Prevalence and trends in obesity and severe obesity in Korean children and adolescents, 2007-2020: A population-based study.

BACKGROUND: The age-adjusted prevalence of child and adolescent obesity has been stabilized in the Korean population, although severe obesity has increased with adverse health effects. In this study, we detailed the prevalence of and trends in overweight, obesity, and severe obesity in Korean children and adolescents by age group and sex from a nationally representative sample, using a new, 2017 age- and sex-specific reference for body mass index. METHODS: We collected Korea National Health and Nutrition Examination Survey data from the years 2007-2020. A total of 23,595 subjects (11,210 females) aged 2-18 years were included in this study. We calculated the recent prevalence of overweight and obesity, including severe obesity, by weighted data from 2019 and 2020. RESULTS: The prevalence of overweight and obesity (class II and class III obesity) was 23.5% and 14.2% (2.5% and 0.5%), respectively. Males showed a higher prevalence of overweight and obesity. Adolescents aged 13-15 years showed the highest prevalence of severe obesity. A positive linear trend was significant for overweight (p = 0.025), class I obesity (p < 0.001), and class II obesity (p = 0.002) for both sexes and all ages combined. However, the trend of obesity prevalence was different in each subgroup. Comparing pre- and post- COVID-19 pandemic, obesity prevalence seemed to increase, but not significantly. CONCLUSIONS: Despite previous reports that obesity in children and adolescents has remained stable, we found that the prevalence of overweight, obesity, and severe obesity has increased in Korean children and adolescents. The effects of COVID-19 on this trend require further evaluation.

Low Bone Mineral Density at Initial Diagnosis in Children and Adolescents with Graves' Disease.

Previous studies have reported reduced bone mineral density (BMD) in patients with hyperthyroidism. We assessed the association of BMD in children and adolescents with Graves' disease (GD) after correcting for potential confounders affecting BMD such as age, sex, and pubertal status. Forty-four children and adolescents with GD and 172 age- and sex-matched healthy controls were enrolled in this study. We analyzed auxological features, BMD, and levels of thyroid hormone, thyroid-stimulating hormone, and thyroid autoantibodies. We measured BMD by dual-energy X-ray absorptiometry at the time of diagnosis in all patients. The mean age of all patients with GD (9 boys and 32 girls) was 12.1 ± 2.2 years (range, 7.0-16.0). Their initial mean free T4 and thyroid-stimulating hormone levels were 3.51 ± 1.56 ng/dL and 0.04 ± 0.03 IU/L, respectively. The mean BMD Z-scores of the lumbar spine (LS), femoral neck, and total body less head of patients with GD were significantly lower than those of control subjects. Eleven patients (26.8%) had low bone density (LS BMD Z-scores < -2.0). To identify correlations of patient characteristics with BMD Z-scores at each site, alkaline phosphatase had a significant negative correlation with BMD Z-scores at LS and femoral neck, but not total body less head (r = -0.441; p = 0.004 and r = -0.351; p = 0.025, respectively). Children and adolescents with newly diagnosed GD had lower bone mass than their healthy peers. These results suggest that BMD measurement at initial evaluation may be necessary in this population.

Trends of Diabetes and Prediabetes Prevalence among Korean Adolescents From 2007 to 2018.

BACKGROUND: To provide updated prevalence data and to estimate changes in the prevalence of diabetes among Korean adolescents by sex and age between 2007 and 2018. METHODS: We used the data of children and adolescents (8,718 subjects aged 10 to 18 years) from the Korea National Health and Nutrition Examination Survey IV-VII (KNHANES 2007-2018). The recent prevalence of diabetes and pre-diabetes was estimated by using the latest KNHANES VII. The linear trends were estimated by comparing 3-year KNHANES cycles according to sex and by using logistic regression. RESULTS: The prevalence of diabetes and pre-diabetes was 0.298% (95% confidence interval [CI], 0.289-0.308) and 7.914% (95% CI, 0.43-0.49). The prevalence of diabetes significantly increased from 0.189 to 0.430 during KNHANE IV and VII. A positive linear trend is significant for diabetes (P trends = 0.006) in only male subjects. The prevalence of pre-diabetes significantly increased from 5.86 to 12.08 in both sexes. During KNHANES IV and VII, the prevalence of obesity increased significantly. CONCLUSION: Between 2007 and 2018, the prevalence of diabetes among Korean adolescents increased. Further studies are required to determine the causes of these increases.

Influenza Vaccine Effectiveness among Elementary School Students in Korea during the 2016-2017 Seasons: a Cross-Sectional Survey.

BACKGROUND: Annual vaccination is the principal way to reduce the mortality and morbidity associated with influenza. In the 2016-2017 influenza seasons, the influenza epidemic appeared to exhibit a different pattern from the previous years. Because of the unusual trend, the incidence of influenza-like patients among school-aged children had increased, causing doubts about the effectiveness of the influenza vaccine. Therefore, this study aimed to evaluate the effectiveness of the influenza vaccine among elementary school students in Korea. METHODS: The study was conducted in elementary schools in each province of Korea in cooperation with the Student Health Policy Division of the Ministry of Education. Each Provincial Office of Education of Korea, except for Jeju, randomly selected one to two elementary schools for each District Office of Education. A total of 2,739 elementary school students were enrolled and vaccination and influenza infection status were collected from the subjects' parents through questionnaires, from February 13th to 21st in 2017. Vaccine effectiveness was defined as calculating the infection rate of influenza among the vaccinated and unvaccinated groups and determining the decreased infection rate of the vaccinated group relative to the unvaccinated group, while adjusting for time of vaccination and infection. RESULTS: Adjusting for the interval between vaccination and infection, vaccine effectiveness of influenza was 17.6% (95% confidence interval [CI], 4.6% to 28.9%), 22.5% (95% CI, 10.3% to 33%), and 28.7% (95% CI, 17.5% to 38.3%) at 2 or more weeks, 3 or more weeks, and 4 or more weeks after vaccination, respectively. CONCLUSION: In conclusion, considering the time required for adequate immunogenicity, the 2016-2017 seasonal influenza vaccine effectiveness in Korean elementary school students was 17.6%-28.7%, which was less effective than that of previous years.

The Relationship Between Bone Mineral Density and Type 2 Diabetes in Obese Children and Adolescents at the Time of Initial Diagnosis.

Long-term effects of type 2 diabetes mellitus (T2D) on bone health remain unclear. The objective of this study was to assess the possible association of bone mineral density (BMD) at multiple sites with T2D after correcting for several potential confounders such as age, sex, Tanner stage, and BMI known to affect BMD in adolescents with newly developed T2D. In this cross-sectional study, 17 children and adolescents with T2D and 59 age, sex, and BMI-matched controls were included. All subjects underwent dual-energy X-ray absorptiometry to measure regional and whole-body composition with Lunar Prodigy at the time of initial diagnosis. A BMD Z-score was calculated using data from healthy Korean children and adolescents after adjusting for height-for-age. The mean age of all subjects was 12.9±2.4 years (range, 8.3-18.3 years). BMDht Z-scores for lumbar spine and total body after adjusted for age, sex, BMI SDS, and Tanner stage were not significantly different between patients and controls. However, BMDht Z-scores for femur neck and bone mineral apparent density (BMAD) Z-scores of lumbar spine were significantly lower in T2D patients than those in healthy controls. HOMA-IR or HbA1c was not associated with BMDht Z-scores at multiple sites. BMDht Z-scores at multiple sites except femur neck in adolescents with newly developed T2D were similar to those in obese controls after adjustment for potential confounders.

Prevalence of Pathological Brain Lesions in Girls with Central Precocious Puberty: Possible Overestimation?

BACKGROUND: Brain magnetic resonance imaging (MRI) is routinely performed to identify brain lesions in girls with central precocious puberty (CPP). We aimed to investigate the prevalence and type of brain lesions among Korean girls with CPP and evaluate the need for routine brain MRI examinations. METHODS: This retrospective cross-sectional study evaluated data on 3,528 girls diagnosed with CPP from April 2003 to December 2016, and identified 317 girls who underwent sellar MRI. Exclusion criteria were patients with a known brain tumor or who did not undergo brain MRI due to refusal or the decision of the pediatric endocrinologist. RESULTS: Normal sellar MRI findings were observed in 291 of the 317 girls (91.8%). Incidental findings were observed in 26 girls (8.2%). None of the patients had pathological brain lesions. CONCLUSION: The prevalence of intracranial lesions among girls who were generally healthy and without neurological symptoms but diagnosed with CPP was lower than that previously reported. Furthermore, none of the identified lesions required treatment. It may be prudent to reconsider the routine use of brain MRI to screen all patients with CPP, especially if they are healthy and neurologically asymptomatic, and are girls aged 6-8 years.

Early menarche is associated with non-alcoholic fatty liver disease in adulthood.

BACKGROUND: The aim of this study was to examine the association between early menarche (<12 years) and non-alcoholic fatty liver disease (NAFLD) in premenopausal women and to explore whether it is mediated by adult obesity and insulin resistance. METHODS: We analyzed data of premenopausal women, aged ≥15 years, from the Korea National Health and Nutrition Examination Survey (2007-2009). We divided the women into three groups: early menarche, reference (12.00-15.99 years), and late menarche. The presence of NAFLD was determined using hepatic steatosis index >36.0. RESULTS: Of the 4,387 women evaluated, 673 (15.4%) met the criteria for NAFLD. The prevalence of NAFLD was higher in both women with early and late menarche compared with the reference (early, 23.4%; reference, 14.0%; late, 19.9%, P < 0.001). After adjustment of confounders including age, the OR for NAFLD in early menarche compared with the reference was 3.04 (95%CI: 1.99-4.65). Further adjustment of mediators, such as central obesity or insulin resistance, attenuated the association to 1.91-2.17. There was no association, however, between late menarche and NAFLD after adjustment of confounders. CONCLUSIONS: Early menarche was associated with an increased risk of NAFLD in young and middle-aged premenopausal Korean women.

The priming effect of previous natural pandemic H1N1 infection on the immunogenicity to subsequent 2010-2011 influenza vaccination in children: a prospective cohort study.

BACKGROUND: The effect of previous natural pandemic H1N1 (H1N1 pdm09) influenza infection on the immunogenicity to subsequent inactivated influenza vaccination in children has not been well studied. We aimed to evaluate the effect of H1N1 pdm09 natural infection and vaccination on the immunogenicity to subsequent 2010-2011 seasonal inactivated influenza vaccination in children. METHODS: From October 2010 to May 2011, we conducted an open-label, multi-center study in children aged 6 months -18 years in Korea. We measured antibody titers with a hemagglutination-inhibition (HI) assay at baseline, 1 month, and 6 months after vaccination with trivalent split or subunit vaccines containing H1N1 pdm, A/H3N2, and B. The subjects were classified into 4 groups depending on the presence of laboratory-confirmed H1N1 pdm09 infection and/or vaccination in the 2009-2010 season; Group I: vaccination (-)/infection(-), Group II: vaccination (-)/infection(+), Group III: vaccination (+)/infection(-), Group IV: vaccination (+)/infection(+). RESULTS: Among the subjects in group I, 47 subjects who had a baseline titer >1:10 were considered to have an asymptomatic infection. They were included into the final group II (n = 80). We defined the new group II as the infection-primed (IP) group and group III as the vaccine-primed (VP) group. Seroconversion rate (57.5 % vs 35.9 %, p = 0.001), seroprotection rate at 6 months after vaccination (70.8 % vs 61.8 %, p = 0.032), and GMT at 1 month after vaccination (129.9 vs 66.5, p = 0.002) were significantly higher in the IP group than in the VP group. In the 9-18 year-old group, seroconversion rate and immunogenicity at 1 and 6 months were significantly higher in the IP group than in the VP group. However in the 1-7 year-old age group, there was no significant difference between the two groups. CONCLUSIONS: Previous H1N1 pdm09 infection appears to have positive effects on immunogenicity of subsequent inactivated influenza vaccines against H1N1 pdm09 in older children.

Radiotherapy and gemcitabine-docetaxel chemotherapy in children and adolescents with unresectable recurrent or refractory osteosarcoma.

OBJECTIVE: Few reports have described the treatment outcome of osteosarcoma using radiotherapy. We evaluated the efficacy of radiotherapy and gemcitabine and docetaxel chemotherapy for patients with unresectable recurrent or refractory osteosarcoma. METHODS: Data from six patients (five male, one female) who received radiotherapy and gemcitabine and docetaxel chemotherapy at the Korea Cancer Center Hospital were retrospectively reviewed. Tumor response was evaluated according to metabolic changes using (18)F-fluorodeoxy-D-glucose-positron emission tomography. RESULTS: The median age of the patients was 15.0 years (range, 14.0-15.8 years). Two patients had single bone lesions, and four had multiple metastatic bone lesions. Patients received a median 3.5 courses of gemcitabine and docetaxel chemotherapy (range, 2-6 courses). The median dose of radiotherapy was 50.0 Gy (range, 46-84 Gy). There were two complete metabolic responses and one partial metabolic response. The objective response rate was 50.0% (3/6). Responses were maintained for 4.6, 6.1 and 13.7 months, respectively. Patients were followed up for a median of 5.8 months (range, 2.7-84.6 months), and the median progression-free survival after this treatment was 3.6 months (range, 1.1-13.7 months). At the time of analysis, two patients were alive, one was lost to follow-up and three had died. CONCLUSION: Radiotherapy with gemcitabine and docetaxel chemotherapy showed some improvement in cases of refractory tumors or multiple bone metastases. Further studies are needed to investigate the efficacy of newer radiotherapy modalities, as well as to identify new radiosensitizing chemotherapy regimens.

Early menarche is associated with metabolic syndrome and insulin resistance in premenopausal Korean women.

In pediatrics, identifying risk factors is important in planning the prevention of cardiovascular disease. The aim of this study was to determine whether there is an independent association between early menarche (<12 years) and metabolic syndrome (MetS) in Korean women. We analyzed data from 4463 premenopausal women from the Fourth Korea National Health and Nutrition Examination Survey-IV (2007-2009). MetS was defined by the International Diabetes Federation for Asians and insulin resistance (IR) was defined as HOMA-IR more than 3.05. The prevalence of MetS and IR was 7.9 and 15.0%. Women (55.6%) with MetS also showed IR. The prevalence of MetS was higher in both women with early menarche and late menarche (≥16 years) compared with the reference group (early, 12.8%; reference, 7.0%; late, 11.0%, both P = 0.002). However, the odds ratio for MetS was 3.54 (95% confidence interval (CI), 2.14-5.87) and for IR was 2.98 (95% CI, 1.99-4.47) after adjusting for age and other confounders such as lifestyle variables, reproductive variables and sociodemographic variables only in women with early menarche CONCLUSION: Early menarche was associated with an increased risk of MetS and IR in premenopausal Korean women. WHAT IS KNOWN: Early menarche is associated with higher risk of CVD-related death and all-cause mortality in Western studies. Early menarche is associated with higher risk of diabetes in Korean premenopausal women. WHAT IS NEW: Early menarche (<12 years) is associated with metabolic syndrome and insulin resistance in nationally representative Korean premenopausal women. However, late menarche (>16 years) is not associated with metabolic syndrome after controlling for age and other confounders.

The hemoglobin values of Korean adolescents show distinctive characteristics in comparison to those of Caucasians and African Americans.

BACKGROUND: Hematologic reference values vary by ethnicity. We aimed to determine reference values of hemoglobin (Hb) for Korean adolescents. METHODS: Using data from the 5th Korean National Health and Nutrition Examination Survey (KNHANES), we obtained reference values for Hb in adolescents aged 10-20 years. RESULTS: Among 2,526 subjects recruited, 330 were excluded due to chronic diseases (9 congenital heart disease, 6 epilepsy, and 1 thyroid disease) or abnormal laboratory values (253 subjects with Fe/TIBC <16%, 103 subjects with MCV <80 fl). Accordingly, data from 2,196 subjects (male = 1,196 and female = 1,000) were analyzed and age- and gender-stratified means and percentile values of Hb were obtained. Pertinent findings observed in the current study were: (i) Hb levels in Korean male were similar to those of non-Hispanic Caucasians; (ii) Hb values in females were similar to those of non-Hispanic Caucasians until age of 15, and thereafter were slightly lower. Prevalence of anemia according to WHO criteria and our own criteria (Hb levels <2 standard deviations of age- and gender-specific values) in total sample was 3.5% (88/2,526) and 3.8% (97/2,526), respectively. Anemia was more prevalent in female in comparison with male (6.5% vs. 1.0%, P < 0.001). CONCLUSIONS: Our results could be used as a national reference standard to correctly classify a large population sample. Further studies are necessary to determine reference Hb values for children younger than 10 years and identify genetic variations associated with distinctive characteristics observed in this study.

Low vitamin D levels are associated with both iron deficiency and anemia in children and adolescents.

BACKGROUND: We aimed to examine the association between vitamin D deficiency and anemia in a nationally representative sample of Korean children and adolescents. METHODS: Cross-sectional data on 2526 children and adolescents aged 10-20 years from the Korea National Health and Nutrition Examination Survey-V (2010-2012) were used. Anemia was defined according to specifications of the World Health Organization. Iron deficiency was defined as serum ferritin level of <12 ng/mL and transferrin saturation (TSAT) <16%. RESULTS: The prevalence of vitamin D deficiency in Korean children and adolescents was high especially in female (35.7% vs. 50.9%, P < 0.001). The prevalence of anemia was also higher in female (1.1% vs. 6.8%; P < 0.001). In logistic regression, risk factors for anemia were female sex, old age, post-menarche, low household income, vitamin D deficiency, and iron deficiency. The Odds Ratio for anemia, iron deficiency and iron deficiency anemia (IDA) in subjects with vitamin D deficiency (<15 ng/mL) were 1.81(95% CI, 1.13-2.88), 1.94(95% CI, 1.27-2.97), and 2.26 (95% CI, 1.20-4.24) after controlling for other risk factors. However, after examining the sexes separately, only female subjects showed statistical significance. After further controlling for iron deficiency, the risk of anemia was not significant (P = 0.261). CONCLUSIONS: Vitamin D deficiency is associated with increased risk of anemia, especially iron deficiency anemia, in healthy female children and adolescents. However, the association is attenuated after adjustment for iron deficiency. Further studies are needed to determine whether vitamin D deficiency is the cause of anemia, or bystander of nutritional deficiency which cause iron deficiency.

Reference values for bone mineral density according to age with body size adjustment in Korean children and adolescents.

Bone acquisition failure during growth or low bone mineral density (BMD) in childhood and adolescence might increase future osteoporosis risk. To identify these children and adolescents, appropriate reference values are necessary. The robust reference values must be community based as well as sex-, age-, and ethnicity specific. In addition, body size adjustment is necessary because individuals demonstrate different body sizes and different tempos of growth, which affect measured BMD. We aimed to provide reference data with body size adjustment of Korean children and adolescents. We used dual-energy X-ray absorptiometry data of 1,650 subjects (aged 10-20 years; 788 female) from the Korea National Health and Nutrition Examination Survey (2009-2010). The BMD of each region of interest (ROI), including the lumbar spine, total body less head, total body, and femoral neck, were obtained. We calculated the mean and percentiles for each ROI. Because height and weight variations were high and correlated independently with BMD within the same age group, we developed equations to calculate the "predicted BMD Z score." Although 12.8-17.9 % of subjects with short stature showed a low measured BMD Z score depending on the measured site, only 2.6 % of those of short stature had a low adjusted BMD Z score after applying the predicted BMD Z score. We also compared the BMD of children and adolescents of other ethnicities using the same device. This study provided robust reference values for the assessment and monitoring of bone health in Korean children and adolescents. Additionally, it extended the knowledge of bone acquisition in Asian children and adolescents.

Gemcitabine and docetaxel for the treatment of children and adolescents with recurrent or refractory osteosarcoma: Korea Cancer Center Hospital experience.

BACKGROUND: We evaluated the efficacy of gemcitabine and docetaxel chemotherapy (GEM + DOC) in children and adolescents with recurrent or refractory osteosarcoma. METHODS: Data of 28 patients (20 male, 8 female) who received gemcitabine (675 or 900 mg/m(2) on days 1 and 8) and docetaxel (100 mg/m(2) on day 8) at Korea Cancer Center Hospital were retrospectively reviewed. RESULTS: Patients (ages 5.0-19.7 years) received a total of 96 courses of chemotherapy (median 3 courses; range, 1-8 courses) and were followed for a median of 14.9 months (range, 0.6-81.4 months). Eleven patients received GEM + DOC after surgery as adjuvant chemotherapy. Seventeen patients received GEM + DOC as palliative therapy, and were eligible for response evaluation; there were three (17.6%) complete response (CR, including two metabolic CR), one (5.9%) partial responses (PR), and three (29.4%) stable disease (SD). The objective response rate (CR + PR) and tumor control rate (CR + PR + SD) were 23.5% and 41.2%, respectively. The median duration of response was 11.2 months (range, 2.8-14.6 months). Dose of gemcitabine (675 or 900 mg/m(2)) did not influence the response rate. Overall survival at 1-year was 53.6 ± 9.4% and patients who received GEM + DOC as adjuvant chemotherapy fared better than those who received GEM + DOC as palliative therapy (72.7 ± 13.4% vs. 35.3 ± 11.6%, P = 0.006). CONCLUSION: GEM + DOC showed some activity in osteosarcoma. Better than expected survival after GEM + DOC was seen both in patients with and without surgery. These results may indicate that dose dense combinations of gemcitabine and taxanes (e.g., gemcitabine + nab-paclitaxel) should be investigated in bone sarcomas.

Healthy range of serum alanine aminotransferase and its predictive power for cardiovascular risk in children and adolescents.

BACKGROUND AND AIM: Serum alanine aminotransferase (ALT) is not only a surrogate marker of chronic liver disease but also predictive of future development of cardiovascular disease (CVD) in adults; however, pediatric reference data are rare, and "healthy-range ALT limits" have not been assessed to predict cardiovascular risk in children and adolescents. METHODS: Data from 2242 examinees (1171 boys and 1071 girls; 10-18 years of age) in the Korea National Health and Nutrition Examination Survey IV (2007-2009) were analyzed. The reference values of ALT levels were determined according to age and sex. Multiple logistic regressions were used to assess the association between healthy-range ALT limits (ALT level >30 IU/L for boys and >19 IU/L for girls) and each cardiovascular risk factor. RESULTS: The 50th, 90th, and 95th percentiles of ALT levels were respectively 14, 27, and 35 IU/L in boys and 11, 19, and 24 IU/L in girls. Subjects with ALT levels higher than healthy-range ALT limits not only exhibited higher odds ratios for metabolic syndrome but also showed higher each cardiovascular risk related to obesity, hypertension, and dyslipidemia compared with subjects whose ALT levels were within the healthy range (P < 0.001). CONCLUSIONS: The present study shows normal ALT reference data of Korean children and adolescents. The present study also showed the effectiveness of healthy-range ALT limits in predicting each cardiovascular risk factor in a national representative population.

Comparison of immunogenicity and reactogenicity of split versus subunit influenza vaccine in Korean children aged 6-35 months.

BACKGROUND: Studies comparing the immunogenicity and reactogenicity of trivalent inactivated subunit (SU) and split (SPL) vaccines in children in Asia are limited. In 2008, we assessed the safety and immunogenicity of SU and SPL influenza vaccines in Korean children aged 6-35 months. METHODS: We studied 2 non-randomized cohorts of children who received either SU or SPL vaccine in an open-label non-stratified controlled trial at 6 hospitals in Korea. We measured antibody titers with a hemagglutination-inhibition assay at baseline and 30 days after the first or second flu shot. The primary goal was the determination of vaccine immunogenicity according to the European Union Committee of Human Medicinal Products licensing criteria. RESULTS: Out of a total of 106 participants aged 6-35 months, 47 received the SPL vaccine and 59 the SU vaccine. After vaccination, 41 (87.2%), 40 (85.1%), and 33 (70.2%) of the 47 subjects in the SPL group had titers ≥ 1:40 against H1N1, H3N2, and B, respectively. In the SU group, 42 (71.2%), 34 (57.6%), and 22 (37.3%) of 59 subjects had titers ≥ 1:40 against H1N1, H3N2, and B, respectively. The post-vaccination geometric mean titers of H1N1, H3N2, and B (SPL vs SU) were 119.1, 99.8, and 61.4 vs 75.4, 51.2, and 24.1, respectively. There were no serious vaccine-related adverse events. There were no differences between the SPL and SU vaccines with respect to adverse events. CONCLUSIONS: The immunogenicity of the SPL vaccine appears to be better than that of the SU vaccine in children aged 6-35 months in Korea.

Young age at diagnosis, male sex, and decreased lean mass are risk factors of osteoporosis in long-term survivors of osteosarcoma.

BACKGROUND: Long-term survival of children with osteosarcoma has increased, but most suffer from osteoporosis in adulthood. The aim of this study was to investigate the prevalence and identify the risk factors of osteoporosis. METHODS: Forty long-term survivors of osteosarcoma and 55 controls were enrolled. The mean age of the survivors was 21.8 ± 5.2 years. They were diagnosed at younger than 23 years of age (mean, 14.9 + 5.0 y). Bone mineral densities (BMD) and body compositions were measured by dual-energy x-ray absorptiometry. RESULTS: Nineteen (47.5%) subjects had osteoporosis and 12 (30.0%) had osteopenia. The regions affected by osteoporosis were: femur neck of osteosarcoma site (47.5%), unaffected femur neck (12.5%), lumbar spine (12.5%), and total body (15.0%). Twelve subjects (30.0%) had 14 episodes of fractures. The identified risk factors of osteoporosis were young age at diagnosis, male sex, and low lean mass. Subjects diagnosed before attainment of puberty (male ≤ 16 y, female ≤ 14 y) were found to have a higher prevalence of osteoporosis (37.5% vs. 10.0%, P < 0.01). Males had a higher prevalence of osteopenia or osteoporosis than females (86.4% vs. 66.7%, P < 0.01). Total lean mass was positively correlated with unaffected femur neck BMD. Regional lean mass in affected limb was significantly reduced along with affected femur neck BMD. CONCLUSIONS: In long-term survivors of osteosarcoma, prevalence of osteoporosis and fracture was higher than expected. Initial evaluation and regular follow-up of BMD should be performed in all osteosarcoma patients, especially in those who did not attain puberty, males, and those with a low lean mass.

Comparison of immune response by virus infection and vaccination to 2009 pandemic influenza A/H1N1 in children.

We aimed to compare the immune response induced by natural infection with 2009 pandemic influenza A/H1N1 (pH1N1) virus and by monovalent pH1N1 vaccination in children and adolescents. This cross-sectional clinical study was conducted at 3 hospitals in Korea from February to May 2010. A total of 266 healthy subjects aged from 6 months to 18 yr were tested for the presence of the antibody against pH1N1 using hemagglutination inhibition (HI) test. Information about pH1N1 vaccination and laboratory-confirmed pH1N1 infection history was obtained. The overall rate of HI titers of ≥ 1:40 against pH1N1 was 38.7%, and the geometric mean titer (GMT) was 20.5. Immunogenicity of pH1N1 vaccination only was reflected by a 41.1% of seroprotection rate and a GMT of 22.5. Immunogenicity of natural infection only was reflected by a 61.0% of seroprotection rate and a GMT of 40.0. GMT was significantly higher in the subjects of natural infection group than in the subjects of pH1N1 vaccination group (P < 0.001). The immune responses induced by natural pH1N1 infection exceed those induced by pH1N1 vaccinations.

Effect of bisphosphonates on bone mineral density and fracture prevention in gastric cancer patients after gastrectomy.

GOAL: To evaluate the effectiveness of bisphosphonates in preventing fractures in gastric cancer patients by increasing bone mineral density (BMD). BACKGROUND: The effectiveness of bisphosphonates is questionable in gastric cancer patients who have undergone gastrectomy, although they display a high prevalence of osteoporosis. STUDY: Forty-seven gastric cancer patients with osteoporosis were retrospectively analyzed. All patients were supplemented with calcium and vitamin D. Twenty-four patients were treated with bisphosphonate (bisphosphonate group) and 23 patients were untreated (control group). Fractures, severe bone pain, and adverse effects of bisphosphonates were monitored. BMD of the lumbar spine and femoral neck were measured before and 1-year treatment with bisphosphonates by dual-energy X-ray absorptiometry. RESULTS: During a 1-year follow-up, 7 of the 47 (15%) patients developed new fractures. The bisphosphonate-treated group had a significantly lower fracture rate than the control group (n=1 vs. 6, P<0.05). Lumbar spine BMD increased in both groups (0.047 ± 0.03 vs. 0.021 ± 0.03 g/cm², respectively), whereas femoral neck BMD increased only in the bisphosphonate group (0.032 ± 0.03 vs. -0.004 ± 0.02 g/cm², respectively). Furthermore, the bisphosphonate group showed greater increases in lumbar spine and femoral neck BMDs than the controls (P<0.05). No difference was found between alendronate and risedronate in terms of BMD at follow-up. CONCLUSIONS: Therapy using bisphosphonates might be effective at increasing BMD and reducing fracture risk in gastric cancer patients after gastrectomy. Further well-designed randomized controlled trials are needed for confirmation.

The association between C-reactive protein, metabolic syndrome, and prediabetes in Korean children and adolescents.

PURPOSE: Metabolic syndrome (MetS) is a state of chronic inflammation, and high-sensitivity C-reactive protein (hsCRP) indicates inflammation. This paper evaluates the associations between hsCRP and MetS and its components in Korean children and adolescents. METHODS: We analyzed the data of 1,247 subjects (633 males, 14.2±2.7 years) from the Korea National Health and Nutrition Examination Survey 2016-2017. This study defined MetS and its components using the modified National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria. RESULTS: The mean hsCRP level was 0.86±1.57 mg/dL (median and interquartile range: 0.37 and 0.43 mg/dL). Subjects with MetS had higher hsCRP level than subjects without MetS (geometric mean: 1.08 mg/dL vs. 0.46 mg/dL, p<0.001). With a higher quartile value of hsCRP, the prevalence of MetS increased. Compared to the lowest quartile, the odds ratio (OR) for MetS in the highest quartile was 7.34 (3.07-17.55) after adjusting for age and sex. In the top quartile of hsCRP, the risk of abdominal obesity and low HDL was high after adjusting for age, sex, and other components of MetS. Additionally, the OR for prediabetes (HbA1c ≥5.7%) in the highest quartile was 2.70. CONCLUSION: Serum hsCRP level was positively associated with MetS and prediabetes using NCEP-ATP III criteria. Among the MetS components, abdominal obesity and low HDL were highly correlated with hsCRP in Korean children and adolescents.