Heidi Splete

"The benefits of sun protection clearly outweigh the risks," said Dr. Sheila Fallon Friedlander, but the debate continues over how to balance the benefits of outdoor activities for children with protection against skin cancer.

Some studies suggest outdoor activity is protective against melanoma, Dr. Friedlander said  She cited a case-control study of 583 cases of cutaneous malignant melanoma and 608 controls (Int. J. Epidemiol. 1999;28:418-27). Intermittent sun exposure, such as beach vacations during adolescence and the use of tanning beds and sunlamps, was associated with a significantly greater risk for melanoma, whereas chronic exposure, indicated by days of outdoor activity during adolescence and by outdoor jobs in adulthood, was associated with a significantly reduced risk for melanoma.

But sun protection and patient education does appear to play a role in reducing the number of nevi in children. Dr. Friedlander, clinical professor of pediatrics and medicine at the University of California, San Diego, cited another study in which 458 children in first to fourth grade in Canada were randomized to receive sunscreen and counseling about sun protection. Three years later, the sunscreen group had significantly fewer new nevi compared with the control group (JAMA 2000;283:2955-60).

What's a dermatologist to do? "Common sense prevails," Dr. Friedlander said. She advised dermatologists to counsel children and their parents to protect against sunburns by using sunscreens and sun-protective clothing. Also, "identify high-risk patients and follow them" so that any problems can be spotted early, she said.

But once parents and children are on board with sun protection, what should they use? The Environmental Working Group (EWG), a nonprofit organization that reviews and disseminates information about contaminants in consumer products and the environment, has come down in favor of physical sunscreens, based on a review of 400 studies and 2,000 sunscreens, Dr. Friedlander said.

Some parents and children prefer organic sunscreens, which contain oxybenzones, but the EWG rates these products as more dangerous than physical sunscreens. Some research suggests that oxybenzones can be absorbed into the skin in a way that the nano-particles of zinc oxide and titanium dioxide in physical sunscreens cannot, Dr. Friedlander said.

Be aware of what sunscreen characteristics raise concerns in your patients and their parents, Dr. Friedlander said. Share information with them, refer them to the EWG Web (www.ewg.org) and come up with a reasonable plan for sun protection.

Dr. Friedlander has served as a clinical investigator for Johnson & Johnson, which manufactures sunscreen products. SDEF and this news organization are owned by Elsevier.

"The benefits of sun protection clearly outweigh the risks," said Dr. Sheila Fallon Friedlander, but the debate continues over how to balance the benefits of outdoor activities for children with protection against skin cancer.

Some studies suggest outdoor activity is protective against melanoma, Dr. Friedlander said  She cited a case-control study of 583 cases of cutaneous malignant melanoma and 608 controls (Int. J. Epidemiol. 1999;28:418-27). Intermittent sun exposure, such as beach vacations during adolescence and the use of tanning beds and sunlamps, was associated with a significantly greater risk for melanoma, whereas chronic exposure, indicated by days of outdoor activity during adolescence and by outdoor jobs in adulthood, was associated with a significantly reduced risk for melanoma.

But sun protection and patient education does appear to play a role in reducing the number of nevi in children. Dr. Friedlander, clinical professor of pediatrics and medicine at the University of California, San Diego, cited another study in which 458 children in first to fourth grade in Canada were randomized to receive sunscreen and counseling about sun protection. Three years later, the sunscreen group had significantly fewer new nevi compared with the control group (JAMA 2000;283:2955-60).

What's a dermatologist to do? "Common sense prevails," Dr. Friedlander said. She advised dermatologists to counsel children and their parents to protect against sunburns by using sunscreens and sun-protective clothing. Also, "identify high-risk patients and follow them" so that any problems can be spotted early, she said.

But once parents and children are on board with sun protection, what should they use? The Environmental Working Group (EWG), a nonprofit organization that reviews and disseminates information about contaminants in consumer products and the environment, has come down in favor of physical sunscreens, based on a review of 400 studies and 2,000 sunscreens, Dr. Friedlander said.

Some parents and children prefer organic sunscreens, which contain oxybenzones, but the EWG rates these products as more dangerous than physical sunscreens. Some research suggests that oxybenzones can be absorbed into the skin in a way that the nano-particles of zinc oxide and titanium dioxide in physical sunscreens cannot, Dr. Friedlander said.

Be aware of what sunscreen characteristics raise concerns in your patients and their parents, Dr. Friedlander said. Share information with them, refer them to the EWG Web (www.ewg.org) and come up with a reasonable plan for sun protection.

Dr. Friedlander has served as a clinical investigator for Johnson & Johnson, which manufactures sunscreen products. SDEF and this news organization are owned by Elsevier.

"The benefits of sun protection clearly outweigh the risks," said Dr. Sheila Fallon Friedlander, but the debate continues over how to balance the benefits of outdoor activities for children with protection against skin cancer.

Some studies suggest outdoor activity is protective against melanoma, Dr. Friedlander said  She cited a case-control study of 583 cases of cutaneous malignant melanoma and 608 controls (Int. J. Epidemiol. 1999;28:418-27). Intermittent sun exposure, such as beach vacations during adolescence and the use of tanning beds and sunlamps, was associated with a significantly greater risk for melanoma, whereas chronic exposure, indicated by days of outdoor activity during adolescence and by outdoor jobs in adulthood, was associated with a significantly reduced risk for melanoma.

But sun protection and patient education does appear to play a role in reducing the number of nevi in children. Dr. Friedlander, clinical professor of pediatrics and medicine at the University of California, San Diego, cited another study in which 458 children in first to fourth grade in Canada were randomized to receive sunscreen and counseling about sun protection. Three years later, the sunscreen group had significantly fewer new nevi compared with the control group (JAMA 2000;283:2955-60).

What's a dermatologist to do? "Common sense prevails," Dr. Friedlander said. She advised dermatologists to counsel children and their parents to protect against sunburns by using sunscreens and sun-protective clothing. Also, "identify high-risk patients and follow them" so that any problems can be spotted early, she said.

But once parents and children are on board with sun protection, what should they use? The Environmental Working Group (EWG), a nonprofit organization that reviews and disseminates information about contaminants in consumer products and the environment, has come down in favor of physical sunscreens, based on a review of 400 studies and 2,000 sunscreens, Dr. Friedlander said.

Some parents and children prefer organic sunscreens, which contain oxybenzones, but the EWG rates these products as more dangerous than physical sunscreens. Some research suggests that oxybenzones can be absorbed into the skin in a way that the nano-particles of zinc oxide and titanium dioxide in physical sunscreens cannot, Dr. Friedlander said.

Be aware of what sunscreen characteristics raise concerns in your patients and their parents, Dr. Friedlander said. Share information with them, refer them to the EWG Web (www.ewg.org) and come up with a reasonable plan for sun protection.

Dr. Friedlander has served as a clinical investigator for Johnson & Johnson, which manufactures sunscreen products. SDEF and this news organization are owned by Elsevier.

Major Finding: Reducing salt by 3 g daily may reduce the annual new cases of coronary heart disease in the United States by 60,000 to 120,000, annual new cases of stroke by 32,000 to 60,000, and annual new cases of myocardial infarction by 54,000 to 99,000.

Data Source: The Coronary Heart Disease Policy Model.

Disclosures: The study was supported in part by a grant from the American Heart Association Western States Affiliate and an intramural pilot grant from the University of California, San Francisco Clinical and Translational Sciences Institute. Study investigators reported no financial disclosures. The editorialists report their financial disclosures at

A reduction in salt intake of 3 g per day could have an impact on cardiovascular disease and reduce all-cause mortality in the United States by an estimated 44,000 to 99,000 deaths each year, according to study findings.

“A reduction in dietary salt of 3 g per day would have approximately the same effect on rates of coronary heart disease (CHD) events as a 50% reduction in tobacco use, a 5% reduction in body mass index among obese adults, or the use of statins to treat persons at low or intermediate risk for CHD events,” the researchers wrote.

Dr. Kirsten Bibbins-Domingo of the University of California, San Francisco, and colleagues used a computer simulation model to predict the effects of a population-wide reduction of salt intake on cardiovascular events in the United States (NEJM 2010 Jan. 20 [Epub doi: 10.1056/NEJMoa0907355

Reducing daily dietary salt by 3 g would reduce the number of new cases of coronary heart disease per year by an estimated 60,000 to 120,000, according to the computer model. New cases of stroke would be reduced by 32,000 to 66,000, and new cases of myocardial infarction would be reduced by 54,000 to 99,000.

Cutting daily salt consumption would benefit adults of all ages, both genders, and all races, according to the model, but “the anticipated relative benefits among blacks would be greater than those among nonblacks across all age groups and both sexes,” the researchers noted.

The model predicted that, although all age groups would benefit, middle-aged and older populations would likely have larger relative reductions in CHD incidence and in rates of new and recurrent myocardial infarction and stroke.

In adults aged 35 to 64 years, the relative reduction in mortality would be approximately 7%–11% for blacks and 3%–6% for nonblacks.

In addition, a nationwide 3 g per day decrease in salt consumption would save approximately $10 billion to $24 billion in health care costs annually and add approximately 194,000 to 392,000 quality-adjusted life years.

The researchers acknowledged that the results were limited by the uncertainty of the data used in the model, but add that, despite those limitations, their findings build on those from previous studies.

“Our findings underscore the need for an urgent call to action that will make it possible to achieve these readily attainable cardiovascular benefits,” they said.

The results also showed positive, although less dramatic, improvements in all-cause mortality, CHD, stroke, and myocardial infarction with reductions of daily salt intake by either 1 g or 2 g.

“As salt intake is reduced, people appear to prefer food with less salt, a phenomenon that is probably related to the accommodation of taste receptors over the course of weeks to months,” the researchers noted.

The benefits seen in the study may be an underestimate, according to an accompanying editorial by Dr. Lawrence J. Appel and Cheryl A.M. Anderson, Ph.D., of Johns Hopkins University in Baltimore. The study did not factor in the impact of modest daily salt reduction on reducing blood pressure in children or mitigating age-related rise in blood pressure in adults, they wrote (NEJM 2010 Jan. 20 [Epub doi: 10.1056/NEJMe0910352

Major Finding: Reducing salt by 3 g daily may reduce the annual new cases of coronary heart disease in the United States by 60,000 to 120,000, annual new cases of stroke by 32,000 to 60,000, and annual new cases of myocardial infarction by 54,000 to 99,000.

Data Source: The Coronary Heart Disease Policy Model.

Disclosures: The study was supported in part by a grant from the American Heart Association Western States Affiliate and an intramural pilot grant from the University of California, San Francisco Clinical and Translational Sciences Institute. Study investigators reported no financial disclosures. The editorialists report their financial disclosures at

A reduction in salt intake of 3 g per day could have an impact on cardiovascular disease and reduce all-cause mortality in the United States by an estimated 44,000 to 99,000 deaths each year, according to study findings.

“A reduction in dietary salt of 3 g per day would have approximately the same effect on rates of coronary heart disease (CHD) events as a 50% reduction in tobacco use, a 5% reduction in body mass index among obese adults, or the use of statins to treat persons at low or intermediate risk for CHD events,” the researchers wrote.

Dr. Kirsten Bibbins-Domingo of the University of California, San Francisco, and colleagues used a computer simulation model to predict the effects of a population-wide reduction of salt intake on cardiovascular events in the United States (NEJM 2010 Jan. 20 [Epub doi: 10.1056/NEJMoa0907355

Reducing daily dietary salt by 3 g would reduce the number of new cases of coronary heart disease per year by an estimated 60,000 to 120,000, according to the computer model. New cases of stroke would be reduced by 32,000 to 66,000, and new cases of myocardial infarction would be reduced by 54,000 to 99,000.

Cutting daily salt consumption would benefit adults of all ages, both genders, and all races, according to the model, but “the anticipated relative benefits among blacks would be greater than those among nonblacks across all age groups and both sexes,” the researchers noted.

The model predicted that, although all age groups would benefit, middle-aged and older populations would likely have larger relative reductions in CHD incidence and in rates of new and recurrent myocardial infarction and stroke.

In adults aged 35 to 64 years, the relative reduction in mortality would be approximately 7%–11% for blacks and 3%–6% for nonblacks.

In addition, a nationwide 3 g per day decrease in salt consumption would save approximately $10 billion to $24 billion in health care costs annually and add approximately 194,000 to 392,000 quality-adjusted life years.

The researchers acknowledged that the results were limited by the uncertainty of the data used in the model, but add that, despite those limitations, their findings build on those from previous studies.

“Our findings underscore the need for an urgent call to action that will make it possible to achieve these readily attainable cardiovascular benefits,” they said.

The results also showed positive, although less dramatic, improvements in all-cause mortality, CHD, stroke, and myocardial infarction with reductions of daily salt intake by either 1 g or 2 g.

“As salt intake is reduced, people appear to prefer food with less salt, a phenomenon that is probably related to the accommodation of taste receptors over the course of weeks to months,” the researchers noted.

The benefits seen in the study may be an underestimate, according to an accompanying editorial by Dr. Lawrence J. Appel and Cheryl A.M. Anderson, Ph.D., of Johns Hopkins University in Baltimore. The study did not factor in the impact of modest daily salt reduction on reducing blood pressure in children or mitigating age-related rise in blood pressure in adults, they wrote (NEJM 2010 Jan. 20 [Epub doi: 10.1056/NEJMe0910352

Major Finding: Reducing salt by 3 g daily may reduce the annual new cases of coronary heart disease in the United States by 60,000 to 120,000, annual new cases of stroke by 32,000 to 60,000, and annual new cases of myocardial infarction by 54,000 to 99,000.

Data Source: The Coronary Heart Disease Policy Model.

Disclosures: The study was supported in part by a grant from the American Heart Association Western States Affiliate and an intramural pilot grant from the University of California, San Francisco Clinical and Translational Sciences Institute. Study investigators reported no financial disclosures. The editorialists report their financial disclosures at

A reduction in salt intake of 3 g per day could have an impact on cardiovascular disease and reduce all-cause mortality in the United States by an estimated 44,000 to 99,000 deaths each year, according to study findings.

“A reduction in dietary salt of 3 g per day would have approximately the same effect on rates of coronary heart disease (CHD) events as a 50% reduction in tobacco use, a 5% reduction in body mass index among obese adults, or the use of statins to treat persons at low or intermediate risk for CHD events,” the researchers wrote.

Dr. Kirsten Bibbins-Domingo of the University of California, San Francisco, and colleagues used a computer simulation model to predict the effects of a population-wide reduction of salt intake on cardiovascular events in the United States (NEJM 2010 Jan. 20 [Epub doi: 10.1056/NEJMoa0907355

Reducing daily dietary salt by 3 g would reduce the number of new cases of coronary heart disease per year by an estimated 60,000 to 120,000, according to the computer model. New cases of stroke would be reduced by 32,000 to 66,000, and new cases of myocardial infarction would be reduced by 54,000 to 99,000.

Cutting daily salt consumption would benefit adults of all ages, both genders, and all races, according to the model, but “the anticipated relative benefits among blacks would be greater than those among nonblacks across all age groups and both sexes,” the researchers noted.

The model predicted that, although all age groups would benefit, middle-aged and older populations would likely have larger relative reductions in CHD incidence and in rates of new and recurrent myocardial infarction and stroke.

In adults aged 35 to 64 years, the relative reduction in mortality would be approximately 7%–11% for blacks and 3%–6% for nonblacks.

In addition, a nationwide 3 g per day decrease in salt consumption would save approximately $10 billion to $24 billion in health care costs annually and add approximately 194,000 to 392,000 quality-adjusted life years.

The researchers acknowledged that the results were limited by the uncertainty of the data used in the model, but add that, despite those limitations, their findings build on those from previous studies.

“Our findings underscore the need for an urgent call to action that will make it possible to achieve these readily attainable cardiovascular benefits,” they said.

The results also showed positive, although less dramatic, improvements in all-cause mortality, CHD, stroke, and myocardial infarction with reductions of daily salt intake by either 1 g or 2 g.

“As salt intake is reduced, people appear to prefer food with less salt, a phenomenon that is probably related to the accommodation of taste receptors over the course of weeks to months,” the researchers noted.

The benefits seen in the study may be an underestimate, according to an accompanying editorial by Dr. Lawrence J. Appel and Cheryl A.M. Anderson, Ph.D., of Johns Hopkins University in Baltimore. The study did not factor in the impact of modest daily salt reduction on reducing blood pressure in children or mitigating age-related rise in blood pressure in adults, they wrote (NEJM 2010 Jan. 20 [Epub doi: 10.1056/NEJMe0910352

WASHINGTON — When assessing patients with refractory obesity, it's useful to consider separately each of the factors that influence obesity, Dr. Arya M. Sharma said at the annual meeting of the Obesity Society.

Lifestyle changes are important in maintaining long-term weight loss, whether the initial weight loss was achieved by diet, exercise, pharmacotherapy, surgery, or a combination of methods, noted Dr. Sharma, a professor of medicine and research chair for obesity research and management at the University of Alberta in Edmonton (Canada). As part of long-term obesity management, he said, it's important to address the “Four Ms”:

▸ Mental health. Disorders that may influence obesity treatment include mood, anxiety, sleep, addiction, psychotic, and cognitive disorders.

▸ Mechanical problems. Obese patients may face a variety of mechanical difficulties, including osteoarthritis, obstructive sleep apnea, urinary incontinence, and plantar fasciitis. Addressing such problems can help patients maintain an exercise regimen and sleep better.

▸ Medical disorders. Treatment of conditions such as hypertension or diabetes can affect how well patients follow an obesity treatment plan.

▸ Money issues. Obesity-related monetary issues include expenses for oversized clothes and furniture. A low income might limit access to healthy food, or financial stress might trigger overeating.

Disclosures: Dr. Sharma has received grants from and been an adviser or consultant to several companies.

WASHINGTON — When assessing patients with refractory obesity, it's useful to consider separately each of the factors that influence obesity, Dr. Arya M. Sharma said at the annual meeting of the Obesity Society.

Lifestyle changes are important in maintaining long-term weight loss, whether the initial weight loss was achieved by diet, exercise, pharmacotherapy, surgery, or a combination of methods, noted Dr. Sharma, a professor of medicine and research chair for obesity research and management at the University of Alberta in Edmonton (Canada). As part of long-term obesity management, he said, it's important to address the “Four Ms”:

▸ Mental health. Disorders that may influence obesity treatment include mood, anxiety, sleep, addiction, psychotic, and cognitive disorders.

▸ Mechanical problems. Obese patients may face a variety of mechanical difficulties, including osteoarthritis, obstructive sleep apnea, urinary incontinence, and plantar fasciitis. Addressing such problems can help patients maintain an exercise regimen and sleep better.

▸ Medical disorders. Treatment of conditions such as hypertension or diabetes can affect how well patients follow an obesity treatment plan.

▸ Money issues. Obesity-related monetary issues include expenses for oversized clothes and furniture. A low income might limit access to healthy food, or financial stress might trigger overeating.

Disclosures: Dr. Sharma has received grants from and been an adviser or consultant to several companies.

WASHINGTON — When assessing patients with refractory obesity, it's useful to consider separately each of the factors that influence obesity, Dr. Arya M. Sharma said at the annual meeting of the Obesity Society.

Lifestyle changes are important in maintaining long-term weight loss, whether the initial weight loss was achieved by diet, exercise, pharmacotherapy, surgery, or a combination of methods, noted Dr. Sharma, a professor of medicine and research chair for obesity research and management at the University of Alberta in Edmonton (Canada). As part of long-term obesity management, he said, it's important to address the “Four Ms”:

▸ Mental health. Disorders that may influence obesity treatment include mood, anxiety, sleep, addiction, psychotic, and cognitive disorders.

▸ Mechanical problems. Obese patients may face a variety of mechanical difficulties, including osteoarthritis, obstructive sleep apnea, urinary incontinence, and plantar fasciitis. Addressing such problems can help patients maintain an exercise regimen and sleep better.

▸ Medical disorders. Treatment of conditions such as hypertension or diabetes can affect how well patients follow an obesity treatment plan.

▸ Money issues. Obesity-related monetary issues include expenses for oversized clothes and furniture. A low income might limit access to healthy food, or financial stress might trigger overeating.

Disclosures: Dr. Sharma has received grants from and been an adviser or consultant to several companies.

WASHINGTON — Obese women are less likely to be screened for osteoporosis than are normal- or overweight women, according to findings from a study of more than 140,000 women included in an integrated health care plan database.

Previous studies have shown mixed results on the disparity in preventive health care for obese patients, compared with normal-weight patients, said Kristi Reynolds, Ph.D., of Kaiser Permanente in Pasadena, Calif., and her colleagues.

“It is largely unknown whether obesity is associated with the quality of care for osteoporosis,” the researchers said. Physicians may be less inclined to screen obese women for osteoporosis because body weight is associated with higher bone density, they noted.

Data from 146,975 health care provider visits between July 1, 2007, and June 30, 2008, were reviewed.

The average age of the women was 73 years; 35% were normal weight; 35% were overweight; and the rest were obese.

About 67% of the women had undergone bone mineral density testing within 4 years of the study, which was the criteria by which participants could be considered “screened.” Only 52% of women with a BMI of 40 kg/m

The findings were presented in a poster at the annual meeting of the Obesity Society.

Disclosures: The researchers reported having no financial conflicts of interest.

WASHINGTON — Obese women are less likely to be screened for osteoporosis than are normal- or overweight women, according to findings from a study of more than 140,000 women included in an integrated health care plan database.

Previous studies have shown mixed results on the disparity in preventive health care for obese patients, compared with normal-weight patients, said Kristi Reynolds, Ph.D., of Kaiser Permanente in Pasadena, Calif., and her colleagues.

“It is largely unknown whether obesity is associated with the quality of care for osteoporosis,” the researchers said. Physicians may be less inclined to screen obese women for osteoporosis because body weight is associated with higher bone density, they noted.

Data from 146,975 health care provider visits between July 1, 2007, and June 30, 2008, were reviewed.

The average age of the women was 73 years; 35% were normal weight; 35% were overweight; and the rest were obese.

About 67% of the women had undergone bone mineral density testing within 4 years of the study, which was the criteria by which participants could be considered “screened.” Only 52% of women with a BMI of 40 kg/m

The findings were presented in a poster at the annual meeting of the Obesity Society.

Disclosures: The researchers reported having no financial conflicts of interest.

WASHINGTON — Obese women are less likely to be screened for osteoporosis than are normal- or overweight women, according to findings from a study of more than 140,000 women included in an integrated health care plan database.

Previous studies have shown mixed results on the disparity in preventive health care for obese patients, compared with normal-weight patients, said Kristi Reynolds, Ph.D., of Kaiser Permanente in Pasadena, Calif., and her colleagues.

“It is largely unknown whether obesity is associated with the quality of care for osteoporosis,” the researchers said. Physicians may be less inclined to screen obese women for osteoporosis because body weight is associated with higher bone density, they noted.

Data from 146,975 health care provider visits between July 1, 2007, and June 30, 2008, were reviewed.

The average age of the women was 73 years; 35% were normal weight; 35% were overweight; and the rest were obese.

About 67% of the women had undergone bone mineral density testing within 4 years of the study, which was the criteria by which participants could be considered “screened.” Only 52% of women with a BMI of 40 kg/m

The findings were presented in a poster at the annual meeting of the Obesity Society.

Disclosures: The researchers reported having no financial conflicts of interest.

WASHINGTON — Large breast size may not predict increased risk of type 2 diabetes, based on data from 92 overweight or obese premenopausal women.

Instead, “the previously documented association between breast size and type 2 diabetes risk may be explained by excess visceral adipose tissue and/or intermuscular adipose tissue,” Peter Janiszewski, a Ph.D. candidate at Queen's University in Kingston, Ont., said in a poster presented at the annual meeting of the Obesity Society.

The researchers reviewed full-body MRI data for overweight or obese women whose average age was 40 years. They were assessed for breast volume, visceral adipose tissue (VAT), abdominal and lower-body subcutaneous adipose tissue, and intermuscular adipose tissue (IMAT).

Breast volume was not significantly associated with any of the cardiometabolic risk factors assessed in the study. Instead, visceral adipose tissue was associated with high levels of glucose and insulin on a 2-hour oral glucose tolerance test, Mr. Janiszewski said.

After controlling for age, body mass index, and waist circumference, breast volume was significantly associated with greater amounts of visceral adipose tissue and intermuscular adipose tissue. Overall, women with the greatest breast volume had about 1.1 kg more VAT and 1.3 kg more IMAT, compared with women with the smallest breasts. But abdominal and lower-body subcutaneous adipose tissue mass was not significantly different between women with the largest and smaller breast volumes.

Disclosures: None.

WASHINGTON — Large breast size may not predict increased risk of type 2 diabetes, based on data from 92 overweight or obese premenopausal women.

Instead, “the previously documented association between breast size and type 2 diabetes risk may be explained by excess visceral adipose tissue and/or intermuscular adipose tissue,” Peter Janiszewski, a Ph.D. candidate at Queen's University in Kingston, Ont., said in a poster presented at the annual meeting of the Obesity Society.

The researchers reviewed full-body MRI data for overweight or obese women whose average age was 40 years. They were assessed for breast volume, visceral adipose tissue (VAT), abdominal and lower-body subcutaneous adipose tissue, and intermuscular adipose tissue (IMAT).

Breast volume was not significantly associated with any of the cardiometabolic risk factors assessed in the study. Instead, visceral adipose tissue was associated with high levels of glucose and insulin on a 2-hour oral glucose tolerance test, Mr. Janiszewski said.

After controlling for age, body mass index, and waist circumference, breast volume was significantly associated with greater amounts of visceral adipose tissue and intermuscular adipose tissue. Overall, women with the greatest breast volume had about 1.1 kg more VAT and 1.3 kg more IMAT, compared with women with the smallest breasts. But abdominal and lower-body subcutaneous adipose tissue mass was not significantly different between women with the largest and smaller breast volumes.

Disclosures: None.

WASHINGTON — Large breast size may not predict increased risk of type 2 diabetes, based on data from 92 overweight or obese premenopausal women.

Instead, “the previously documented association between breast size and type 2 diabetes risk may be explained by excess visceral adipose tissue and/or intermuscular adipose tissue,” Peter Janiszewski, a Ph.D. candidate at Queen's University in Kingston, Ont., said in a poster presented at the annual meeting of the Obesity Society.

The researchers reviewed full-body MRI data for overweight or obese women whose average age was 40 years. They were assessed for breast volume, visceral adipose tissue (VAT), abdominal and lower-body subcutaneous adipose tissue, and intermuscular adipose tissue (IMAT).

Breast volume was not significantly associated with any of the cardiometabolic risk factors assessed in the study. Instead, visceral adipose tissue was associated with high levels of glucose and insulin on a 2-hour oral glucose tolerance test, Mr. Janiszewski said.

After controlling for age, body mass index, and waist circumference, breast volume was significantly associated with greater amounts of visceral adipose tissue and intermuscular adipose tissue. Overall, women with the greatest breast volume had about 1.1 kg more VAT and 1.3 kg more IMAT, compared with women with the smallest breasts. But abdominal and lower-body subcutaneous adipose tissue mass was not significantly different between women with the largest and smaller breast volumes.

Disclosures: None.

WASHINGTON — Almost one-third of adolescents approved for bariatric surgery reported using psychotropic medications, but the use of substances was lower than expected, according to data from 82 subjects collected as part of a larger longitudinal study.

“Some of the worst consequences of extreme obesity are psychosocial,” Meg H. Zeller, Ph.D., a psychologist at Cincinnati Children's Hospital Medical Center, said at the annual scientific meeting of the Obesity Society.

Longitudinal psychosocial assessment helps document changes associated with bariatric surgery and identify factors that might predict optimal mental and physical health in adolescents after surgery, she said.

To determine the baseline psychosocial characteristics of teens undergoing bariatric surgery, Dr. Zeller and her colleagues reviewed data from adolescents aged 19 years and younger within 30 days before surgery. The average age of the members in study group was 17 years, and the average body mass index was 56 kg/m

The researchers used several validated questionnaires, including the Beck Depression Inventory (BDI), the Impact of Weight on Quality of Life–Kids (IWQOL-Kids), and the Questionnaire on Eating and Weight Patterns–Revised (QEWP-R). The adolescents also responded to questions about substance use and use of mental health services within the previous 12 months.

Overall, 76% of the adolescents reported depressive symptoms based on the BDI. Based the QEWP-R, 11% met screening criteria for binge eating disorder and 6% reported alcohol use, Dr. Zeller said. But 31% reported use of a psychotropic medication, 28% were taking antidepressants, and 11% were taking mood stabilizers. In addition, data from IWQOL-Kids showed significant and global impairments in weight-related quality of life issues.

The low use of drugs and alcohol in the study population may reflect less exposure to peer contacts and peer pressure because of the patients' extreme weight, and it's not unusual for very obese adolescents to be home schooled, Dr. Zeller noted.

“What is critical and ongoing is our follow-up, 6, 12, and 24 months after surgery,” Dr. Zeller added.

The adolescents are part of the ongoing Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS). Teen-LABS includes five clinical centers collaborating to facilitate studies of bariatric surgery in adolescents, and to study the causes and effects of severe obesity in teens, according to the Web site, www.teen-LABS.org

Disclosures: The study was supported in part by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases.

WASHINGTON — Almost one-third of adolescents approved for bariatric surgery reported using psychotropic medications, but the use of substances was lower than expected, according to data from 82 subjects collected as part of a larger longitudinal study.

“Some of the worst consequences of extreme obesity are psychosocial,” Meg H. Zeller, Ph.D., a psychologist at Cincinnati Children's Hospital Medical Center, said at the annual scientific meeting of the Obesity Society.

Longitudinal psychosocial assessment helps document changes associated with bariatric surgery and identify factors that might predict optimal mental and physical health in adolescents after surgery, she said.

To determine the baseline psychosocial characteristics of teens undergoing bariatric surgery, Dr. Zeller and her colleagues reviewed data from adolescents aged 19 years and younger within 30 days before surgery. The average age of the members in study group was 17 years, and the average body mass index was 56 kg/m

The researchers used several validated questionnaires, including the Beck Depression Inventory (BDI), the Impact of Weight on Quality of Life–Kids (IWQOL-Kids), and the Questionnaire on Eating and Weight Patterns–Revised (QEWP-R). The adolescents also responded to questions about substance use and use of mental health services within the previous 12 months.

Overall, 76% of the adolescents reported depressive symptoms based on the BDI. Based the QEWP-R, 11% met screening criteria for binge eating disorder and 6% reported alcohol use, Dr. Zeller said. But 31% reported use of a psychotropic medication, 28% were taking antidepressants, and 11% were taking mood stabilizers. In addition, data from IWQOL-Kids showed significant and global impairments in weight-related quality of life issues.

The low use of drugs and alcohol in the study population may reflect less exposure to peer contacts and peer pressure because of the patients' extreme weight, and it's not unusual for very obese adolescents to be home schooled, Dr. Zeller noted.

“What is critical and ongoing is our follow-up, 6, 12, and 24 months after surgery,” Dr. Zeller added.

The adolescents are part of the ongoing Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS). Teen-LABS includes five clinical centers collaborating to facilitate studies of bariatric surgery in adolescents, and to study the causes and effects of severe obesity in teens, according to the Web site, www.teen-LABS.org

Disclosures: The study was supported in part by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases.

WASHINGTON — Almost one-third of adolescents approved for bariatric surgery reported using psychotropic medications, but the use of substances was lower than expected, according to data from 82 subjects collected as part of a larger longitudinal study.

“Some of the worst consequences of extreme obesity are psychosocial,” Meg H. Zeller, Ph.D., a psychologist at Cincinnati Children's Hospital Medical Center, said at the annual scientific meeting of the Obesity Society.

Longitudinal psychosocial assessment helps document changes associated with bariatric surgery and identify factors that might predict optimal mental and physical health in adolescents after surgery, she said.

To determine the baseline psychosocial characteristics of teens undergoing bariatric surgery, Dr. Zeller and her colleagues reviewed data from adolescents aged 19 years and younger within 30 days before surgery. The average age of the members in study group was 17 years, and the average body mass index was 56 kg/m

The researchers used several validated questionnaires, including the Beck Depression Inventory (BDI), the Impact of Weight on Quality of Life–Kids (IWQOL-Kids), and the Questionnaire on Eating and Weight Patterns–Revised (QEWP-R). The adolescents also responded to questions about substance use and use of mental health services within the previous 12 months.

Overall, 76% of the adolescents reported depressive symptoms based on the BDI. Based the QEWP-R, 11% met screening criteria for binge eating disorder and 6% reported alcohol use, Dr. Zeller said. But 31% reported use of a psychotropic medication, 28% were taking antidepressants, and 11% were taking mood stabilizers. In addition, data from IWQOL-Kids showed significant and global impairments in weight-related quality of life issues.

The low use of drugs and alcohol in the study population may reflect less exposure to peer contacts and peer pressure because of the patients' extreme weight, and it's not unusual for very obese adolescents to be home schooled, Dr. Zeller noted.

“What is critical and ongoing is our follow-up, 6, 12, and 24 months after surgery,” Dr. Zeller added.

The adolescents are part of the ongoing Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS). Teen-LABS includes five clinical centers collaborating to facilitate studies of bariatric surgery in adolescents, and to study the causes and effects of severe obesity in teens, according to the Web site, www.teen-LABS.org

Disclosures: The study was supported in part by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases.

Major Finding: Reducing salt by 3 g daily may reduce the annual new cases of coronary heart disease in the United States by 60,000 to 120,000, annual new cases of stroke by 32,000 to 60,000, and annual new cases of myocardial infarction by 54,000 to 99,000.

Data Source: The Coronary Heart Disease Policy Model.

Disclosures: The study was supported in part by a grant from the American Heart Association Western States Affiliate and an intramural pilot grant from the University of California, San Francisco Clinical and Translational Sciences Institute. Study investigators reported no financial disclosures. The editorialists report their financial disclosures at

A reduction in salt intake of 3 g per day could have an impact on cardiovascular disease and reduce all-cause mortality in the United States by an estimated 44,000 to 99,000 deaths each year, based on a recent study.

“A reduction in dietary salt of 3 g per day would have approximately the same effect on rates of coronary heart disease (CHD) events as a 50% reduction in tobacco use, a 5% reduction in body mass index among obese adults, or the use of statins to treat persons at low or intermediate risk for CHD events,” the researchers wrote.

Dr. Kirsten Bibbins-Domingo of the University of California, San Francisco, and her colleagues used a computer simulation model to predict the effects of a population-wide reduction of salt intake on cardiovascular events in the United States (N. Engl. J. Med. 2010 Jan. 20 [Epub doi: 10.1056/NEJMoa0907355

Reducing daily dietary salt by 3 g would reduce the number of new cases of CHD per year by an estimated 60,000-120,000, according to the computer model. New cases of stroke would be reduced by 32,000-66,000, and new cases of MI would be reduced by 54,000-99,000.

The model predicted that, although all age groups would benefit, middle-aged and older populations would likely have larger relative reductions in CHD incidence and in rates of new and recurrent MI and stroke.

In adults aged 35-64 years, the relative reduction in mortality would be approximately 7%-11% for blacks and 3%-6% for nonblacks.

In addition, a nationwide 3 g per day decrease in salt consumption would save approximately $10 billion to $24 billion in health care costs annually and add approximately 194,000-392,000 quality-adjusted life years.

The researchers acknowledged that the results were limited by the uncertainty of the data used in the model, but added that, despite those limitations, their findings build on those from previous studies.

“Our findings underscore the need for an urgent call to action that will make it possible to achieve these readily attainable cardiovascular benefits,” they said.

The results also showed positive, although less dramatic, improvements in all-cause mortality, CHD, stroke, and MI with reductions of daily salt intake by either 1 g or 2 g.

“As salt intake is reduced, people appear to prefer food with less salt, a phenomenon that is probably related to the accommodation of taste receptors over the course of weeks to months,” the researchers noted.

The benefits seen in the study may be an underestimate, according to an accompanying editorial by Dr. Lawrence J. Appel and Cheryl A.M. Anderson, Ph.D., of Johns Hopkins University in Baltimore. The study did not factor in the impact of modest daily salt reduction on reducing blood pressure in children or mitigating age-related rise in blood pressure in adults, they wrote (N. Engl. J. Med. 2010 Jan. 20 [Epub doi: 10.1056/NEJMe09103.52

Also, results from previous studies suggest that reduced salt intake may reduce the risk of other conditions not included in the computer model: gastric cancer, end-stage kidney disease, congestive heart failure, osteoporosis, and left ventricular hypertrophy, they noted.

Major Finding: Reducing salt by 3 g daily may reduce the annual new cases of coronary heart disease in the United States by 60,000 to 120,000, annual new cases of stroke by 32,000 to 60,000, and annual new cases of myocardial infarction by 54,000 to 99,000.

Data Source: The Coronary Heart Disease Policy Model.

Disclosures: The study was supported in part by a grant from the American Heart Association Western States Affiliate and an intramural pilot grant from the University of California, San Francisco Clinical and Translational Sciences Institute. Study investigators reported no financial disclosures. The editorialists report their financial disclosures at

A reduction in salt intake of 3 g per day could have an impact on cardiovascular disease and reduce all-cause mortality in the United States by an estimated 44,000 to 99,000 deaths each year, based on a recent study.

“A reduction in dietary salt of 3 g per day would have approximately the same effect on rates of coronary heart disease (CHD) events as a 50% reduction in tobacco use, a 5% reduction in body mass index among obese adults, or the use of statins to treat persons at low or intermediate risk for CHD events,” the researchers wrote.

Dr. Kirsten Bibbins-Domingo of the University of California, San Francisco, and her colleagues used a computer simulation model to predict the effects of a population-wide reduction of salt intake on cardiovascular events in the United States (N. Engl. J. Med. 2010 Jan. 20 [Epub doi: 10.1056/NEJMoa0907355

Reducing daily dietary salt by 3 g would reduce the number of new cases of CHD per year by an estimated 60,000-120,000, according to the computer model. New cases of stroke would be reduced by 32,000-66,000, and new cases of MI would be reduced by 54,000-99,000.

The model predicted that, although all age groups would benefit, middle-aged and older populations would likely have larger relative reductions in CHD incidence and in rates of new and recurrent MI and stroke.

In adults aged 35-64 years, the relative reduction in mortality would be approximately 7%-11% for blacks and 3%-6% for nonblacks.

In addition, a nationwide 3 g per day decrease in salt consumption would save approximately $10 billion to $24 billion in health care costs annually and add approximately 194,000-392,000 quality-adjusted life years.

The researchers acknowledged that the results were limited by the uncertainty of the data used in the model, but added that, despite those limitations, their findings build on those from previous studies.

“Our findings underscore the need for an urgent call to action that will make it possible to achieve these readily attainable cardiovascular benefits,” they said.

The results also showed positive, although less dramatic, improvements in all-cause mortality, CHD, stroke, and MI with reductions of daily salt intake by either 1 g or 2 g.

“As salt intake is reduced, people appear to prefer food with less salt, a phenomenon that is probably related to the accommodation of taste receptors over the course of weeks to months,” the researchers noted.

The benefits seen in the study may be an underestimate, according to an accompanying editorial by Dr. Lawrence J. Appel and Cheryl A.M. Anderson, Ph.D., of Johns Hopkins University in Baltimore. The study did not factor in the impact of modest daily salt reduction on reducing blood pressure in children or mitigating age-related rise in blood pressure in adults, they wrote (N. Engl. J. Med. 2010 Jan. 20 [Epub doi: 10.1056/NEJMe09103.52

Also, results from previous studies suggest that reduced salt intake may reduce the risk of other conditions not included in the computer model: gastric cancer, end-stage kidney disease, congestive heart failure, osteoporosis, and left ventricular hypertrophy, they noted.

Major Finding: Reducing salt by 3 g daily may reduce the annual new cases of coronary heart disease in the United States by 60,000 to 120,000, annual new cases of stroke by 32,000 to 60,000, and annual new cases of myocardial infarction by 54,000 to 99,000.

Data Source: The Coronary Heart Disease Policy Model.

Disclosures: The study was supported in part by a grant from the American Heart Association Western States Affiliate and an intramural pilot grant from the University of California, San Francisco Clinical and Translational Sciences Institute. Study investigators reported no financial disclosures. The editorialists report their financial disclosures at

A reduction in salt intake of 3 g per day could have an impact on cardiovascular disease and reduce all-cause mortality in the United States by an estimated 44,000 to 99,000 deaths each year, based on a recent study.

“A reduction in dietary salt of 3 g per day would have approximately the same effect on rates of coronary heart disease (CHD) events as a 50% reduction in tobacco use, a 5% reduction in body mass index among obese adults, or the use of statins to treat persons at low or intermediate risk for CHD events,” the researchers wrote.

Dr. Kirsten Bibbins-Domingo of the University of California, San Francisco, and her colleagues used a computer simulation model to predict the effects of a population-wide reduction of salt intake on cardiovascular events in the United States (N. Engl. J. Med. 2010 Jan. 20 [Epub doi: 10.1056/NEJMoa0907355

Reducing daily dietary salt by 3 g would reduce the number of new cases of CHD per year by an estimated 60,000-120,000, according to the computer model. New cases of stroke would be reduced by 32,000-66,000, and new cases of MI would be reduced by 54,000-99,000.

The model predicted that, although all age groups would benefit, middle-aged and older populations would likely have larger relative reductions in CHD incidence and in rates of new and recurrent MI and stroke.

In adults aged 35-64 years, the relative reduction in mortality would be approximately 7%-11% for blacks and 3%-6% for nonblacks.

In addition, a nationwide 3 g per day decrease in salt consumption would save approximately $10 billion to $24 billion in health care costs annually and add approximately 194,000-392,000 quality-adjusted life years.

The researchers acknowledged that the results were limited by the uncertainty of the data used in the model, but added that, despite those limitations, their findings build on those from previous studies.

“Our findings underscore the need for an urgent call to action that will make it possible to achieve these readily attainable cardiovascular benefits,” they said.

The results also showed positive, although less dramatic, improvements in all-cause mortality, CHD, stroke, and MI with reductions of daily salt intake by either 1 g or 2 g.

“As salt intake is reduced, people appear to prefer food with less salt, a phenomenon that is probably related to the accommodation of taste receptors over the course of weeks to months,” the researchers noted.

The benefits seen in the study may be an underestimate, according to an accompanying editorial by Dr. Lawrence J. Appel and Cheryl A.M. Anderson, Ph.D., of Johns Hopkins University in Baltimore. The study did not factor in the impact of modest daily salt reduction on reducing blood pressure in children or mitigating age-related rise in blood pressure in adults, they wrote (N. Engl. J. Med. 2010 Jan. 20 [Epub doi: 10.1056/NEJMe09103.52

Also, results from previous studies suggest that reduced salt intake may reduce the risk of other conditions not included in the computer model: gastric cancer, end-stage kidney disease, congestive heart failure, osteoporosis, and left ventricular hypertrophy, they noted.

ORLANDO, Fla. – Growing numbers of patients with deeper skin tones are seeking cosmetic procedures involving injectable fillers.

“Many women of color do not have fine lines and wrinkles; they have loss of volume of the skin with

descent of the malar fat pads, prominence of the nasolabial folds, and prominence of the tear troughs, so those are the very areas that are appropriate for injections in women with skin of color, and men as well,” said Dr. Susan Taylor at the Orlando Dermatology Aesthetic and Clinical Conference.

Dr. Taylor, who helped to establish the Skin of Color Center at St. Luke’s–Roosevelt Hospital Center (N.Y.), is now in private practice in Philadelphia. She reviewed the characteristics of aging in patients with skin of color and evidence for the safe use of fillers in these patients.

Patients with skin of color often appear about 10 years younger than white patients of the same age, Dr. Taylor noted. As patients with skin of color age, they tend to have fewer fine and deep rhytids than white patients. But patients with deeper skin tones in their 40s and 50s do experience gravity-dependent changes and volume loss, as well as skeletal changes and soft tissue changes. Thus, these transformations lend themselves to treatment with injectable fillers.

“The options for your skin of color patients are the same options that you have for Caucasian patients,” Dr. Taylor said.

But is it just as safe for persons of color as it is for patients with fair skin? “We know that keloidal scarring develops 3-18 times as often in African American patients as in Caucasian patients,” said Dr. Taylor.

Potential adverse events from soft tissue fillers in patients with Fitzpatrick skin types IV, V, and VI could include postinflammatory hyperpigmentation, postinflammatory hypopigmentation, keloidal scarring, and hypertrophic scarring.

The Food and Drug Administration has conducted postapproval safety studies in Fitzpatrick skin types IV (brown), V (dark brown), and VI (deepest brown to black) for nine dermal fillers, including Restylane, Perlane, and Sculptra, Dr. Taylor said.

Data from three postapproval studies of three fillers each showed that none of the patients with skin of color had hypersensitivity reactions or developed keloids after one or two injections of any of the fillers. Patients in the studies were followed for up to 6 months, approximately.

Overall, 20 (6%) of the 369 patients across the studies developed hyperpigmentation, and 1 developed hypopigmentation, Dr. Taylor said.

“The pigmentation changes were very subtle,” she said.

Changes in pigmentation after injecting fillers in skin or color patients may be due to injection techniques, the use of concomitant anesthesia, or the specific product, Dr. Taylor said.

She advised physicians to look carefully at a patient’s skin prior to injecting any filler to document any pigmentation that was already present to help determine sensitivity and guide their injections techniques accordingly.

There were limitations to the postapproval studies, including the lack of controls and relatively short-term follow-up, and the need for more data.

“But what we can say now is that it’s very important that you warn your patients about the possibility of postinflammatory hyperpigmentation in particular, although hypopigmentation can occur,” Dr. Taylor said. Inform patients that there is a theoretical risk of keloidal scarring, but there have been no reports of keloids in the literature, she added.

To reduce the risk of hyperpigmentation, try a linear threading technique or injecting a bit more deeply to reduce the risk of hyperpigmentation, and note any pigmentation changes over a long-term follow-up period, she said.

Dr. Taylor has served as an investigator, speaker, and/or advisory board member for Allergan, Bioform, Genzyme, Johnson & Johnson, Medicis, Mentor, and Merz.

_{Image above is of Dr. Susan Taylor/Photo Credit: Heidi Splete}

ORLANDO, Fla. – Growing numbers of patients with deeper skin tones are seeking cosmetic procedures involving injectable fillers.

“Many women of color do not have fine lines and wrinkles; they have loss of volume of the skin with

descent of the malar fat pads, prominence of the nasolabial folds, and prominence of the tear troughs, so those are the very areas that are appropriate for injections in women with skin of color, and men as well,” said Dr. Susan Taylor at the Orlando Dermatology Aesthetic and Clinical Conference.

Dr. Taylor, who helped to establish the Skin of Color Center at St. Luke’s–Roosevelt Hospital Center (N.Y.), is now in private practice in Philadelphia. She reviewed the characteristics of aging in patients with skin of color and evidence for the safe use of fillers in these patients.

Patients with skin of color often appear about 10 years younger than white patients of the same age, Dr. Taylor noted. As patients with skin of color age, they tend to have fewer fine and deep rhytids than white patients. But patients with deeper skin tones in their 40s and 50s do experience gravity-dependent changes and volume loss, as well as skeletal changes and soft tissue changes. Thus, these transformations lend themselves to treatment with injectable fillers.

“The options for your skin of color patients are the same options that you have for Caucasian patients,” Dr. Taylor said.

But is it just as safe for persons of color as it is for patients with fair skin? “We know that keloidal scarring develops 3-18 times as often in African American patients as in Caucasian patients,” said Dr. Taylor.

Potential adverse events from soft tissue fillers in patients with Fitzpatrick skin types IV, V, and VI could include postinflammatory hyperpigmentation, postinflammatory hypopigmentation, keloidal scarring, and hypertrophic scarring.

The Food and Drug Administration has conducted postapproval safety studies in Fitzpatrick skin types IV (brown), V (dark brown), and VI (deepest brown to black) for nine dermal fillers, including Restylane, Perlane, and Sculptra, Dr. Taylor said.

Data from three postapproval studies of three fillers each showed that none of the patients with skin of color had hypersensitivity reactions or developed keloids after one or two injections of any of the fillers. Patients in the studies were followed for up to 6 months, approximately.

Overall, 20 (6%) of the 369 patients across the studies developed hyperpigmentation, and 1 developed hypopigmentation, Dr. Taylor said.

“The pigmentation changes were very subtle,” she said.

Changes in pigmentation after injecting fillers in skin or color patients may be due to injection techniques, the use of concomitant anesthesia, or the specific product, Dr. Taylor said.

She advised physicians to look carefully at a patient’s skin prior to injecting any filler to document any pigmentation that was already present to help determine sensitivity and guide their injections techniques accordingly.

There were limitations to the postapproval studies, including the lack of controls and relatively short-term follow-up, and the need for more data.

“But what we can say now is that it’s very important that you warn your patients about the possibility of postinflammatory hyperpigmentation in particular, although hypopigmentation can occur,” Dr. Taylor said. Inform patients that there is a theoretical risk of keloidal scarring, but there have been no reports of keloids in the literature, she added.

To reduce the risk of hyperpigmentation, try a linear threading technique or injecting a bit more deeply to reduce the risk of hyperpigmentation, and note any pigmentation changes over a long-term follow-up period, she said.

Dr. Taylor has served as an investigator, speaker, and/or advisory board member for Allergan, Bioform, Genzyme, Johnson & Johnson, Medicis, Mentor, and Merz.

_{Image above is of Dr. Susan Taylor/Photo Credit: Heidi Splete}

ORLANDO, Fla. – Growing numbers of patients with deeper skin tones are seeking cosmetic procedures involving injectable fillers.

“Many women of color do not have fine lines and wrinkles; they have loss of volume of the skin with

descent of the malar fat pads, prominence of the nasolabial folds, and prominence of the tear troughs, so those are the very areas that are appropriate for injections in women with skin of color, and men as well,” said Dr. Susan Taylor at the Orlando Dermatology Aesthetic and Clinical Conference.

Dr. Taylor, who helped to establish the Skin of Color Center at St. Luke’s–Roosevelt Hospital Center (N.Y.), is now in private practice in Philadelphia. She reviewed the characteristics of aging in patients with skin of color and evidence for the safe use of fillers in these patients.

Patients with skin of color often appear about 10 years younger than white patients of the same age, Dr. Taylor noted. As patients with skin of color age, they tend to have fewer fine and deep rhytids than white patients. But patients with deeper skin tones in their 40s and 50s do experience gravity-dependent changes and volume loss, as well as skeletal changes and soft tissue changes. Thus, these transformations lend themselves to treatment with injectable fillers.

“The options for your skin of color patients are the same options that you have for Caucasian patients,” Dr. Taylor said.

But is it just as safe for persons of color as it is for patients with fair skin? “We know that keloidal scarring develops 3-18 times as often in African American patients as in Caucasian patients,” said Dr. Taylor.

Potential adverse events from soft tissue fillers in patients with Fitzpatrick skin types IV, V, and VI could include postinflammatory hyperpigmentation, postinflammatory hypopigmentation, keloidal scarring, and hypertrophic scarring.

The Food and Drug Administration has conducted postapproval safety studies in Fitzpatrick skin types IV (brown), V (dark brown), and VI (deepest brown to black) for nine dermal fillers, including Restylane, Perlane, and Sculptra, Dr. Taylor said.

Data from three postapproval studies of three fillers each showed that none of the patients with skin of color had hypersensitivity reactions or developed keloids after one or two injections of any of the fillers. Patients in the studies were followed for up to 6 months, approximately.

Overall, 20 (6%) of the 369 patients across the studies developed hyperpigmentation, and 1 developed hypopigmentation, Dr. Taylor said.

“The pigmentation changes were very subtle,” she said.

Changes in pigmentation after injecting fillers in skin or color patients may be due to injection techniques, the use of concomitant anesthesia, or the specific product, Dr. Taylor said.

She advised physicians to look carefully at a patient’s skin prior to injecting any filler to document any pigmentation that was already present to help determine sensitivity and guide their injections techniques accordingly.

There were limitations to the postapproval studies, including the lack of controls and relatively short-term follow-up, and the need for more data.

“But what we can say now is that it’s very important that you warn your patients about the possibility of postinflammatory hyperpigmentation in particular, although hypopigmentation can occur,” Dr. Taylor said. Inform patients that there is a theoretical risk of keloidal scarring, but there have been no reports of keloids in the literature, she added.

To reduce the risk of hyperpigmentation, try a linear threading technique or injecting a bit more deeply to reduce the risk of hyperpigmentation, and note any pigmentation changes over a long-term follow-up period, she said.

Dr. Taylor has served as an investigator, speaker, and/or advisory board member for Allergan, Bioform, Genzyme, Johnson & Johnson, Medicis, Mentor, and Merz.

_{Image above is of Dr. Susan Taylor/Photo Credit: Heidi Splete}

ORLANDO — "There is no perfect lip," according to Dr. Deborah Sarnoff. Instead, the perfect lip is a lip that is aesthetically pleasing to each patient.

She advised dermatologists to keep Leonardo da Vinci's classic proportions in mind when evaluating a patient for perioral rejuvenation. Leonardo's proportions translate approximately to dividing the face into thirds. Consider the area from the base of the nose to the tip of the chin as the lower third of the face, Dr. Sarnoff said at the Orlando Dermatology Aesthetic and Clinical Conference.

Although everyone is different, and cosmetic trends (including lip size) come and go, "we can agree that certain things are more aesthetic," said Dr. Sarnoff, a dermatologic surgeon in Greenvale, N.Y., and clinical professor of dermatology at New York University.

Many younger women are focused on fuller lips, while older women are usually more concerned about fine lines around the lips. Listen to what the patient wants, but "when you analyze someone, think beyond what they are asking for," Dr. Sarnoff said.

Be mindful of trends, and use Leonardo's classic proportions as a guide.

Theoretically, the ratio of the vertical height of the lower lip to the vertical height of the upper lip should be 1.4:1. "Analyze the person's face and see what they want to achieve, and give it the best aesthetic sense you can," she said.

To create the best lip for each patient, start by identifying the cause of the patient's concerns, Dr. Sarnoff said.

She described three factors to consider in perioral aging to help dermatologists and patients decide which treatment or combination of treatments will yield the most aesthetic result:

• Photodamage. If photodamage is the primary problem in the perioral area, consider using dermabrasion, a chemical peel, or a nonablative, erbium, or CO2 laser (standard and fractional).
• Muscle loss. If muscle is the problem, botulinum toxin remains the treatment of choice for dynamic rhytids, including "lipstick bleed lines" and lines that turn down at the corners of the mouth, she said.
• Fat loss. If volume loss due to loss of fat is the problem, choose fillers. Replacement fillers, including hyaluronic acid and collagen, can be injected in the perioral area to add volume to the face, or into the lips themselves.

"Think about what would be the ideal program to rejuvenate around the mouth," Dr. Sarnoff said. It may be that a combination strategy using fillers, laser treatment, and an injection of neurotoxin as a final step to prevent migration of the filler may be the blueprint for the perfect lip for some patients, rather than a single procedure.

During a live demonstration, Dr. Sarnoff shared some additional tips for injecting fillers in the perioral area. The filler should be injected as the needle is pulled out, she suggested, and the injected area should be molded. Physicians should not feel like they have to use the whole syringe in one area—consider adding a bit at the nasolabial fold.

When performing some perioral rejuvenation procedures, she prefers to stand behind the patient's head, instead of standing beside the patient.

Dr. Sarnoff has served as an investigator for Cynosure and DEKA/Eclipse Med. She also has served as a consultant to Allergan, Bioform Medical, Beiersdorf, Home Skinovations, and Abbe Laboratories.

Watch a video interview with Dr. Sarnoff discussing the three keys to lip rejuvenation.

ORLANDO — "There is no perfect lip," according to Dr. Deborah Sarnoff. Instead, the perfect lip is a lip that is aesthetically pleasing to each patient.

She advised dermatologists to keep Leonardo da Vinci's classic proportions in mind when evaluating a patient for perioral rejuvenation. Leonardo's proportions translate approximately to dividing the face into thirds. Consider the area from the base of the nose to the tip of the chin as the lower third of the face, Dr. Sarnoff said at the Orlando Dermatology Aesthetic and Clinical Conference.

Although everyone is different, and cosmetic trends (including lip size) come and go, "we can agree that certain things are more aesthetic," said Dr. Sarnoff, a dermatologic surgeon in Greenvale, N.Y., and clinical professor of dermatology at New York University.

Many younger women are focused on fuller lips, while older women are usually more concerned about fine lines around the lips. Listen to what the patient wants, but "when you analyze someone, think beyond what they are asking for," Dr. Sarnoff said.

Be mindful of trends, and use Leonardo's classic proportions as a guide.

Theoretically, the ratio of the vertical height of the lower lip to the vertical height of the upper lip should be 1.4:1. "Analyze the person's face and see what they want to achieve, and give it the best aesthetic sense you can," she said.

To create the best lip for each patient, start by identifying the cause of the patient's concerns, Dr. Sarnoff said.

She described three factors to consider in perioral aging to help dermatologists and patients decide which treatment or combination of treatments will yield the most aesthetic result:

• Photodamage. If photodamage is the primary problem in the perioral area, consider using dermabrasion, a chemical peel, or a nonablative, erbium, or CO2 laser (standard and fractional).
• Muscle loss. If muscle is the problem, botulinum toxin remains the treatment of choice for dynamic rhytids, including "lipstick bleed lines" and lines that turn down at the corners of the mouth, she said.
• Fat loss. If volume loss due to loss of fat is the problem, choose fillers. Replacement fillers, including hyaluronic acid and collagen, can be injected in the perioral area to add volume to the face, or into the lips themselves.

"Think about what would be the ideal program to rejuvenate around the mouth," Dr. Sarnoff said. It may be that a combination strategy using fillers, laser treatment, and an injection of neurotoxin as a final step to prevent migration of the filler may be the blueprint for the perfect lip for some patients, rather than a single procedure.

During a live demonstration, Dr. Sarnoff shared some additional tips for injecting fillers in the perioral area. The filler should be injected as the needle is pulled out, she suggested, and the injected area should be molded. Physicians should not feel like they have to use the whole syringe in one area—consider adding a bit at the nasolabial fold.

When performing some perioral rejuvenation procedures, she prefers to stand behind the patient's head, instead of standing beside the patient.

Dr. Sarnoff has served as an investigator for Cynosure and DEKA/Eclipse Med. She also has served as a consultant to Allergan, Bioform Medical, Beiersdorf, Home Skinovations, and Abbe Laboratories.

Watch a video interview with Dr. Sarnoff discussing the three keys to lip rejuvenation.

ORLANDO — "There is no perfect lip," according to Dr. Deborah Sarnoff. Instead, the perfect lip is a lip that is aesthetically pleasing to each patient.

She advised dermatologists to keep Leonardo da Vinci's classic proportions in mind when evaluating a patient for perioral rejuvenation. Leonardo's proportions translate approximately to dividing the face into thirds. Consider the area from the base of the nose to the tip of the chin as the lower third of the face, Dr. Sarnoff said at the Orlando Dermatology Aesthetic and Clinical Conference.

Although everyone is different, and cosmetic trends (including lip size) come and go, "we can agree that certain things are more aesthetic," said Dr. Sarnoff, a dermatologic surgeon in Greenvale, N.Y., and clinical professor of dermatology at New York University.

Many younger women are focused on fuller lips, while older women are usually more concerned about fine lines around the lips. Listen to what the patient wants, but "when you analyze someone, think beyond what they are asking for," Dr. Sarnoff said.

Be mindful of trends, and use Leonardo's classic proportions as a guide.

Theoretically, the ratio of the vertical height of the lower lip to the vertical height of the upper lip should be 1.4:1. "Analyze the person's face and see what they want to achieve, and give it the best aesthetic sense you can," she said.

To create the best lip for each patient, start by identifying the cause of the patient's concerns, Dr. Sarnoff said.

She described three factors to consider in perioral aging to help dermatologists and patients decide which treatment or combination of treatments will yield the most aesthetic result:

• Photodamage. If photodamage is the primary problem in the perioral area, consider using dermabrasion, a chemical peel, or a nonablative, erbium, or CO2 laser (standard and fractional).
• Muscle loss. If muscle is the problem, botulinum toxin remains the treatment of choice for dynamic rhytids, including "lipstick bleed lines" and lines that turn down at the corners of the mouth, she said.
• Fat loss. If volume loss due to loss of fat is the problem, choose fillers. Replacement fillers, including hyaluronic acid and collagen, can be injected in the perioral area to add volume to the face, or into the lips themselves.

"Think about what would be the ideal program to rejuvenate around the mouth," Dr. Sarnoff said. It may be that a combination strategy using fillers, laser treatment, and an injection of neurotoxin as a final step to prevent migration of the filler may be the blueprint for the perfect lip for some patients, rather than a single procedure.

During a live demonstration, Dr. Sarnoff shared some additional tips for injecting fillers in the perioral area. The filler should be injected as the needle is pulled out, she suggested, and the injected area should be molded. Physicians should not feel like they have to use the whole syringe in one area—consider adding a bit at the nasolabial fold.

When performing some perioral rejuvenation procedures, she prefers to stand behind the patient's head, instead of standing beside the patient.

Dr. Sarnoff has served as an investigator for Cynosure and DEKA/Eclipse Med. She also has served as a consultant to Allergan, Bioform Medical, Beiersdorf, Home Skinovations, and Abbe Laboratories.

Watch a video interview with Dr. Sarnoff discussing the three keys to lip rejuvenation.

More than half of the adults hospitalized in the early days of the influenza A(H1N1) pandemic in New York City were obese, and 92% of the obese patients had underlying medical conditions, according a review published in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

To quickly assess the severity of illness and identify those at greatest risk from the emerging virus, researchers at the New York City Department of Health and Mental Hygiene reviewed data from the first 99 patients with polymerase chain reaction–confirmed H1N1 influenza admitted to any hospital in the city during April 25–May 24, 2009.

The study population of 54 men and 45 women was disproportionately young, compared with the general population, the researchers indicated (MMWR 2010;58:1436-40).

A total of 95 patients had fevers when they were admitted to the hospital, and 89 complained of cough. In addition, 37 children and 36 adults had at least one underlying medical condition known to increase the risk of complications from flu, and 7 children and 10 adults had more than one such condition.

Asthma, the most common underlying medical condition, was noted in 29 children (50%) and 19 adults (46%). Chronic metabolic disorders, including diabetes, were reported in 11 patients (11%).

Body mass index data were available for 28 children and 20 adults. Five children and 12 adults were obese (BMI between 30 and 40 kg/m

Three of the four patients who died were obese, and their underlying medical conditions included asthma and Down syndrome, according to the investigators.

A total of 76 patients (77%) were treated with oseltamivir, and 36 (47%) of these were treated within 2 days of the onset of symptoms, but the median time to treatment from the onset of illness was 3 days. Hospital stays were significantly shorter for patients who started antiviral therapy within 2 days, the researchers noted.

The study was limited by several factors including the potential underreporting of cases and the difference in reporting protocol later in the pandemic, when data were collected from sentinel hospitals only.

But H1N1 data collection from sentinel hospitals is underway, with an emphasis on gathering height and weight information to better determine the impact of obesity on hospitalization.

Meanwhile, “public education campaigns should encourage patients at high risk of severe illness to be vaccinated,” the researchers said.

More than half of the adults hospitalized in the early days of the influenza A(H1N1) pandemic in New York City were obese, and 92% of the obese patients had underlying medical conditions, according a review published in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

To quickly assess the severity of illness and identify those at greatest risk from the emerging virus, researchers at the New York City Department of Health and Mental Hygiene reviewed data from the first 99 patients with polymerase chain reaction–confirmed H1N1 influenza admitted to any hospital in the city during April 25–May 24, 2009.

The study population of 54 men and 45 women was disproportionately young, compared with the general population, the researchers indicated (MMWR 2010;58:1436-40).

A total of 95 patients had fevers when they were admitted to the hospital, and 89 complained of cough. In addition, 37 children and 36 adults had at least one underlying medical condition known to increase the risk of complications from flu, and 7 children and 10 adults had more than one such condition.

Asthma, the most common underlying medical condition, was noted in 29 children (50%) and 19 adults (46%). Chronic metabolic disorders, including diabetes, were reported in 11 patients (11%).

Body mass index data were available for 28 children and 20 adults. Five children and 12 adults were obese (BMI between 30 and 40 kg/m

Three of the four patients who died were obese, and their underlying medical conditions included asthma and Down syndrome, according to the investigators.

A total of 76 patients (77%) were treated with oseltamivir, and 36 (47%) of these were treated within 2 days of the onset of symptoms, but the median time to treatment from the onset of illness was 3 days. Hospital stays were significantly shorter for patients who started antiviral therapy within 2 days, the researchers noted.

The study was limited by several factors including the potential underreporting of cases and the difference in reporting protocol later in the pandemic, when data were collected from sentinel hospitals only.

But H1N1 data collection from sentinel hospitals is underway, with an emphasis on gathering height and weight information to better determine the impact of obesity on hospitalization.

Meanwhile, “public education campaigns should encourage patients at high risk of severe illness to be vaccinated,” the researchers said.

More than half of the adults hospitalized in the early days of the influenza A(H1N1) pandemic in New York City were obese, and 92% of the obese patients had underlying medical conditions, according a review published in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

To quickly assess the severity of illness and identify those at greatest risk from the emerging virus, researchers at the New York City Department of Health and Mental Hygiene reviewed data from the first 99 patients with polymerase chain reaction–confirmed H1N1 influenza admitted to any hospital in the city during April 25–May 24, 2009.

The study population of 54 men and 45 women was disproportionately young, compared with the general population, the researchers indicated (MMWR 2010;58:1436-40).

A total of 95 patients had fevers when they were admitted to the hospital, and 89 complained of cough. In addition, 37 children and 36 adults had at least one underlying medical condition known to increase the risk of complications from flu, and 7 children and 10 adults had more than one such condition.

Asthma, the most common underlying medical condition, was noted in 29 children (50%) and 19 adults (46%). Chronic metabolic disorders, including diabetes, were reported in 11 patients (11%).

Body mass index data were available for 28 children and 20 adults. Five children and 12 adults were obese (BMI between 30 and 40 kg/m

Three of the four patients who died were obese, and their underlying medical conditions included asthma and Down syndrome, according to the investigators.

A total of 76 patients (77%) were treated with oseltamivir, and 36 (47%) of these were treated within 2 days of the onset of symptoms, but the median time to treatment from the onset of illness was 3 days. Hospital stays were significantly shorter for patients who started antiviral therapy within 2 days, the researchers noted.

The study was limited by several factors including the potential underreporting of cases and the difference in reporting protocol later in the pandemic, when data were collected from sentinel hospitals only.

But H1N1 data collection from sentinel hospitals is underway, with an emphasis on gathering height and weight information to better determine the impact of obesity on hospitalization.

Meanwhile, “public education campaigns should encourage patients at high risk of severe illness to be vaccinated,” the researchers said.