Lee Soo-Kyung
Department of Food and Nutrition, Inha University, Incheon, Korea.
Ann Pediatr Endocrinol Metab. 2017 Dec;22(4):231-239. doi: 10.6065/apem.2017.22.4.231. Epub 2017 Dec 31.
North Korea suffered from severe famine in the mid-1990s; this impacted many areas, including people's transnational movement, child growth, and mortality. This review carefully examined nutritional status trends of children in North Korea using published reports from national nutrition assessment surveys. Nutritional adaptation of North Korean child refugees living in South Korea was also studied with their growth and food consumption, using published researches. The nutritional status of children in North Korea has recovered to a "low" level acute malnutrition status and a "medium" level chronic malnutrition status. Large disparities by geographic region still remain. North Korean child refugees in South Korea were significantly shorter and lighter than their age- and sex-matched South Korean counterparts (<0.05); however, North Korean child refugees were catching up, and weight was improving faster than height. Linear growth retarded (height for age -score < -1) North Korean children showed a significantly higher respiratory quotient than nonlinear growth retarded children, indicating metabolic adaptation responding to the food shortage. These changes, accompanied by abundant access to food in South Korea, have led to the elimination of significant differences in the obesity ratio between North Korean and South Korean children living in South Korea after approximately 2 years of residency. This nutritional adaptation may not be beneficial to North Korean child refugees, especially given the prediction of Barker's theory. The lack of studies prevented a better understanding of this issue; therefore, large cohort studies, preferably with random sampling strategies, are needed to further understand this issue and to design appropriate interventions.
朝鲜在20世纪90年代中期遭受了严重饥荒；这影响了许多领域，包括人口的跨国流动、儿童成长和死亡率。本综述利用国家营养评估调查的已发表报告，仔细研究了朝鲜儿童的营养状况趋势。还利用已发表的研究，通过朝鲜儿童难民在韩国的成长情况和食物消费情况，对他们的营养适应情况进行了研究。朝鲜儿童的营养状况已恢复到“低”水平的急性营养不良状态和“中”水平的慢性营养不良状态。不同地理区域之间仍然存在很大差距。在韩国的朝鲜儿童难民明显比年龄和性别匹配的韩国儿童更矮、更轻（<0.05）；然而，朝鲜儿童难民正在追赶，体重的改善速度比身高更快。线性生长迟缓（年龄别身高得分<-1）的朝鲜儿童的呼吸商显著高于非线性生长迟缓的儿童，这表明他们对食物短缺做出了代谢适应。这些变化，再加上在韩国有充足的食物供应，使得在韩国居住约两年后，朝鲜儿童和韩国儿童在肥胖率方面的显著差异消失了。这种营养适应可能对朝鲜儿童难民没有好处，尤其是考虑到巴克理论的预测。由于缺乏研究，无法更好地理解这个问题；因此，需要进行大规模队列研究，最好采用随机抽样策略，以进一步了解这个问题并设计适当的干预措施。
