Journal List > J Korean Med Assoc > v.53(2) > 1042240

Chu and Choe: Obesity and Metabolic Syndrome among Children and Adolescents in Korea

Abstract

Obesity is a disease that decreases life span. Childhood obesity leads to the higher prevalence of obesity in adulthood, which increases the risk of metabolic syndrome. Recently, the prevalence of obesity and metabolic syndrome is rapidly increasing among children and adolescents in Korea. The percentage of affected individuals was 17.9% among 10 to 14 year-old boys at its highest or 9.7% (boys 11.3%, girls 8.0%) on average, according to KNHANES III (The Third Korea National Health and Nutrition Examination Survey, 2005) and 2005 Korean children and adolescents' growth standard program, respectively. The incidence of metabolic syndrome was 30 to 40% in obese children and adolescents in Korea. Intervention program to prevent and reduce childhood obesity on a national scale is required.

Figures and Tables

Table 1
Co-morbidities observed during childhood and adolescence(28)
jkma-53-142-i001

Adopted and modified from Nelson Textbook of Pediatrics, 18th

Table 2
WHO definition of the metabolic syndrome(48, 49).
jkma-53-142-i002
Table 3
The IDF definition of the at risk group and metabolic syndrome in children and adeloscents (Diagnosing the metabolic syndrome requires the presence of central obesity plus any two of the other four factors.)
jkma-53-142-i003

*For clinical purposes, but not for diagnosing the metabolic syndrome, if fasting plasma glucose 5.6~6.9 mmol/L (100~125 mg/dL) and not known to have diabetes, an oral glucose tolerance test should be performed.

References

1. The Third Korea National Health and Nutrition Examination Survey (KNHANES III), 2005 -Health Examination-. 2006. Korea Centers for Disease Control and Prevention;38–44.
2. Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999~2002. JAMA. 2004. 291:2847–2850.
3. Oh KW, Jang MJ, Lee NY, Moon JS, Lee CG, Yoo MH, Kim YT. Prevalence and trends in obesity among Korean children and adolescents in 1997 and 2005. Korean J Pediatr. 2008. 51:950–955.
4. Kang SK, Kim SD, Lee JS. Prevalence rates and risk factors of overweight and obesity in children and adolescents-using Korean national health and nutrition examination survey 2005 data-. Korean J Epidemiol. 2008. 30:188–197.
5. Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children and adolescents, 1999~2000. JAMA. 2002. 288:1728–1732.
6. Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med. 1997. 337:869–873.
7. Ko JA. Childhood obesity and familial environmental factor according to the developmental stages: the Korea NHANES study. J Korean Acad Fam Med. 2008. 29:939–947.
8. Whitaker RC, Pepe MS, Wright JA, Seidel KD, Dietz WH. Early adiposity rebound and the risk of adult obesity. Pediatrics. 1998. 101:E5.
9. Dietz WH. Critical periods in childhood for the development of obesity. Am J Clin Nutr. 1994. 59:955–959.
10. Ravussin E, Swinburn BA. Pathophysiology of obesity. Lancet. 1992. 340:404–408.
11. Garn SM, LaVelle M. Two-decade follow-up of fatness in early childhood. Am J Dis Child. 1985. 139:181–185.
12. Cho SJ, Kim EY, Rho YI, Yang ES, Park YB, Moon KR, Lee CG. The Long-term Follow-up Studies of Childhood Obesity after Puberty. Korean J Pediatr Gastroenterol Nutr. 2003. 6:47–53.
13. Rankinen T, Zuberi A, Chagnon YC, Weisnagel SJ, Argyropoulos G, Walts B, Perusse L, Bouchard C. The human obesity gene map: the 2005 update. Obesity (Silver Spring). 2006. 14:529–644.
14. Perusse L, Chagnon YC, Dionne FT, Bouchard C. The human obesity gene map: the 1996 update. Obes Res. 1997. 5:49–61.
15. Klish W. Childhood obesity. Pediatr Rev. 1998. 19:312–315.
16. Cho SJ, Kim EY, Moon KR. Correlations of Leptin, Adiponectin and Leptin/Adiponectin Ratio with Metabolic Disorders in the Childhood Obesity. Korean J Pediatr Gastroenterol Nutr. 2006. 9:48–57.
17. Yang HR, Ko JS, Seo JK. The Role of Adipokines in the Pathogenesis of Non-alcoholic Fatty Liver Disease in Obese Children; the Relationship between Body Fat Distribution and Insulin Resistance. Korean J Pediatr Gastroenterol Nutr. 2007. 10:185–192.
18. Seo JW, Jung JA, Park HS, Ko JS, Kim YJ, Kim JY, Ryoo E, Bae SH, Sim JG, Yang HR, Choe BH, Cho KY. Assessment of modifiable lifestyle factors for obese children and adolescents through questionnaires. Korean J Pediatr. 2008. 51:576–583.
19. Goldfield GS, Kalakanis LE, Ernst MM, Epstein LH. Open-loop feedback to increase physical activity in obese children. Int J Obes Relat Metab Disord. 2000. 24:888–892.
20. Andersen RE, Crespo CJ, Bartlett SJ, Cheskin LJ, Pratt M. Relationship of physical activity and television watching with body weight and level of fatness among children: results from the Third National Health and Nutrition Examination Survey. JAMA. 1998. 279:938–942.
21. Cho KY, Park HS, Seo JW. The relationship between llifestyle and metabolic syndrome in obese children and adolescents. Korean J Pediatr Gastroenterol Nutr. 2009. 11:150–159.
22. Dietz WH Jr, Gortmaker SL. Do we fatten our children at the television set? Obesity and television viewing in children and adolescents. Pediatrics. 1985. 75:807–812.
23. Goodman E, Whitaker RC. A prospective study of the role of depression in the development and persistence of adolescent obesity. Pediatrics. 2002. 110:497–504.
24. De Simone M, Farello G, Palumbo M, Gentile T, Ciuffreda M, Olioso P, Cinque M, De Matteis F. Growth charts, growth velocity and bone development in childhood obesity. Int J Obes Relat Metab Disord. 1995. 19:851–857.
25. Sandhu J, Ben-Shlomo Y, Cole TJ, Holly J, Davey Smith G. The impact of childhood body mass index on timing of puberty, adult stature and obesity: a follow-up study based on adolescent anthropometry recorded at Christ's Hospital (1936-1964). Int J Obes (Lond). 2006. 30:14–22.
26. Schneider MB, Brill SR. Obesity in children and adolescents. Pediatr Rev. 2005. 26:155–162.
27. Baker S, Barlow S, Cochran W, Fuchs G, Klish W, Krebs N, Strauss R, Tershakovec A, Udall J. Overweight children and adolescents: a clinical report of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2005. 40:533–543.
28. Skelton JA, Rudolph CD. Kliegman RM, Behrman RE, Jenson HB, Stanton BF, editors. Overweight and obesity. Nelson Textbook of Pediatrics. 2007. 18 ed. Philadelphia: Saunders;232–242.
29. Inoue S, Zimmet P, Caterson I, Chunming C, Ikeda Y, Khalid AK, Kim YS, Bassett J. The Asia-Pacific perspective: redefining obesity and its treatment. 2000. International Diabetes Institute;1–55.
30. Korea Center for Disease Control and Prevention. The Korean Pediatric Society. The Committee for the Development of Growth Standard for Korean Children and Adolescents. 2007 Korean Children and Adolescents Growth Standard (commentary for the development of 2007 growth chart). [Government report online]. 2007 Nov. Seoul: Division of Chronic Disease Surveillance;Available from: URL: http://www.cdc.go.kr/.
31. Korea Center for Disease Control and Prevention. The Korean Pediatric Society. 2007 Korean Children and Adolescents Growth Standard. [Government report online]. 2007 Nov. Seoul: Division of Chronic Disease Surveillance;Available from: URL: http://www.cdc.go.kr/.
32. The Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV). Korea Centers for Disease Control and Prevention;Available from http://knhanes.cdc.go.kr/.
33. Janssen I, Katzmarzyk PT, Ross R. Body mass index, waist circumference, and health risk: evidence in support of current National Institutes of Health guidelines. Arch Intern Med. 2002. 162:2074–2079.
34. Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988. 37:1595–1607.
35. Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med. 1998. 338:1650–1656.
36. Steinberger J. Diagnosis of the metabolic syndrome in children. Curr Opin Lipidol. 2003. 14:555–559.
37. Schonfeld-Warden N, Warden CH. Pediatric obesity. An overview of etiology and treatment. Pediatr Clin North Am. 1997. 44:339–361.
38. Seo SJ, Lee HY, Lee SW. The prevalence of the metabolic syndrome in Korean children and adolescents: comparisons of the criteria of Cook et al., Cruz and Goran, and ferranti et al. Yonsei Med J. 2008. 49:563–572.
39. Ryu SY, Kweon SS, Park HC, Shin JH, Rhee JA. Obesity and the Metabolic Syndrome in Korean Adolescents. J Korean Med Sci. 2007. 22:513–517.
40. Chang JH, Kim DH, Kim HS, Choi IK, Cheong MY, Kim DK. Prevalence of metabolic syndrome in obese children. Korean J Pediatr. 2004. 47:1149–1156.
41. Huh K, Park MJ. Preliminary analysis of metabolic syndrome components in Korean adolescents by using korean national health and nutrition examination survey pooling data(1998, 2001 and 2005). Korean J Pediatr. 2008. 51:1300–1309.
42. Nho HN, Kim CR, Uhm JH, Kim JT, Jin SM, Seo JY, Hahn HW, Park HY, Yoon HS, Ahn YM, Shon KC. The prevalence of obesity and metabolic abnormalities in Korean pediatric population. Korean J Pediatr Gastroenterol Nutr. 2009. 12:207–214.
43. Janssen I, Katzmarzyk PT, Srinivasan SR, Chen W, Malina RM, Bouchard C, Berenson GS. Combined influence of body mass index and waist circumference on coronary artery disease risk factors among children and adolescents. Pediatrics. 2005. 115:1623–1630.
44. Pouliot MC, Despres JP, Lemieux S, Moorjani S, Bouchard C, Tremblay A, Nadeau A, Lupien PJ. Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol. 1994. 73:460–468.
45. Maffeis C, Pietrobelli A, Grezzani A, Provera S, Tato L. Waist circumference and cardiovascular risk factors in prepubertal children. Obes Res. 2001. 9:179–187.
46. Freedman DS, Serdula MK, Srinivasan SR, Berenson GS. Relation of circumferences and skinfold thicknesses to lipid and insulin concentrations in children and adolescents: the Bogalusa Heart Study. Am J Clin Nutr. 1999. 69:308–317.
47. D'Adamo E, Santoro N, Caprio S. Metabolic syndrome in pediatrics: old concepts revised, new concepts discussed. Endocrinol Metab Clin North Am. 2009. 38:549–563.
48. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001. 285:2486–2497.
49. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998. 15:539–553.
50. Balkau B, Charles MA, Drivsholm T, Borch-Johnsen K, Wareham N, Yudkin JS, Morris R, Zavaroni I, van Dam R, Feskins E, Gabriel R, Diet M, Nilsson P, Hedblad B. Frequency of the WHO metabolic syndrome in European cohorts, and an alternative definition of an insulin resistance syndrome. Diabetes Metab. 2002. 28:364–376.
51. Einhorn D, Reaven GM, Cobin RH, Ford E, Ganda OP, Handelsman Y, Hellman R, Jellinger PS, Kendall D, Krauss RM, Neufeld ND, Petak SM, Rodbard HW, Seibel JA, Smith DA, Wilson PW. American College of Endocrinology position statement on the insulin resistance syndrome. Endocr Pract. 2003. 9:237–252.
52. Bloomgarden ZT. Definitions of the insulin resistance syndrome: the 1st World Congress on the Insulin Resistance Syndrome. Diabetes Care. 2004. 27:824–830.
53. Pi-Sunyer X. The metabolic syndrome: how to approach differing definitions. Med Clin North Am. 2007. 91:1025–1040. vii.
54. Ford ES, Li C. Defining the metabolic syndrome in children and adolescents: will the real definition please stand up? J Pediatr. 2008. 152:160–164.
55. Bloch CA, Clemons P, Sperling MA. Puberty decreases insulin sensitivity. J Pediatr. 1987. 110:481–487.
56. Reinehr T, Kiess W, Kapellen T, Andler W. Insulin sensitivity among obese children and adolescents, according to degree of weight loss. Pediatrics. 2004. 114:1569–1573.
57. Vikram NK, Misra A, Pandey RM, Luthra K, Wasir JS, Dhingra V. Heterogeneous phenotypes of insulin resistance and its implications for defining metabolic syndrome in Asian Indian adolescents. Atherosclerosis. 2006. 186:193–199.
58. Golley RK, Magarey AM, Steinbeck KS, Baur LA, Daniels LA. Comparison of metabolic syndrome prevalence using six different definitions in overweight pre-pubertal children enrolled in a weight management study. Int J Obes (Lond). 2006. 30:853–860.
59. Ford ES, Giles WH. A comparison of the prevalence of the metabolic syndrome using two proposed definitions. Diabetes Care. 2003. 26:575–581.
60. Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med. 2003. 157:821–827.
61. Cruz ML, Goran MI. The metabolic syndrome in children and adolescents. Curr Diab Rep. 2004. 4:53–62.
62. Steinbeck KS. Insulin resistance syndrome in children and adolescents: clinical meaning and indication for action. Int J Obes Relat Metab Disord. 2004. 28:829–832.
63. Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, Wong G, Bennett P, Shaw J, Caprio S. The meta-bolic syndrome in children and adolescents-an IDF consensus report. Pediatr Diabetes. 2007. 8:299–306.
64. Seo JW, Ko JS, Kim YJ, Kim JY, Ryoo E, Bae SH, Sim JG, Yang HR, Jung JA, Choe BH. Childhood obesity-guidlines on obesity: The Korean Pediatric Society. 2006.
65. August GP, Caprio S, Fennoy I, Freemark M, Kaufman FR, Lustig RH, Silverstein JH, Speiser PW, Styne DM, Montori VM. Prevention and treatment of pediatric obesity: an endocrine society clinical practice guideline based on expert opinion. J Clin Endocrinol Metab. 2008. 93:4576–4599.
66. Willi SM, Oexmann MJ, Wright NM, Collop NA, Key LL, Jr . The effects of a high-protein, low-fat, ketogenic diet on adolescents with morbid obesity: body composition, blood chemistries, and sleep abnormalities. Pediatrics. 1998. 101:61–67.
67. Brown MR, Klish WJ, Hollander J, Campbell MA, Forbes GB. A high protein, low calorie liquid diet in the treatment of very obese adolescents: long-term effect on lean body mass. Am J Clin Nutr. 1983. 38:20–31.
68. Stallings VA, Archibald EH, Pencharz PB, Harrison JE, Bell LE. One-year follow-up of weight, total body potassium, and total body nitrogen in obese adolescents treated with the protein-sparing modified fast. Am J Clin Nutr. 1988. 48:91–94.
69. Verity LS, Ismail AH. Effects of exercise on cardiovascular disease risk in women with NIDDM. Diabetes Res Clin Pract. 1989. 6:27–35.
70. Wood PD, Stefanick ML, Dreon DM, Frey-Hewitt B, Garay SC, Williams PT, Superko HR, Fortmann SP, Albers JJ, Vranizan KM, Ellsworth NM, Terry RB, Haskell WL. Changes in plasma lipids and lipoproteins in over-weight men during weight loss through dieting as compared with exercise. N Engl J Med. 1988. 319:1173–1179.
71. Turcotte LP, Richter EA, Kiens B. Increased plasma FFA uptake and oxidation during prolonged exercise in trained vs. untrained humans. Am J Physiol. 1992. 262:E791–E799.
72. Richter EA, Turcotte L, Hespel P, Kiens B. Metabolic responses to exercise. Effects of endurance training and implications for diabetes. Diabetes Care. 1992. 15:1767–1776.
73. McCall A, Raj R. Exercise for prevention of obesity and diabetes in children and adolescents. Clin Sports Med. 2009. 28:393–421.
74. Andersen LB, Harro M, Sardinha LB, Froberg K, Ekelund U, Brage S, Anderssen SA. Physical activity and clustered cardiovascular risk in children: a cross-sectional study (The European Youth Heart Study). Lancet. 2006. 368:299–304.
75. Epstein LH, Wing RR, Steranchak L, Dickson B, Michelson J. Comparison of family-based behavior modification and nutrition education for childhood obesity. J Pediatr Psychol. 1980. 5:25–36.
76. Fabricatore AN. Behavior therapy and cognitive-behavioral therapy of obesity: is there a difference? J Am Diet Assoc. 2007. 107:92–99.
77. Epstein LH, Paluch RA, Gordy CC, Dorn J. Decreasing sedentary behaviors in treating pediatric obesity. Arch Pediatr Adolesc Med. 2000. 154:220–226.
78. Robinson TN. Reducing children's television viewing to prevent obesity: a randomized controlled trial. JAMA. 1999. 282:1561–1567.
79. Speiser PW, Rudolf MC, Anhalt H, Camacho-Hubner C, Chiarelli F, Eliakim A, Freemark M, Gruters A, Hershkovitz E, Iughetti L, Krude H, Latzer Y, Lustig RH, Pescovitz OH, Pinhas-Hamiel O, Rogol AD, Shalitin S, Sultan C, Stein D, Vardi P, Werther GA, Zadik Z, Zuckerman-Levin N, Hochberg Z. Childhood obesity. J Clin Endocrinol Metab. 2005. 90:1871–1887.
80. Hansen DL, Toubro S, Stock MJ, Macdonald IA, Astrup A. Thermogenic effects of sibutramine in humans. Am J Clin Nutr. 1998. 68:1180–1186.
81. Rolls BJ, Shide DJ, Thorwart ML, Ulbrecht JS. Sibutramine reduces food intake in non-dieting women with obesity. Obes Res. 1998. 6:1–11.
82. Seagle HM, Bessesen DH, Hill JO. Effects of sibutramine on resting metabolic rate and weight loss in overweight women. Obes Res. 1998. 6:115–121.
83. Mun EC, Blackburn GL, Matthews JB. Current status of medical and surgical therapy for obesity. Gastroenterology. 2001. 120:669–681.
84. Davidson MH, Hauptman J, DiGirolamo M, Foreyt JP, Halsted CH, Heber D, Heimburger DC, Lucas CP, Robbins DC, Chung J, Heymsfield SB. Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat: a randomized controlled trial. JAMA. 1999. 281:235–242.
85. Hill JO, Hauptman J, Anderson JW, Fujioka K, O'Neil PM, Smith DK, Zavoral JH, Aronne LJ. Orlistat, a lipase inhibitor, for weight maintenance after conventional dieting: a 1-y study. Am J Clin Nutr. 1999. 69:1108–1116.
86. Atabek ME, Pirgon O. Use of metformin in obese adolescents with hyperinsulinemia: a 6-month, randomized, double-blind, placebo-controlled clinical trial. J Pediatr Endocrinol Metab. 2008. 21:339–348.
87. Shin SW, Kim EY, Rho YI, Yang ES, Park SK, Park YB, Moon KR. Evaluation of Web Sites on Treatment of Childhood and Adolescent Obesity. Korean J Pediatr Gastroenterol Nutr. 2005. 8:49–55.
TOOLS
ORCID iDs

Byung-Ho Choe
https://orcid.org/http://orcid.org/0000-0001-9899-9120

Similar articles