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Translating best evidence into best care
This Month in
THE JOURNAL OF
PEDIATRICS January 2009 • Volume 154 • Number 1 Copyright © 2009 by Mosby, Inc.
THE EDITORS’ PERSPECTIVES Translating best evidence into best care
Fat, muscle, bone, and television
Evidence-based medicine (EBM) involves asking a clinical question, identifying evidence to help answer the question, appraising the evidence, and then applying it to the care of patients. For a number of years, The Journal has been publishing structured abstracts with expert commentaries in the section entitled, “Current Best Evidence: Clinical Research Abstracts for Pediatricians.” We recognize that applying evidence to the care of patients can be challenging, and busy clinicians continue to look for concise summaries of evidence. By renaming this section of The Journal as “Current Best Evidence: Translating Best Evidence into Best Care,” we reaffirm our commitment to bringing concise summaries of the best evidence to our readers to help you provide the highest quality care to the patients you serve.
It seems that abnormalities in nearly every body system and function have been linked to obesity. Although many of these are likely to be significant, other observations have been difficult to reproduce or associated with many confounding variables. This has been the case for bone mineral density in obese children. Earlier studies have been complicated by differences in activity, pubertal status, body composition, and methodologic concerns. In the current issue of The Journal, Wosje et al report a study of this association, which appears to address the weaknesses in previous work. A group of over 200 pre-pubertal children were followed serially with measurements of body composition, activity, bone area and mass, and TV viewing. The study design allowed for much better dissection of the contributions of individual variables to bone accrual. The report is complex, with a number of intriguing conclusions. It appears clear that higher fat mass at age 3.5 years is associated with reductions in both bone area and bone mass at 7 years. Even though a higher amount of TV viewing is also negatively associated with bone accrual, this effect appears to be independent of activity. In other words, there appears to be a negative effect of the “inactivity” associated with watching television that is independent of simply cutting into time available for “activity.” This report provides more ammunition to advocate for obesity prevention and reducing TV exposure. Beyond this, however, it provides a wealth of data upon which additional studies may be based.
—John G. Frohna, MD, MPH —William F. Balistreri, MD page 149
Maternal eating, infant feeding, and growth Clinicians generally focus on weight gain of infants to assess the infants feeding and nutritional status. In this issue of The Journal, Micali et al prospectively evaluated maternal/infant feeding behaviors for a population of women and then focused on women with eating disorders and other psychiatric disorders. They found that women with eating disorders—anorexia nervosa and bulimia—were more likely to breastfeed their infants, but were also more likely to have difficulties feeding those infants than healthy women. The report makes the point that abnormal maternal eating behavior is a red flag for feeding difficulties for the infant.
—Thomas R. Welch, MD page 79
—Alan H. Jobe, MD, PhD page 55
The Journal of Pediatrics (ISSN 0022-3476) is published monthly by Elsevier Inc., 360 Park Avenue South, New York, NY 10010. Business and Editorial Offices: 1600 John F. Kennedy Blvd., Suite 1800, Philadelphia, PA 19103-2899. Accounting and Circulation Offices: 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Periodicals postage paid at New York, NY, and additional mailing offices. POSTMASTER: Send address changes to The Journal of Pediatrics, Elsevier Periodicals Customer Service, 11830 Westline Industrial Drive, St. Louis, MO 63146.
The Journal of Pediatrics
January 2009
A1
THE JOURNAL OF
PEDIATRICS January 2009 • Volume 154 • Number 1 Copyright © 2009 by Mosby, Inc.
THE EDITORS’ PERSPECTIVES Translating best evidence into best care
Fat, muscle, bone, and television
Evidence-based medicine (EBM) involves asking a clinical question, identifying evidence to help answer the question, appraising the evidence, and then applying it to the care of patients. For a number of years, The Journal has been publishing structured abstracts with expert commentaries in the section entitled, “Current Best Evidence: Clinical Research Abstracts for Pediatricians.” We recognize that applying evidence to the care of patients can be challenging, and busy clinicians continue to look for concise summaries of evidence. By renaming this section of The Journal as “Current Best Evidence: Translating Best Evidence into Best Care,” we reaffirm our commitment to bringing concise summaries of the best evidence to our readers to help you provide the highest quality care to the patients you serve.
It seems that abnormalities in nearly every body system and function have been linked to obesity. Although many of these are likely to be significant, other observations have been difficult to reproduce or associated with many confounding variables. This has been the case for bone mineral density in obese children. Earlier studies have been complicated by differences in activity, pubertal status, body composition, and methodologic concerns. In the current issue of The Journal, Wosje et al report a study of this association, which appears to address the weaknesses in previous work. A group of over 200 pre-pubertal children were followed serially with measurements of body composition, activity, bone area and mass, and TV viewing. The study design allowed for much better dissection of the contributions of individual variables to bone accrual. The report is complex, with a number of intriguing conclusions. It appears clear that higher fat mass at age 3.5 years is associated with reductions in both bone area and bone mass at 7 years. Even though a higher amount of TV viewing is also negatively associated with bone accrual, this effect appears to be independent of activity. In other words, there appears to be a negative effect of the “inactivity” associated with watching television that is independent of simply cutting into time available for “activity.” This report provides more ammunition to advocate for obesity prevention and reducing TV exposure. Beyond this, however, it provides a wealth of data upon which additional studies may be based.
—John G. Frohna, MD, MPH —William F. Balistreri, MD page 149
Maternal eating, infant feeding, and growth Clinicians generally focus on weight gain of infants to assess the infants feeding and nutritional status. In this issue of The Journal, Micali et al prospectively evaluated maternal/infant feeding behaviors for a population of women and then focused on women with eating disorders and other psychiatric disorders. They found that women with eating disorders—anorexia nervosa and bulimia—were more likely to breastfeed their infants, but were also more likely to have difficulties feeding those infants than healthy women. The report makes the point that abnormal maternal eating behavior is a red flag for feeding difficulties for the infant.
—Thomas R. Welch, MD page 79
—Alan H. Jobe, MD, PhD page 55
The Journal of Pediatrics (ISSN 0022-3476) is published monthly by Elsevier Inc., 360 Park Avenue South, New York, NY 10010. Business and Editorial Offices: 1600 John F. Kennedy Blvd., Suite 1800, Philadelphia, PA 19103-2899. Accounting and Circulation Offices: 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Periodicals postage paid at New York, NY, and additional mailing offices. POSTMASTER: Send address changes to The Journal of Pediatrics, Elsevier Periodicals Customer Service, 11830 Westline Industrial Drive, St. Louis, MO 63146.
The Journal of Pediatrics
January 2009
A1