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Fitness or fatness—which is more important for cardiovascular risk?
Treatment regimens for acute lymphoblastic leukemia in the 1970s and 1980s are associated with adult short stature today The cross-sectional study reported by Chow et al of adult height of 2,434 survivors of childhood acute lymphoblastic leukemia (ALL) compared with their siblings provides several sound conclusions about treatments in the 1970s and 1980s, as well as worthy hypotheses for testing of current treatments. The investigators report decreased adult height and increased risk of short stature in cancer survivors, with graded adverse effects for diagnosis prior to puberty, increasing doses of cranial radiotherapy, and radiotherapy of any dosage to the spine. The study provides evidence that there was no “catch-up” growth post treatment.
Doses of radiation in protocols for treatment of ALL since this cohort was treated have been reduced or eliminated, but have been replaced by more aggressive chemotherapy regimens. Because even the “milder” chemotherapy circa 1970-1986, without radiation therapy, was associated with decreased adult height in the current report of Chow et al, there is reasonable concern for adverse long-term growth effect of protocols circa 2000s.
—Sarah S. Long, MD page 370
Fitness or fatness—which is more important for cardiovascular risk? There is no question that the epidemic of obesity is resulting in increased risk for cardiovascular disease across the population of children and adolescents. However, there is still much to learn about the mechanisms of this increased risk. One important question relates to the relative role of fitness and fatness. Are there some children who are at lower risk, despite being overweight, because of increased fitness? In this issue of The Journal, two articles report on studies that begin to evaluate elements of these relationships. Allen et al studied overweight middle school children. They found that both percent body fat and V02 Max were associated with the level of fasting insulin. However, particularly in boys, the relationship of cardiorespiratory fitness to fasting insulin was stronger than the relationship of percent body fat and fasting insulin. Rizzo et al examined the association of physical activity and cardiorespiratory fitness with a clustering of metabolic risk factors. They found that cardiorespiratory fitness was more strongly correlated with metabolic risk than total physical activity. However, body fat seems to play an important role in the association of cardiorespiratory fitness and metabolic risk. Both studies emphasize the role of fitness, but also support the role of fatness. This would seem to put physical activity in an important role. However, it should be emphasized that fitness is only partially determined by physical activity. Fitness also has an important genetic component. Further research is needed to evaluate developmental and other aspects of these interrelationships.
—Stephen R. Daniels, MD, PhD page 383 (Allen) page 388 (Rizzo)
Do we need chest radiographs in infants with uncomplicated bronchiolitis? The question of whether we need routine chest radiographs in infants with uncomplicated bronchiolitis is addressed in an article by Schuh et al from The Hospital for Sick Children, Toronto. They performed a prospective cohort study of more than 200 infants in the pediatric emergency department. The results showed that infants with typical bronchiolitis do not need imaging; invariably, it just confirms the diagnosis. In fact, the use of routine chest radiographs appeared to increase the chances of prescribing antibiotics in patients who were otherwise uncomplicated. The risk of air space disease such as pneumonia was particularly low in infants with mild to moderate respiratory distress and oxygen saturations in room air above 92%. These results will help guide the use of radiographic studies in clinical care.
—Robert W. Wilmott, MD page 429
2A
April 2007
The Journal of Pediatrics
Doses of radiation in protocols for treatment of ALL since this cohort was treated have been reduced or eliminated, but have been replaced by more aggressive chemotherapy regimens. Because even the “milder” chemotherapy circa 1970-1986, without radiation therapy, was associated with decreased adult height in the current report of Chow et al, there is reasonable concern for adverse long-term growth effect of protocols circa 2000s.
—Sarah S. Long, MD page 370
Fitness or fatness—which is more important for cardiovascular risk? There is no question that the epidemic of obesity is resulting in increased risk for cardiovascular disease across the population of children and adolescents. However, there is still much to learn about the mechanisms of this increased risk. One important question relates to the relative role of fitness and fatness. Are there some children who are at lower risk, despite being overweight, because of increased fitness? In this issue of The Journal, two articles report on studies that begin to evaluate elements of these relationships. Allen et al studied overweight middle school children. They found that both percent body fat and V02 Max were associated with the level of fasting insulin. However, particularly in boys, the relationship of cardiorespiratory fitness to fasting insulin was stronger than the relationship of percent body fat and fasting insulin. Rizzo et al examined the association of physical activity and cardiorespiratory fitness with a clustering of metabolic risk factors. They found that cardiorespiratory fitness was more strongly correlated with metabolic risk than total physical activity. However, body fat seems to play an important role in the association of cardiorespiratory fitness and metabolic risk. Both studies emphasize the role of fitness, but also support the role of fatness. This would seem to put physical activity in an important role. However, it should be emphasized that fitness is only partially determined by physical activity. Fitness also has an important genetic component. Further research is needed to evaluate developmental and other aspects of these interrelationships.
—Stephen R. Daniels, MD, PhD page 383 (Allen) page 388 (Rizzo)
Do we need chest radiographs in infants with uncomplicated bronchiolitis? The question of whether we need routine chest radiographs in infants with uncomplicated bronchiolitis is addressed in an article by Schuh et al from The Hospital for Sick Children, Toronto. They performed a prospective cohort study of more than 200 infants in the pediatric emergency department. The results showed that infants with typical bronchiolitis do not need imaging; invariably, it just confirms the diagnosis. In fact, the use of routine chest radiographs appeared to increase the chances of prescribing antibiotics in patients who were otherwise uncomplicated. The risk of air space disease such as pneumonia was particularly low in infants with mild to moderate respiratory distress and oxygen saturations in room air above 92%. These results will help guide the use of radiographic studies in clinical care.
—Robert W. Wilmott, MD page 429
2A
April 2007
The Journal of Pediatrics