 - 15 years and living in urban and rural areas of Chungnam. The seasonal differences of nutrient intake were tested by repealed measure ANOVA. Comparing nutrient intakes among flour seasons using repealed measure ANOVA, mean values of daily intakes were higher in winter and autumn for most nutrients, and were the lowest in summer in the urban areas and in spring in rural areas. Girls recieved the largest amount of nutrients, except Ca and vitamin $B_12$, in winter and the lowest amount in summer, while in boys significant differences were not observed among the four seasons for meet nutrients, except fats, Mg, and vitamin E. Interestingly, the seasonal differences for many nutrients were more evident in rural areas than in urban areas. Vitamin A intake in urban areas was higher in winter and spring, while in rural oreas, in summer. Mean values of daily intakes as a percent of the RDA throughout the year in boys and girls ware 82.2% and 84.2% for energy and 88.9% and 82.7% for protein, respectively. Ca and vitamin A intakes were as low as 32.4% and 24.2% of the RDA in boys and 39.7% and 30.6% in girls. Intakes of Fe, Zn, folic acid and vitamin B$_{12}$ ranged from 40 - 60% of the RDA. The nutrients which showed the largest seasonal difference in the percent of RDA were vitamin E in boys and vitamin C, vitamin E, and Fe in girls. The index of nutritional quality(INQ) for Fe was significantly lower in autumn in both genders. The INQ for vitamin C in girls of both areas was much higher in winter. Annual mean adequacy ratio(MAR), an index of overall nutritional quality, ranged from 0.57 - 0.69, which was higher in winter than in other seasons. Conclusively, nutrient intakes of Korean adolescents showed seasonal variations, particularly in girls and in rural area. Thus, seasonal variations should be considered in the assessing nutritional status, particularly ill the rural areas of Korea.a.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.23 no.4
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• pp.319-328
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• 2020

Purpose: To examine the prevalence and clinical manifestations of eosinophilic esophagitis (EoE) in Korea children. Methods: The study was designed as a 1:2 matching case-control study. Using information from the endoscopic database of a tertiary center, we retrospectively reviewed the medical records of patients aged 18 years or younger who underwent upper gastrointestinal endoscopy between January 2014 and December 2017. A total of 21 patients were diagnosed with EoE based on current diagnostic criteria. In addition, 42 controls with normal esophageal biopsy findings matched to each EoE case by sex, age (±1 months), and season were randomly selected during the study period. Results: The mean age of EoE diagnosis was 12.1±4.0 years and the male-to-female ratio was 2:1. The proportion of allergic diseases in patients with EoE (28.6%) was higher than that in the controls (6.8%) (p=0.04). Most EoE patients tested for allergy were positive for at least one antigen, which was significantly different to the controls (88.2% vs. 47.4%, p=0.01). Characteristic endoscopic findings of EoE were noted in 19 patients (90.5%), but 2 patients (9.5%) showed normal esophageal mucosa. The clinical symptoms of EoE were improved by a proton-pump inhibitor in 10 patients (50.0%), and by an H₂ blocker in 9 patients (45.0%). Only one patient (5.0%) required inhaled steroids. Conclusion: While EoE is rare in the Korean pediatric population, the results of this study will improve our understanding of the clinical manifestations of the disease.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.5 no.1
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• pp.108-112
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• 2002

Solid and papillary epithelial neoplasm (SPEN) of the pancreas is an uncommon tumor and is found predominantly in young females. The most common clinical presentation is an abdominal mass. The tumor has a low grade malignant potential and complete removal is the treatment of choice. We report a case of SPEN in a 13-year-old girl who presented with abdominal pain and increasing size of an abdominal mass after abdominal trauma. CT and sonographic findings showed a well-demarcated mass in the pancreas tail with solid and cystic portion. She got a distal pancreatectomy and pathologic finding was SPEN of pancreas.