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A biomarker in meconium for fetal exposure to alcohol
Does increasing physical activity really make a difference? Show me the evidence
Bone mineral density with children with cerebral palsy
In this issue of The Journal, Strong et al review what is known about the effects of physical activity on the health and behavior of school-aged children. A Consensus Conference was held in 1993 that resulted in the recommendation that adolescents should engage in three or more sessions per week of activities that last 20 minutes or more and require moderate to vigorous levels of exertion. What have we learned in 10 years? The information obtained from this extensive literature review was shared with individuals representing several organizations and agencies, and after vigorous debate and based on this evidence-based approach, the authors recommend that schoolaged youth should participate in 60 minutes of vigorous physical activity on a daily basis. It appears that this amount of activity will have a positive effect on the academic performance and musculoskeletal development of children. It will also have a positive effect on the adiposity in the overweight child, will decrease blood pressure in the children with hypertension, and will have a beneficial effect on lipids if they are elevated. Increasing physical activity will have no detrimental effect on safety and well-being based on the literature available to date. Armed with this information, the practitioner can, without reservation, now recommend vigorous daily physical activity in all school-aged youth. Further research is needed to continue to document the benefits of regular, vigorous physical activity in children.
Children significantly involved with cerebral palsy are well-known to have osteopenia and to be at risk for pathologic fractures. The natural history of this phenomenon is not well understood. In the current issue of The Journal, Henderson et al at the University of North Carolina report a longitudinal study of 69 children to examine bone mineral density (BMD) compared to a number of measures of disease severity, growth, and nutrition. As expected, BMD correlated negatively with severity of cerebral palsy. Overall, there was an increase in BMD with time, but, in spite of this, z-scores for BMD in the distal femur actually fell. The suggestion was that these children were not so much losing bone mineral as not gaining it at the rate to be expected in typical children. This information will be very valuable for those designing interventions.
—Reginald L. Washington, MD page 732
A biomarker in meconium for fetal exposure to alcohol Alcohol exposure of the fetus is the largest preventable cause of mental retardation, and maternal histories of alcohol exposure are notoriously unreliable. The identification of which infant will be adversely affected by alcohol remains problematic because maternal metabolism of alcohol (based on genetic differences in enzymatic activities), drinking quantity and pattern, maternal age, and no doubt other factors contribute to the fetal risk. Furthermore, physical examination of infants at birth will miss a great majority of infants negatively impacted by fetal alcohol exposure. Bearer et al report the further development of biomarkers in meconium as indicators of amount of fetal exposure to alcohol. They find that the fatty acid ester ethyl linoleate, a non-oxidative metaboliltic of ethanol, is potentially useful for identifying fetal alcohol exposure. Such biomarkers should be helpful for epidemiologic and interventional studies of this intractable problem.
—Thomas R. Welch, MD page 769
Dealing with the density of bone mineral content studies Even the casual reader of The Journal must be aware of the increasing number of studies we have been publishing addressing bone mineral density (BMD) in children. These studies are beginning to use a vocabulary which may be confusing to those not current with the literature, such as the differences between BMD and bone mineral content (BMC). Readers will also see differing methodologies employed in these studies, ranging from the more typical DXA to the more recent quantitative computed tomography and quantitative ultrasound (‘‘speed of sound’’). Each of these techniques provide different information, and are not directly comparable. The editors decided that it was necessary to invite a Medical Progress article to summarize this information succinctly for the practitioner. In the current issue of The Journal, Bonny Specker, PhD, does this very nicely. The information provided in this review is not available in such an accessible, clinically-relevant form anywhere else. Dr. Specker proceeds to discuss situations in pediatrics in which measurement of BMD (or BMC) is appropriate.
—Thomas R. Welch, MD page 726
—Alan H. Jobe, MD, PhD page 824
2A
June 2005
The Journal of Pediatrics
Bone mineral density with children with cerebral palsy
In this issue of The Journal, Strong et al review what is known about the effects of physical activity on the health and behavior of school-aged children. A Consensus Conference was held in 1993 that resulted in the recommendation that adolescents should engage in three or more sessions per week of activities that last 20 minutes or more and require moderate to vigorous levels of exertion. What have we learned in 10 years? The information obtained from this extensive literature review was shared with individuals representing several organizations and agencies, and after vigorous debate and based on this evidence-based approach, the authors recommend that schoolaged youth should participate in 60 minutes of vigorous physical activity on a daily basis. It appears that this amount of activity will have a positive effect on the academic performance and musculoskeletal development of children. It will also have a positive effect on the adiposity in the overweight child, will decrease blood pressure in the children with hypertension, and will have a beneficial effect on lipids if they are elevated. Increasing physical activity will have no detrimental effect on safety and well-being based on the literature available to date. Armed with this information, the practitioner can, without reservation, now recommend vigorous daily physical activity in all school-aged youth. Further research is needed to continue to document the benefits of regular, vigorous physical activity in children.
Children significantly involved with cerebral palsy are well-known to have osteopenia and to be at risk for pathologic fractures. The natural history of this phenomenon is not well understood. In the current issue of The Journal, Henderson et al at the University of North Carolina report a longitudinal study of 69 children to examine bone mineral density (BMD) compared to a number of measures of disease severity, growth, and nutrition. As expected, BMD correlated negatively with severity of cerebral palsy. Overall, there was an increase in BMD with time, but, in spite of this, z-scores for BMD in the distal femur actually fell. The suggestion was that these children were not so much losing bone mineral as not gaining it at the rate to be expected in typical children. This information will be very valuable for those designing interventions.
—Reginald L. Washington, MD page 732
A biomarker in meconium for fetal exposure to alcohol Alcohol exposure of the fetus is the largest preventable cause of mental retardation, and maternal histories of alcohol exposure are notoriously unreliable. The identification of which infant will be adversely affected by alcohol remains problematic because maternal metabolism of alcohol (based on genetic differences in enzymatic activities), drinking quantity and pattern, maternal age, and no doubt other factors contribute to the fetal risk. Furthermore, physical examination of infants at birth will miss a great majority of infants negatively impacted by fetal alcohol exposure. Bearer et al report the further development of biomarkers in meconium as indicators of amount of fetal exposure to alcohol. They find that the fatty acid ester ethyl linoleate, a non-oxidative metaboliltic of ethanol, is potentially useful for identifying fetal alcohol exposure. Such biomarkers should be helpful for epidemiologic and interventional studies of this intractable problem.
—Thomas R. Welch, MD page 769
Dealing with the density of bone mineral content studies Even the casual reader of The Journal must be aware of the increasing number of studies we have been publishing addressing bone mineral density (BMD) in children. These studies are beginning to use a vocabulary which may be confusing to those not current with the literature, such as the differences between BMD and bone mineral content (BMC). Readers will also see differing methodologies employed in these studies, ranging from the more typical DXA to the more recent quantitative computed tomography and quantitative ultrasound (‘‘speed of sound’’). Each of these techniques provide different information, and are not directly comparable. The editors decided that it was necessary to invite a Medical Progress article to summarize this information succinctly for the practitioner. In the current issue of The Journal, Bonny Specker, PhD, does this very nicely. The information provided in this review is not available in such an accessible, clinically-relevant form anywhere else. Dr. Specker proceeds to discuss situations in pediatrics in which measurement of BMD (or BMC) is appropriate.
—Thomas R. Welch, MD page 726
—Alan H. Jobe, MD, PhD page 824
2A
June 2005
The Journal of Pediatrics