Seulki Kim

Background: Body mass index (BMI) is widely used to assess pediatric obesity but has limitations in distinguishing between fat and muscle mass. This study aimed to investigate the association between various body composition parameters and insulin resistance (IR) and to evaluate their clinical utility in prepubertal children with obesity. Methods: This retrospective cross-sectional study evaluated prepubertal children with obesity. Anthropometric measures and body composition, including percent body fat (PBF) and fat-to-muscle ratio (FMR), were assessed using bioelectrical impedance analysis. IR was defined as a homeostasis model assessment of insulin resistance (HOMA-IR) ≥2.5. Spearman rank correlation, linear regression, and multivariate logistic regression analysis were performed to identify independent associated factors for IR. Results: A total of 147 prepubertal children (61 males, 86 females) were analyzed. The IR group exhibited significantly higher waist circumference SDS (WC_SDS), waist circumference-to-height ratio SDS (WHtR_SDS), and FMR compared to the non-IR group (all p < 0.05). In correlation analysis, HOMA-IR showed significant positive associations with WC_SDS (ρ = 0.39) and FMR (ρ = 0.22). After adjusting for age and sex, WC SDS (odds ratio (OR) = 6.04; 95% CI: 2.47–14.75; p < 0.001), FMR (OR = 4.41; 95% CI: 1.16–16.78; p = 0.030), BMI SDS (OR = 2.31; 95% CI: 1.30–4.10; p = 0.004), and PBF (OR = 1.12; 95% CI: 1.04–1.20; p = 0.004) remained independent risk factors for IR. Conclusions: In prepubertal children with obesity, WC SDS, FMR, BMI SDS and PBF were each significantly associated with IR after adjusting for age and sex. These findings suggest that measures of central adiposity and fat-to-muscle balance, in addition to conventional weight-based indices, are relevant to metabolic risk assessment in this age group.

This study aimed to investigate the impact of hypogonadism on bone mineral density (BMD) in children and adolescents with chronic diseases to determine the relationship between sex hormones and BMD. This retrospective study included 672 children and adolescents with chronic diseases such as hemato-oncologic, rheumatoid, gastrointestinal, and endocrinologic diseases. The relationship between the sex- and Tanner-stage-matched Z-scores for sex hormones and the sex- and age-matched lumbar spine BMD (LSBMD) Z-scores was evaluated. Adjustments were made for confounders such as underlying diseases, age at diagnosis, and age- and sex-matched body mass index Z-scores. Patients had a mean LSBMD Z-score of −0.55 ± 1.31. In the multivariate regression analysis, male testosterone showed a positive association with the LSBMD Z-score (p < 0.001), whereas female estradiol, luteinizing hormone, and follicular-stimulating hormone showed no significant association with the LSBMD Z-scores. In the male group, the testosterone level was associated with LSBMD Z-scores > −1.0 (p < 0.001), > −2.0 (p < 0.001), and > −3.0 (p = 0.002), while the estradiol level was associated with LSBMD Z-scores > −2.0 (p = 0.001) and > −3.0 (p = 0.002) in the female group. In conclusion, sex hormones are associated with BMD in children and adolescents with chronic diseases. Therefore, various measures may be necessary to predict future skeletal problems and improve bone health in these patients.

In this study, we investigated bone mineral deficits in children who survived childhood acute leukemia and explored the association between the insulin-like growth factor-1 (IGF-1) level and bone mineral density (BMD). This retrospective analysis enrolled 214 patients treated for acute leukemia, measuring various factors including height, weight, body mass index (BMI), and lumbar spine BMD after the end of treatment. The study found an overall prevalence of low BMD in 15% of participants. Notably, IGF-1 levels were significantly different between patients with low BMD and those with normal BMD, and correlation analyses revealed associations of the IGF-1 level and BMI with lumbar spine BMD. Regression analyses further supported this relationship, suggesting that higher IGF-1 levels were associated with a decreased risk of low BMD. The study findings suggest that IGF-1 may serve as a valuable tool for evaluating and predicting osteoporosis in survivors of childhood acute leukemia.

Children with diabetes, and particularly those with obesity, have poor glycemic control. They are thus at higher risk of early microvascular complications. Renal tubulointerstitial markers are integral to evaluating diabetic nephropathy. Various biomarkers have been proposed, but their role in the obese pediatric population is uncertain. We investigated renal injury markers in children with diabetes, according to obesity, and determined their role as early predictors of diabetic nephropathy. Fifty-three children and adolescents, diagnosed with either type 1 or 2 diabetes mellitus, and 43 control children, aged 7–18 years, were included. Clinical and laboratory characteristics, including six renal injury markers, were compared among subjects according to body mass index and presence of diabetes mellitus. Urine neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and N-acetyl-β-D-glucosaminidase (NAG) showed significant difference between controls and diabetic children, whereas urine NAG was the only biomarker that was significantly lower either in non-obese or obese controls as compared to diabetic children. Urine NGAL, KIM-1, and NAG showed significant correlations with both HbA1c and urine ACR, whereas only urine NAG was significantly correlated with HbA1c even when groups were subdivided based on the presence of either obesity or diabetes. After adjusting for age, sex, body mass index, duration of known diabetes, and urine albumin-to-creatinine ratio, HbA1c remained a significant risk factor for elevated urine NAG. Urine NAG could be a useful indicator of tubulointerstitial damage in children with diabetes in the pre-albuminuric state. Tighter glycemic control appears to be crucial for avoiding early progression to diabetic nephropathy.

Fetuin-A and adiponectin are inflammatory cytokines associated with obesity and insulin resistance. This study aimed to examine the fetuin-A-to-adiponectin ratio (FAR) in diabetic children and to determine the role of FAR. A total of 54 children and adolescents with diabetes mellitus (DM) and 44 controls aged 9–16 years were included in this study. Clinical characteristics, including plasma fetuin-A and adiponectin levels, were compared with respect to body mass index (BMI) and diabetes type. Of 98 children, 54.1% were obese, whereas 18.4% were obese and diabetic. FAR was higher in obese children with DM than in non-obese children and also in type 2 DM children than in type 1. FAR showed a stronger association with BMI than with fetuin-A and adiponectin individually, and its association was more prominent in diabetic children than in controls. BMI was a risk factor for increased FAR. Plasma fetuin-A was elevated in obese children, and its association with insulin resistance and β cell function seemed more prominent in diabetic children after adjustment for adiponectin. Thus, FAR could be a useful surrogate for the early detection of childhood metabolic complications in diabetic children, particularly those who are obese.

Prolonged hyperinsulinemic hypoglycemia in infancy can result in developmental sequelae. A mutation in the paired box-6 gene (PAX6) has been reported to cause disorders in oculogenesis and neurogenesis. A limited number of cases of diabetes mellitus in adults with a PAX6 mutation suggest that the gene also plays a role in glucose homeostasis. The present case report describes a boy with a PAX6 mutation, born with anophthalmia, who underwent hypoglycemic seizures starting at 5 months old, and showed a prediabetic condition at 60 months. This patient provides novel evidence that connects PAX6 to glucose homeostasis and highlights that life-threatening hypoglycemia or early onset glucose intolerance may be encountered. The role of PAX6 in glucose metabolism and insulin regulation should be further investigated.

Diabetic nephropathy (DN) is a serious microvascular complication in childhood diabetes and microalbuminuria has been a solid indicator in the assessment of DN. Nevertheless, renal injury may still occur in the presence of normoalbuminuria (NA) and various tubular injury biomarkers have been proposed to assess such damage. This case-controlled study aimed to evaluate plasma and urinary neutrophil gelatinase-associated lipocalin and kidney injury molecule-1 (KIM-1) levels in diabetic children particularly in those with normo- and high-NA stages and determine their role in predicting DN. Fifty-four children/adolescents with type 1 and 2 diabetes and forty-four controls aged 7–18 years were included. The baseline clinical and laboratory characteristics including plasma and urinary biomarkers were compared. The plasma KIM-1 levels were significantly higher in diabetic children than in the controls and in high-NA children than normo-NA children. Glycosylated hemoglobin (HbA1c) was identified as a significant risk factor for increased plasma KIM-1. The optimal cutoff for HbA1c when the plasma KIM-1 was > 23.10 pg/mL was 6.75% with an area under the curve of 0.77. For diabetic children with mildly increased albuminuria, the plasma KIM-1 complementary to MA may help increase the yield of detecting DN. Our findings also suggested an HbA1c cutoff of 6.75% correlated with increased plasma KIM-1.

Background. Little information is available on the association between parents’ metabolic syndrome (MetS) and adolescent offspring’s obesity in Korea. The aim of our study is to determine the association between parent’s metabolic syndrome and offspring’s obesity. Methods. The study data were obtained from the Korean National Health and Nutrition Examination Survey conducted during 2009–2016. In the present study, 3140 adolescents aged 12 to 18 years, their paternal pairs (PP, fathers = 2244), and maternal pairs (MP, mothers = 3022) were analyzed. Of these 3140 adolescents, 2637 had normal weight {age- and sex-specific body mass index (BMI) under the 85th percentile}, whereas 467 were overweight (age- and sex-specific BMI over the 85th percentile). Results. Offspring’s overweight and central obesity were associated with all components of the PP’s metabolic risk factors, including central obesity ( p < 0.001 ), systolic ( p < 0.001 ) and diastolic blood pressure ( p < 0.001 ), glucose intolerance ( p < 0.001 ), and triglyceride ( p < 0.002 ) and high-density lipoprotein levels ( p = 0.049 ). In addition, offspring’s overweight and central obesity were also associated with the metabolic risk factors of MP, including central obesity ( p < 0.001 ), systolic ( p < 0.001 ) and diastolic blood pressure ( p < 0.001 ), glucose intolerance ( p < 0.001 ), and triglyceride levels ( p < 0.001 ). In multivariate logistic regression analysis, offspring’s overweight was significantly and positively associated with parental central obesity (PP, adjusted odds ratio (OR) = 1.593; 95% confidence interval (CI): 1.192–2.128; MP, adjusted OR = 2.221, 95% CI: 1.755–2.812) and parental metabolic syndrome (PP, adjusted OR = 2.032; 95% CI: 1.451–2.846; MP, adjusted OR = 2.972, 95% CI: 2.239–3.964). As the number of parental metabolic risk factors increased, offspring’s risk for overweight and central obesity increased ( p for trends < 0.001). Conclusion. Parental metabolic syndrome was associated with obesity in 12- to 18-year-old offspring in Korea.

To analyze growth patterns over 2 years after birth according to preterm infant birth weight and length percentiles. Anthropometric measurements of 82 preterm infants were retrospectively reviewed. Preterm infants with birth weight or length below the 10th percentile were classified as small for gestational age (SGA) (n=19) and those between the 10th and 89th percentile as appropriate for gestational age (AGA) (n=63). The association between the length standard deviation score (SDS) at 2 years of corrected age and clinical factors were analyzed. The length SDS of the SGA group was significantly increased at 6 months (-1.30±1.71) and 24 months (-0.97±1.06) of corrected age. The length SDS was lower in the SGA group than those in the AGA group at 6 months (-1.30±1.71 vs. -0.25±1.15, P=0.004), 18 months (-0.97±1.39 vs. -0.03±1.29, P=0.015), and 24 months (-0.97±1.06 vs. -0.29±1.12, P=0.022,), respectively. The percentage of children with a length SDS of <-2 (growth failure) at 24 months was 15.8% in the SGA group and 4.8% in the AGA group (P=0.108). Multiple linear regression analysis demonstrated that length at 24 months of corrected age had a negative correlation with birth length below the 10th percentile (coefficient β=-0.91, P=0.001) and duration of stay in the neonatal intensive care unit (coefficient β =-0.01, P=0.001). Despite the fact that the catch-up growth occurs during early period of infancy in a large portion of preterm SGA infants, a significant portion of these infants has growth failure at 24 months of age. Growth over 2 years after birth is affected by birth length and duration of stay in the NICU in children born preterm.