Visceral fat and subcutaneous fat have not only a histological difference but also a difference in metabolic activities: visceral fat is more sensitive to lipolysis by catecholamine than to the anti-lipolytic effect of insulin13). Visceral fat transfers fatty acid to the portal circulation, increases glucogenesis and LDC, and reduces insulin degradation in the liver. As abdominal fat lipolysis increases, fatty acid in the portal and systemic circulation increases and finally induces hyperlipidemia, glucogenesis, and insulin resistance14). Visceral fat is known to increase with age and weight gain in both boys and girls. The waist-hip ratio is generally higher in boys, and it seems that visceral fat is larger in boys compared to girls15). In our study, waist circumference and waist-hip ratio were higher in boys than in girls, but body fat mass was larger in girls than in boys, which is similar to the distribution of body fat mass in adults. In addition, it is known that men have much more visceral fat and much less subcutaneous fat than women8,16). Our study revealed that abdominal fat thickness measured by ultrasound was thicker in boys than in girls among high school students but the difference was not significant. Subcutaneous fat thickness and preperitoneal fat thickness were higher in girls than in boys but were not significant. We think that the characteristic difference of fat distribution between normal men and women may be altered by obesity in adolescence. In the regulation of growth and development of puberty, estrogen and growth hormone interact closely. During growth spurt, estrogen and growth hormone take an action and change the physical development and then make a result sex different body composition change17).
Adolescent obesity is known to be a major risk factor of non-alcoholic fatty liver and atherosclerosis, and combined with hyperlipidemia, hypertension, elevation of liver enzymes, and insulin resistance. Non-alcoholic steatohepatitis is a chronic liver dysfunction and has been reported to progress finally to fibrosis, hepatocirrhosis18). Jang et al.19) reported that obese first-year high school students have an abnormal ALT level, 23.7% in boys and 11.8% in girls. In the obesity group, boys had a statistically higher abnormal rate of AST, ALT, and total cholesterol, but in the normal weight group, the abnormal rate of AST, ALT, and total cholesterol was significantly higher in girls than in boys. In a large cohort of overweight and obese European children and adolescents, the markers of nonalcoholic liver disease, especially elevated ALT, were frequently predicted by severe obesity group and male gender20,21).
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Interestingly, epidemiological studies and most of published case series demonstrate a clear male predominance in the diagnosis of nonalcoholic fatty liver disease. In this study, the incidence of fatty liver in obese adolescents measured by ultrasound was 30% in both sexes. However, compared to the severity of fatty liver, the boys showed a mild to severe degree but the girls showed mostly a mild or moderate degree and no severe degree. This led to the assumption that estrogen might be an important mediator in the pathogenesis of nonalcoholic fatty liver disease. Changes in estrogen metabolism and physiological insulin resistance may determine susceptibility to fatty liver disease and contribute to the gender-specific prevalence pattern which is supported by previous studies26,27).
Limitations of this study were first, only 154 of a high school in Seoul were included and the number of the objectives was small. Second, although, the mean BMI of boys was not different from that of girls, we did not adjust the BMI on the results statistically.
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I don't know how serious myproblem is. Like the girl inyour poem, I am smart, popularand a "successful" person. Andpretty....I guess.... But everytime I look at the mirror, Ican't help but feel like a failure.I'll diet, lose a bit of weight...feelgreat about myself. Then, whenI pig out, I feel like I'vecommitted a crime. Nobody knows how badly I feelabout this, cause I don't talkabout it. Deep down, I reallyfeel very insecure. I nevermention my weight or diets inschool cuz I am worried thatit'll just draw attention tomy "ugly" body. At home, I dosometimes moan and groan aboutmy appearance, but everyonethinks it's just a regular doseof vanity.Well, I've come this far. IfI saw myself thru another person'seyes, I would not consider myselffat or bad-looking. But it'sdifficult to be objective andI admit that I've got ridiculouslyhigh standards for myself onhow I look. I am constantlycomparing myself to other girls-- other "slimmer" and "prettier"girls. Everyone wants to look good,I guess. But looking good canonly come if you feel good.I am trying to feel good aboutmy body. Really. I ask God tohelp me to love myself, becauseHe loves me. I want to acceptmyself, and start living ina healthy body...not the fat,miserable body of my childhood...Thank you for your article.I can really identify with it....andI know I'm not the only one.There are many girls out therelike me. YoursSincerely, Beautiful just beingMe 2ff7e9595c
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