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In This Issue of JAMA Pediatrics
May 2015


JAMA Pediatr. 2015;169(5):415. doi:10.1001/jamapediatrics.2015.0648


School meals provide up to half of daily energy intake for students and present opportunities to improve the consumption of healthy food. This school-based randomized clinical trial conducted by Cohen and colleagues evaluates the short-term and long-term effects of chef-enhanced meals and extended exposure to choice architecture on healthier school food selection and consumption. While both interventions provided benefits, improving food quality and palatability was a more effective long-term method to increase consumption of healthier school foods. The editorial by Patel and Volpp uses insights from behavioral economics to examine the implications of these findings for school policies.


Severe obesity is increasingly common in the adolescent population but, as of yet, very little information exists regarding cardiovascular disease risks in this group. As part of the Teen Longitudinal Assessment of Bariatric Surgery Study, Michalsky and colleagues analyze data collected from a cohort of 242 severely obese adolescents within 30 days preceding a scheduled weight-loss surgery at 5 adolescent centers in the United States. Most participants demonstrated evidence of insulin resistance and inflammation, while approximately half met criteria for dyslipidemia and elevated blood pressure. The clinical assessment and medical care of severely obese adolescents should focus on the identification of these risks and control or prevention of progression of them in this vulnerable population.

While hypotonic intravenous fluids are the current standard of care, there is increasing recognition that many hospitalized children secrete increased antidiuretic hormone and use of such fluids can result in iatrogenic hyponatremia. In this double-blind randomized clinical trial, Friedman and colleagues randomize children admitted to a general pediatric unit who required intravenous fluids for 48 hours or longer to receive isotonic or hypotonic intravenous fluid at maintenance rates. The trial found that isotonic maintenance fluid administration is safe in general pediatric patients and may result in fewer cases of hyponatremia.

Continuing Medical Education and Journal Club

For youths between the ages of 10 and 24 years, suicide was the third leading cause of death in 2010 behind only unintentional injuries and homicide. Fontanella and colleagues examine rural and urban differences in youth suicide mortality in the United States over time and stratified by sex. Across the study from 1996 to 2010, suicide rates for youths in rural areas of the United States were approximately double those in urban areas for both males and females. Rivara’s editorial discusses the role that firearms play in adolescent suicide and the need for physicians to promote safe storage of guns.