Mucosal Immunity Related to FOXP3+ Regulatory T Cells, Th17 Cells and Cytokines in Pediatric Inflammatory Bowel Disease.

BACKGROUND: We aimed to investigate mucosal immunity related to forkhead box P3 (FOXP3+) regulatory T (Treg) cells, T helper 17 (Th17) cells and cytokines in pediatric inflammatory bowel disease (IBD). METHODS: Mucosal tissues from terminal ileum and colon and serum samples were collected from twelve children with IBD and seven control children. Immunohistochemical staining was done using anti-human FOXP3 and anti-RORγt antibodies. Serum levels of cytokines were analyzed using a multiplex assay covering interleukin (IL)-1ß, IL-4, IL-6, IL-10, IL-17A/F, IL-21, IL-22, IL-23, IL-25, IL-31, IL-33, interferon (IFN)-γ, soluble CD40L, and tumor necrosis factor-α. RESULTS: FOXP3+ Treg cells in the lamina propria (LP) of terminal ileum of patients with Crohn's disease were significantly (P < 0.05) higher than those in the healthy controls. RORγt+ T cells of terminal ileum tended to be higher in Crohn's disease than those in the control. In the multiplex assay, serum concentrations (pg/mL) of IL-4 (9.6 ± 1.5 vs. 12.7 ± 3.0), IL-21 (14.9 ± 1.5 vs. 26.4 ± 9.1), IL-33 (14.3 ± 0.9 vs. 19.1 ± 5.3), and IFN-γ (15.2 ± 5.9 vs. 50.2 ± 42.4) were significantly lower in Crohn's disease than those in the control group. However, serum concentration of IL-6 (119.1 ± 79.6 vs. 52.9 ± 39.1) was higher in Crohn's disease than that in the control. Serum concentrations of IL-17A (64.2 ± 17.2 vs. 28.3 ± 10.0) and IL-22 (37.5 ± 8.8 vs. 27.2 ± 3.7) were significantly higher in ulcerative colitis than those in Crohn's disease. CONCLUSION: Mucosal immunity analysis showed increased FOXP3+ T reg cells in the LP with Crohn's disease while Th17 cell polarizing and signature cytokines were decreased in the serum samples of Crohn's disease but increased in ulcerative colitis.

Factors associated with Advanced Bone Age in Overweight and Obese Children.

PURPOSE: Obese children may often present with advanced bone age. We aimed to evaluate the correlation between factors associated with childhood obesity and advanced bone age. METHODS: We enrolled 232 overweight or obese children. Anthropometric and laboratory data, and the degree of nonalcoholic fatty liver disease (NAFLD) were measured. We analyzed factors associated with advanced bone age by measuring the differences between bone and chronological ages. RESULTS: The normal and advanced bone age groups were comprised of 183 (78.9%) and 49 (21.1%) children, respectively. The prevalence of advanced bone age significantly increased as the percentiles of height, weight, waist circumference, and body mass index (BMI) increased. BMI z-score was higher in the advanced bone age group than in the normal bone age group (2.43±0.52 vs. 2.10±0.46; p<0.001). The levels of insulin (27.80±26.13 µU/mL vs. 18.65±12.33 µU/mL; p=0.034) and homeostatic model assessment-insulin resistance (6.56±6.18 vs. 4.43±2.93; p=0.037) were significantly higher, while high density lipoprotein-cholesterol levels were lower (43.88±9.98 mg/dL vs. 48.95±10.50 mg/dL; p=0.005) in the advanced bone age group compared to those in the normal bone age group, respectively. The prevalence of advanced bone age was higher in obese children with metabolic syndrome than in those without (28.2% vs. 14.7%; p=0.016). The prevalence of advanced bone age was higher in obese children with a more severe degree of NAFLD. CONCLUSION: Advanced bone age is associated with a severe degree of obesity and its complications.

The Analysis of Factors Causing the High Prevalence of Child Obesity in Jeju Island.

PURPOSE: For 3 consecutive years from 2012-2014, we analyzed the causative factors for why the Jeju Island had the highest obesity prevalences of school children among the 15 provinces in Korea. METHODS: From our analysis of 28,026 elementary school children with obesity or normal weight in the 15 provinces, we analyzed 12 factors related to eating habits, exercise habits, lifestyle, and mental health. The differences between the obese and normal weight children were researched. Finally, Jeju was compared with Seoul, which has the lowest obesity prevalence in school age children. Statistical analysis was performed using the chi square test of PASW Statistics ver. 18.0. RESULTS: Compared to the normal weight group, the obese group had significantly higher rates of consuming soft drinks (p<0.001), fast food intake (p=0.019), skipping breakfast (p<0.001), insufficient sleep (p<0.001), bullying experiences (p=0.001) and runaway impulses (p=0.012). Compared to Seoul, Jeju Island had significantly higher rates of Ramen intake (3.4% vs. 5.4%, p=0.021) and meat intake (46.0% vs. 52.9%, p=0.003). On the other hand, Jeju Island was significantly lower than was Seoul in their fruit intake (83.4% vs. 67.1%, p<0.001), vegetable intake (71.4% vs. 64.2%, p=0.001), and intense physical activity (63.4% vs. 47.7%, p<0.001). Meanwhile, insufficient sleep (15.4% vs. 9.6%, p<0.001) and runaway impulses (5.6% vs. 3.3%, p=0.027) in children were significantly lower in Jeju Island than in Seoul. CONCLUSION: The results of the obesity factor analysis of elementary school students in Jeju Island can be used as useful educational material for lowering the obesity prevalence in Jeju community.

Associations among the Degree of Nonalcoholic Fatty Liver Disease, Metabolic Syndrome, Degree of Obesity in Children, and Parental Obesity.

PURPOSE: To analyze the associations among the degrees of nonalcoholic fatty liver disease (NAFLD) by ultrasonography and metabolic syndrome, degrees of obesity in children, and degrees of parental obesity. METHODS: A total of 198 children with obesity who visited a pediatric obesity clinic were prospectively enrolled in this study. The severity of NAFLD based on ultrasonography was classified into no, mild, moderate, or severe NAFLD group. The degree of obesity based on the percentage over standard weight for height per sex was classified into mild, moderate, or severe. RESULTS: Of 132 patients evaluated for the degree of NAFLD and metabolic syndrome, the p-value of correlation between the two factors was 0.009. Therefore, metabolic syndrome might significantly affect the degree of NAFLD. Of 158 patients evaluated for the degree of NAFLD and the degree of obesity, the p-value of correlation between the two factors was 0.122. Of 154 patients evaluated for the degree of obesity and father's obesity, the p-value was 0.076. Of 159 patients evaluated for the degree of obesity and mother's obesity, the p-value was 0.000, indicating that mother's obesity could significantly affect the degree of obesity in children. Of 142 patients evaluated for the degree of obesity and metabolic syndrome, the p-value was 0.288. CONCLUSION: Metabolic syndrome might significantly affect the degree of nonalcoholic fatty liver in children. In addition, mother's obesity might be a significant factor that affects the degree of obesity in children.