Annals of Pediatric Endocrinology & Metabolism最新文献

Purpose: Despite the global paradigm emphasizing earlier and more aggressive intervention for youth-onset type 2 diabetes mellitus (T2DM), metformin and insulin are the only drugs approved for Korean adolescents. We investigated the incidence of complications, changes in glycemic control during the transition period, the effect of second-line antidiabetic agents on glycemic control in young adults with youth-onset T2DM.

Methods: Eighty-four patients diagnosed with T2DM at Seoul National University Children's Hospital between January 2001 and July 2023, before age 18 (47 males; mean age, 14 years) with available glycated hemoglobin (HbA1c) data from at least 2 distinct ages between 19 and 22 years old were retrospectively enrolled.

Results: At the last follow-up (mean age, 24.9 years; median follow-up, 9.6 years), complications were found in 33.7% (nephropathy, 25.3%; eye disease, 20.6%), and 83% required insulin or second-line agents. During the transition period, HbA1c levels decreased from 8.2% at age 19 to 7.7% at age 22 (P<0.01), with greater improvements in females, those diagnosed before age 15, and those with HbA1c levels ≥7% at age 19. HbA1c level decreased significantly at 1 year after the addition of second-line medications (P=0.03) and at the last visit (P=0.03) compared with baseline.

Conclusion: Glycemic control improved during the transition period among youth-onset T2DM patients. Given the high incidence of complications and the beneficial effects of second-line agents on glycemic control, there is an urgent need to expand the range of approved second-line agents, along with broader insurance coverage in adolescence.

Recent literature has highlighted an association between severe atopic dermatitis in infancy and biochemical disturbances consistent with secondary hyperaldosteronism. Trans-epidermal sodium loss driving volume depletion has been hypothesised to contribute to this process, but direct evidence of the underlying mechanisms remains sparse. We present a case series of three children, aged three to seven months, who were admitted with severe exudative eczema associated with hyponatraemia and hyperkalaemia, despite evidence of effective RAAS activation and renal mineralocorticoid action. In each case, these biochemical and hormonal disturbances resolved after optimising dermatological and nutritional management of their atopic presentations, supporting the role of extra-renal mechanisms of electrolyte disturbance. Our case series highlights the importance of considering biochemical and hormonal factors in comprehensive, early treatment of infantile atopic dermatitis to prevent complications associated with electrolyte imbalances and nutritional deficiencies.

The increasing prevalence of both type 1 diabetes (T1D) and type 2 diabetes (T2D) among children and adolescents presents major challenges for long-term skeletal health. This review explores the effect of diabetes on bone health during critical phases of skeletal development. In T1D, insulin deficiency disrupts the insulin/insulin-like growth factor-1 axis, which is essential for osteoblast function, leading to decreased bone mineral density (BMD), lower bone formation markers, and altered microarchitecture. Conversely, T2D shows a paradoxical trend of normal or elevated BMD despite higher fracture risk, which is attributed to compromised bone quality from advanced glycation end-product accumulation and altered microarchitecture. Both types of diabetes share common pathophysiological mechanisms, including hyperglycemia, vitamin D deficiency, and oxidative stress, while also exhibiting distinct characteristics. Modern assessment techniques that go beyond conventional densitometry, such as trabecular bone score and high-resolution peripheral quantitative computed tomography, provide valuable insights into diabetes-specific bone abnormalities. Effective management strategies highlight the importance of strict glycemic control, adequate calcium and vitamin D supplementation, weight-bearing physical activities, and, when necessary, pharmacological interventions. Early identification and intervention are critical, as diabetes-related bone impairments during childhood can compromise peak bone mass development, potentially increasing the risk of lifelong fractures. As the prevalence of diabetes continues to rise globally, addressing bone health has become increasingly important for preventing future complications and ensuring good quality of life into adulthood.

Purpose: The increasing prevalence of type 2 diabetes (T2D) among adolescents and young adults (AYAs) is a major public health concern worldwide. This pilot study evaluated the effectiveness of lifestyle education in managing T2D in obese AYAs using continuous glucose monitoring (CGM) and smartwatch-derived lifelog data.

Methods: Seven obese AYAs and T2D aged 12-19 years were enrolled in this prospective interventional study. Patients continued to take their previously prescribed T2D medication. CGM data were collected for 10 days, followed by lifestyle education using CGM and smartwatch data. Outcomes, including anthropometrics, glycemic control, dietary intake, physical activity, and self-management skills, were reassessed after an additional 10 days.

Results: The median time in range increased from 58.1% (53.2%-75%) to 72% (64%-88%) (p=0.043) and time above range (>250 mg/dL) decreased from 10% (2.9%-18.6%) to 3.0% (1.0%-11.0%) (p=0.028). Median peak total caloric intake decreased from 2,854 (2,465-3,040) kcal/day to 2,091 (1,751-2,283) kcal/day and walking calorie expenditure increased from 163.9 (116.7-321.3) kcal/day to 180.2 (165.3-492.4) kcal/day (p=0.018 for both). The Summary of Diabetes Self-Care Activities score improved from 0.29 (0.05-0.43) to 0.33 (0.32-0.68) (p=0.043).

Conclusion: This integrated approach combining CGM and smartwatch-based education exhibited short-term effects on glycemic control, dietary habits, physical activity, and self-management skills in obese AYAs and T2D. Further studies are needed to confirm the long-term effectiveness of this strategy in this challenging population.

Purpose: Cardiometabolic risk factors can originate in childhood, especially in overweight individuals. In this study, we aimed to determine the trends in the prevalence of metabolic phenotypes among Iranian children and adolescents.

Methods: We determined the trends of the data from 3 nationwide school-based studies in Iran from 2003 to 2016 (the CASPIAN [Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease] studies). A total of 8,711 individuals (49.6% boys) aged 10-18 years were studied. Obesity and normal weight were considered as an age- and sex-specific body mass index > 95th percentile and between the 5th to 85th percentile, respectively. Metabolic syndrome (MetS) was defined according to the modified Adult Treatment Panel III criteria for children and adolescents. Children were categorized into 4 groups: metabolically healthy obesity (MHO), metabolically unhealthy obesity (MUO), metabolically healthy normal weight, and metabolically unhealthy normal weight (MUNW).

Results: Over 13 years, the prevalence of obesity increased significantly from 9.8% to 11.6% (p<0.001), whereas that of MetS did not change significantly (from 5.35% in 2003-2004 to 7.76% in 2009-2010 and 4.45% in 2015-2016, p=0.83). The prevalence of MHO increased significantly from 7.1% in 2004 to 9.6% in 2016 (p=0.005). However, the change in prevalence was not significant for MUO and MUNW.

Conclusion: From 2003 to 2016, the prevalence of MetS and metabolic phenotypes except MHO did not change significantly among Iranian children. The marginal increase in MHO prevalence should be considered, as shifts from this phenotype to unhealthy phenotypes may influence the risk of developing noncommunicable diseases in adulthood.

Purpose: Childhood obesity is a growing global health concern associated with various cardiometabolic risk factors. The aim of this study was to examine the relationships between the trunk-to-limb fat ratio on dual-energy x-ray absorptiometry (DXA) and cardiometabolic risk factors in Korean children and adolescents.

Methods: Data for 891 boys and 770 girls aged 10-18 years from the 2009-2011 Korean National Health and Nutrition Examination Survey were analyzed. The trunk-to-limb fat ratio was calculated using DXA measurements. Cardiometabolic risk factors including waist circumference, blood pressure, lipid profiles, and fasting glucose were assessed. The Lambda-Mu-Sigma method was used to evaluate the distribution of the trunk-to-limb fat ratio by sex and age. Correlations between the trunk-to-limb fat ratio and metabolic syndrome risk factors were analyzed using adjusted mean values and odds ratios (ORs).

Results: Trunk-to-limb fat ratio was significantly correlated with various cardiometabolic risk factors, including waist circumference, body mass index, and lipid profiles. The group with the highest trunk-to-limb fat ratio (≥95th percentile) demonstrated significantly increased odds of metabolic syndrome, particularly in girls (adjusted OR, 8.66). Sex-specific patterns in trunk-to-limb fat ratio with age were observed, with boys showing an increasing trend and girls maintaining a relatively stable ratio.

Conclusion: Trunk-to-limb fat ratio on DXA is significantly associated with cardiometabolic risk factors and metabolic syndrome in Korean children and adolescents. This measure provides valuable information beyond traditional anthropometric measurements and may be particularly useful in assessing metabolic health in young populations.

Purpose: This study aimed to evaluate national trends in central precocious puberty (CPP) incidence in Korean children and to examine the association between early childhood obesity and CPP using linked population-based datasets.

Methods: Data were obtained from the National Health Insurance Service (NHIS, 2012-2020) and the Infant/Toddler Health Check-up Program (2013-2016). CPP was defined operationally as having an International Classification of Diseases, 10th Revision code for precocious puberty, NHIS registration for CPP, and at least one year of gonadotropin-releasing hormone agonist treatment initiated before age 8 in girls and 9 in boys. Children with at least 3 health screenings before 6 years of age were included for body mass index (BMI) analysis. Multivariable logistic regression was used to estimate odds ratios (ORs) for CPP across BMI categories.

Results: A total of 195,892 CPP cases were identified. The incidence of CPP increased steadily from 2012 to 2020 in both sexes. In BMI analysis (n=35,766), CPP risk was significantly higher in the overweight (85th-94th percentile) and obese (≥95th percentile) groups compared to the normal-weight group (5th-84th percentile). The association was strongest in obese boys (OR, 2.573; 95% confidence interval, 2.417-2.739). Underweight status (<5th percentile) was associated with reduced CPP risk.

Conclusion: CPP incidence in Korea has increased in recent years. Early childhood obesity is a strong, independent risk factor for CPP, particularly in boys. Early weight management strategies may help reduce CPP risk.a.