Kevin Foley

Vaginal delivery after laparoscopic myomectomy can be accomplished safely without uterine rupture by using management protocols that are similar to those used for vaginal birth after cesarean section, reported Jun Kumakiri, M.D., and his associates at Juntendo University, Tokyo.

In a study of 108 women who wanted to become pregnant after undergoing laparoscopic myomectomy (LM) and were followed for at least 6 months, 40 spontaneous pregnancies and 7 pregnancies by assisted-reproductive technology occurred in 40 women over a 4-year period.

Using Cox regression analysis, the investigators found that pregnancy after LM was positively associated with the diameter of the largest myoma (odds ratio [OR] 1.06) and negatively associated with the patient's age (OR 0.88) and with the number of enucleated myomas (OR 1.17).

A total of 32 deliveries occurred after LM. Of these, vaginal birth was attempted in 23, resulting in 19 (83%) successful vaginal births, with all but one occurring after 37 weeks' gestation. Attempted vaginal birth after LM was unsuccessful in four patients (J. Minim. Invasive Gynecol. 2005;12:241–6).

Vaginal birth after LM was performed according to recommendations from the American College of Obstetricians and Gynecologists on vaginal birth after cesarean section, Dr. Kumakiri said.

In the 19 pregnancies that resulted in vaginal deliveries after LM, the average diameter of the largest myoma at LM was 68.7 mm, the average number of enucleated myomas was 2.9, and the average number of hysterotomies was 2.5.

In the 68 patients who received LM but didn't get pregnant, the average diameter of the largest myoma was 62.3 mm and the average number of enucleated myomas was 3.7.

No patient suffered uterine rupture during or after delivery, the investigators said, perhaps because all enucleation wounds were sutured, as they would be with laparotomy.

Because some patients had infertility factors other than myoma before LM, the researchers said, “it is necessary to examine a larger population, not including such patients, to evaluate whether the implantation environment alone is responsible for the reduced fertility associated with uterine myomas.”

Vaginal delivery after laparoscopic myomectomy can be accomplished safely without uterine rupture by using management protocols that are similar to those used for vaginal birth after cesarean section, reported Jun Kumakiri, M.D., and his associates at Juntendo University, Tokyo.

In a study of 108 women who wanted to become pregnant after undergoing laparoscopic myomectomy (LM) and were followed for at least 6 months, 40 spontaneous pregnancies and 7 pregnancies by assisted-reproductive technology occurred in 40 women over a 4-year period.

Using Cox regression analysis, the investigators found that pregnancy after LM was positively associated with the diameter of the largest myoma (odds ratio [OR] 1.06) and negatively associated with the patient's age (OR 0.88) and with the number of enucleated myomas (OR 1.17).

A total of 32 deliveries occurred after LM. Of these, vaginal birth was attempted in 23, resulting in 19 (83%) successful vaginal births, with all but one occurring after 37 weeks' gestation. Attempted vaginal birth after LM was unsuccessful in four patients (J. Minim. Invasive Gynecol. 2005;12:241–6).

Vaginal birth after LM was performed according to recommendations from the American College of Obstetricians and Gynecologists on vaginal birth after cesarean section, Dr. Kumakiri said.

In the 19 pregnancies that resulted in vaginal deliveries after LM, the average diameter of the largest myoma at LM was 68.7 mm, the average number of enucleated myomas was 2.9, and the average number of hysterotomies was 2.5.

In the 68 patients who received LM but didn't get pregnant, the average diameter of the largest myoma was 62.3 mm and the average number of enucleated myomas was 3.7.

No patient suffered uterine rupture during or after delivery, the investigators said, perhaps because all enucleation wounds were sutured, as they would be with laparotomy.

Because some patients had infertility factors other than myoma before LM, the researchers said, “it is necessary to examine a larger population, not including such patients, to evaluate whether the implantation environment alone is responsible for the reduced fertility associated with uterine myomas.”

Vaginal delivery after laparoscopic myomectomy can be accomplished safely without uterine rupture by using management protocols that are similar to those used for vaginal birth after cesarean section, reported Jun Kumakiri, M.D., and his associates at Juntendo University, Tokyo.

In a study of 108 women who wanted to become pregnant after undergoing laparoscopic myomectomy (LM) and were followed for at least 6 months, 40 spontaneous pregnancies and 7 pregnancies by assisted-reproductive technology occurred in 40 women over a 4-year period.

Using Cox regression analysis, the investigators found that pregnancy after LM was positively associated with the diameter of the largest myoma (odds ratio [OR] 1.06) and negatively associated with the patient's age (OR 0.88) and with the number of enucleated myomas (OR 1.17).

A total of 32 deliveries occurred after LM. Of these, vaginal birth was attempted in 23, resulting in 19 (83%) successful vaginal births, with all but one occurring after 37 weeks' gestation. Attempted vaginal birth after LM was unsuccessful in four patients (J. Minim. Invasive Gynecol. 2005;12:241–6).

Vaginal birth after LM was performed according to recommendations from the American College of Obstetricians and Gynecologists on vaginal birth after cesarean section, Dr. Kumakiri said.

In the 19 pregnancies that resulted in vaginal deliveries after LM, the average diameter of the largest myoma at LM was 68.7 mm, the average number of enucleated myomas was 2.9, and the average number of hysterotomies was 2.5.

In the 68 patients who received LM but didn't get pregnant, the average diameter of the largest myoma was 62.3 mm and the average number of enucleated myomas was 3.7.

No patient suffered uterine rupture during or after delivery, the investigators said, perhaps because all enucleation wounds were sutured, as they would be with laparotomy.

Because some patients had infertility factors other than myoma before LM, the researchers said, “it is necessary to examine a larger population, not including such patients, to evaluate whether the implantation environment alone is responsible for the reduced fertility associated with uterine myomas.”

Varicella vaccination was found to be highly effective during an outbreak of varicella among elementary school children in Utah, reported Maryam B. Haddad of the Centers for Disease Control and Prevention, Atlanta, and associates.

The outbreak occurred from October 2002 until February 2003 in two schools, one with 597 students (school A) and another with 952 students (school B). Parents returned a questionnaire about their children's health. Those who reported varicella symptoms in their children were interviewed, their children's vaccination records verified, and they were asked to submit any existing lesions for polymerase chain reaction (PCR) testing.

Utah implemented a new varicella vaccination requirement for kindergarten children in 2002.

During the outbreak, 57 unvaccinated and 26 vaccinated children were reported to have varicella, with 17 more cases among household contacts, they said. PCR analysis found wild-type varicella in five unvaccinated and three vaccinated children (two other vaccinated children had specimens insufficient for testing). Nine unvaccinated children with varicella reported it as a second occurrence of the disease.

In school A, 27% of the 66 unvaccinated children acquired varicella, while only 4% of the 223 vaccinated children did. In school B, 41% of the 74 unvaccinated children reported varicella, while only 5% of the 348 vaccinated children did (Pediatrics 2005;115:1488–93).

The varicella vaccine overall was 87% effective. It was 90% effective against moderate or severe disease in school A and 99% effective in school B. Among the nine unvaccinated children with a history of varicella, the attack rate was 0.4% in school A and 1.4% in school B. Mild varicella was more common among vaccinated children (69%) than unvaccinated children (15%).

Risk factors for breakthrough varicella included a history of eczema (3.8 times greater risk), time since vaccination (relative risk 3.0 if vaccinated 5 or more years before the outbreak), and age at vaccination (relative risk 2.6 if vaccinated at age 18 months or less).

Among the 163 children vaccinated 5 or more years before the outbreak, children vaccinated at age 18 months or less were 9.3 times more likely than those vaccinated after age 18 months to develop breakthrough varicella.

Varicella vaccination was found to be highly effective during an outbreak of varicella among elementary school children in Utah, reported Maryam B. Haddad of the Centers for Disease Control and Prevention, Atlanta, and associates.

The outbreak occurred from October 2002 until February 2003 in two schools, one with 597 students (school A) and another with 952 students (school B). Parents returned a questionnaire about their children's health. Those who reported varicella symptoms in their children were interviewed, their children's vaccination records verified, and they were asked to submit any existing lesions for polymerase chain reaction (PCR) testing.

Utah implemented a new varicella vaccination requirement for kindergarten children in 2002.

During the outbreak, 57 unvaccinated and 26 vaccinated children were reported to have varicella, with 17 more cases among household contacts, they said. PCR analysis found wild-type varicella in five unvaccinated and three vaccinated children (two other vaccinated children had specimens insufficient for testing). Nine unvaccinated children with varicella reported it as a second occurrence of the disease.

In school A, 27% of the 66 unvaccinated children acquired varicella, while only 4% of the 223 vaccinated children did. In school B, 41% of the 74 unvaccinated children reported varicella, while only 5% of the 348 vaccinated children did (Pediatrics 2005;115:1488–93).

The varicella vaccine overall was 87% effective. It was 90% effective against moderate or severe disease in school A and 99% effective in school B. Among the nine unvaccinated children with a history of varicella, the attack rate was 0.4% in school A and 1.4% in school B. Mild varicella was more common among vaccinated children (69%) than unvaccinated children (15%).

Risk factors for breakthrough varicella included a history of eczema (3.8 times greater risk), time since vaccination (relative risk 3.0 if vaccinated 5 or more years before the outbreak), and age at vaccination (relative risk 2.6 if vaccinated at age 18 months or less).

Among the 163 children vaccinated 5 or more years before the outbreak, children vaccinated at age 18 months or less were 9.3 times more likely than those vaccinated after age 18 months to develop breakthrough varicella.

Varicella vaccination was found to be highly effective during an outbreak of varicella among elementary school children in Utah, reported Maryam B. Haddad of the Centers for Disease Control and Prevention, Atlanta, and associates.

The outbreak occurred from October 2002 until February 2003 in two schools, one with 597 students (school A) and another with 952 students (school B). Parents returned a questionnaire about their children's health. Those who reported varicella symptoms in their children were interviewed, their children's vaccination records verified, and they were asked to submit any existing lesions for polymerase chain reaction (PCR) testing.

Utah implemented a new varicella vaccination requirement for kindergarten children in 2002.

During the outbreak, 57 unvaccinated and 26 vaccinated children were reported to have varicella, with 17 more cases among household contacts, they said. PCR analysis found wild-type varicella in five unvaccinated and three vaccinated children (two other vaccinated children had specimens insufficient for testing). Nine unvaccinated children with varicella reported it as a second occurrence of the disease.

In school A, 27% of the 66 unvaccinated children acquired varicella, while only 4% of the 223 vaccinated children did. In school B, 41% of the 74 unvaccinated children reported varicella, while only 5% of the 348 vaccinated children did (Pediatrics 2005;115:1488–93).

The varicella vaccine overall was 87% effective. It was 90% effective against moderate or severe disease in school A and 99% effective in school B. Among the nine unvaccinated children with a history of varicella, the attack rate was 0.4% in school A and 1.4% in school B. Mild varicella was more common among vaccinated children (69%) than unvaccinated children (15%).

Risk factors for breakthrough varicella included a history of eczema (3.8 times greater risk), time since vaccination (relative risk 3.0 if vaccinated 5 or more years before the outbreak), and age at vaccination (relative risk 2.6 if vaccinated at age 18 months or less).

Among the 163 children vaccinated 5 or more years before the outbreak, children vaccinated at age 18 months or less were 9.3 times more likely than those vaccinated after age 18 months to develop breakthrough varicella.

Predicting Diet Adherence

Obese women who lost more weight in the first 2 weeks of a meal-replacement diet program were more likely to continue the program and maintain their weight loss, reported I. Packianathan of Addenbrooke's Hospital National Health Service Trust, Cambridge, England, and associates.

Phase 1 of the trial lasted 16 weeks and consisted of a 900-calorie/day diet, which included two meal replacements; 114 (76%) of the 150 women completed this phase. Weight loss during the first 2 weeks predicted adherence during phase 1 (P less than .001), and the mean weight loss of women who completed phase 1 was 8.9 kg. Only systolic blood pressure was associated with weight loss at week 16; higher blood pressure was linked to greater weight loss (Diabetes Obes. Metab. 2005;7:439–47).

Seventy participants achieved the target weight loss of at least 9% of initial weight, and 46 of them completed phase 2, which lasted 12 months. Maintaining weight loss by not gaining more than 3% of their weight at the start of phase 2 was predicted by cholesterol and triglyceride levels; higher cholesterol and lower triglycerides were linked to lower risk of regaining weight, the investigators said.

Abdominal Diameter Index

Abdominal diameter index may be the anthropometric measure of choice to gauge prevalent coronary heart disease risk in men, reported Donald A. Smith, M.D., of Mount Sinai School of Medicine, New York, and his associates.

Prevalent coronary heart disease (CHD) was found in 29 of 466 middle-aged men (mean age 45 years). The investigators assessed body mass index (BMI); waist, hip, and thigh circumferences; waist-hip ratio; waist-thigh ratio; sagittal abdominal diameter; and abdominal diameter index. They found that abdominal diameter index had the largest and most significant standardized odds ratio (1.80) for prevalent CHD, which was equivalent to 10-year Framingham CHD risk. The latter is the 10-year probability of developing CHD based on the Framingham algorithm (Diabetes Obes. Metab. 2005;7:370–80).

Subjects in the highest third for abdominal diameter index had a univariate odds ratio of 5.47 for CHD, compared with those in the lowest third of the index, which suggests that abdominal diameter index is the only anthropometric measure that adds information “beyond that provided by a 10-year Framingham risk score,” the authors said.

Obese Men Getting PSA Test

Overweight and obese men aged 50 years and older in the United States were significantly more likely to have had a prostate-specific antigen test than men of healthy weight, reported Kevin Fontaine, Ph.D., of Johns Hopkins University, Baltimore, and his associates.

In an observational study based on the self-reported 2001 Behavioral Risk Factor Surveillance Survey, the median age of the 30,871 subjects was 61 years; nearly 76% reported having had a screening PSA test within the past year (Public Health 2005;119:694–8).

Men who were overweight (BMI of 25–29 kg/m

Other factors associated with PSA testing were having health insurance (OR = 1.73), a high school education or more (OR = 1.35), and an income of at least $25,000 (OR = 1.25).

Parents of Sick Children

Parents of children who were recently diagnosed with cancer report significant psychological distress and weight gain, compared with parents of healthy children, reported A.W. Smith of the University of Pittsburgh Cancer Institute and associates.

In a longitudinal, case-control study, 49 parents of healthy children and 49 parents of cancer patients were evaluated for weight gain and psychological distress within 2 weeks of their child's diagnosis and again 3 months later (Int. J. Obes. Relat. Metab. Disord. 2005;29:244–50).

Among parents of cancer patients, 63% gained weight (mean change, 1.76 kg) over the 3-month study, compared with 31% of controls (mean change, 0.16 kg) who gained weight.

Weight change among parents of cancer patients was strongly associated with the impact of caregiving for a sick child and the severity of life events at baseline, the investigators said.

Parents of cancer patients reported far less physical activity than controls, at 400–500 kcal/wk vs. 1,400–1,500 kcal/wk, respectively, and reported consuming fewer calories than control parents; the latter finding was unexpected.

Predicting Diet Adherence

Obese women who lost more weight in the first 2 weeks of a meal-replacement diet program were more likely to continue the program and maintain their weight loss, reported I. Packianathan of Addenbrooke's Hospital National Health Service Trust, Cambridge, England, and associates.

Phase 1 of the trial lasted 16 weeks and consisted of a 900-calorie/day diet, which included two meal replacements; 114 (76%) of the 150 women completed this phase. Weight loss during the first 2 weeks predicted adherence during phase 1 (P less than .001), and the mean weight loss of women who completed phase 1 was 8.9 kg. Only systolic blood pressure was associated with weight loss at week 16; higher blood pressure was linked to greater weight loss (Diabetes Obes. Metab. 2005;7:439–47).

Seventy participants achieved the target weight loss of at least 9% of initial weight, and 46 of them completed phase 2, which lasted 12 months. Maintaining weight loss by not gaining more than 3% of their weight at the start of phase 2 was predicted by cholesterol and triglyceride levels; higher cholesterol and lower triglycerides were linked to lower risk of regaining weight, the investigators said.

Abdominal Diameter Index

Abdominal diameter index may be the anthropometric measure of choice to gauge prevalent coronary heart disease risk in men, reported Donald A. Smith, M.D., of Mount Sinai School of Medicine, New York, and his associates.

Prevalent coronary heart disease (CHD) was found in 29 of 466 middle-aged men (mean age 45 years). The investigators assessed body mass index (BMI); waist, hip, and thigh circumferences; waist-hip ratio; waist-thigh ratio; sagittal abdominal diameter; and abdominal diameter index. They found that abdominal diameter index had the largest and most significant standardized odds ratio (1.80) for prevalent CHD, which was equivalent to 10-year Framingham CHD risk. The latter is the 10-year probability of developing CHD based on the Framingham algorithm (Diabetes Obes. Metab. 2005;7:370–80).

Subjects in the highest third for abdominal diameter index had a univariate odds ratio of 5.47 for CHD, compared with those in the lowest third of the index, which suggests that abdominal diameter index is the only anthropometric measure that adds information “beyond that provided by a 10-year Framingham risk score,” the authors said.

Obese Men Getting PSA Test

Overweight and obese men aged 50 years and older in the United States were significantly more likely to have had a prostate-specific antigen test than men of healthy weight, reported Kevin Fontaine, Ph.D., of Johns Hopkins University, Baltimore, and his associates.

In an observational study based on the self-reported 2001 Behavioral Risk Factor Surveillance Survey, the median age of the 30,871 subjects was 61 years; nearly 76% reported having had a screening PSA test within the past year (Public Health 2005;119:694–8).

Men who were overweight (BMI of 25–29 kg/m

Other factors associated with PSA testing were having health insurance (OR = 1.73), a high school education or more (OR = 1.35), and an income of at least $25,000 (OR = 1.25).

Parents of Sick Children

Parents of children who were recently diagnosed with cancer report significant psychological distress and weight gain, compared with parents of healthy children, reported A.W. Smith of the University of Pittsburgh Cancer Institute and associates.

In a longitudinal, case-control study, 49 parents of healthy children and 49 parents of cancer patients were evaluated for weight gain and psychological distress within 2 weeks of their child's diagnosis and again 3 months later (Int. J. Obes. Relat. Metab. Disord. 2005;29:244–50).

Among parents of cancer patients, 63% gained weight (mean change, 1.76 kg) over the 3-month study, compared with 31% of controls (mean change, 0.16 kg) who gained weight.

Weight change among parents of cancer patients was strongly associated with the impact of caregiving for a sick child and the severity of life events at baseline, the investigators said.

Parents of cancer patients reported far less physical activity than controls, at 400–500 kcal/wk vs. 1,400–1,500 kcal/wk, respectively, and reported consuming fewer calories than control parents; the latter finding was unexpected.

Predicting Diet Adherence

Obese women who lost more weight in the first 2 weeks of a meal-replacement diet program were more likely to continue the program and maintain their weight loss, reported I. Packianathan of Addenbrooke's Hospital National Health Service Trust, Cambridge, England, and associates.

Phase 1 of the trial lasted 16 weeks and consisted of a 900-calorie/day diet, which included two meal replacements; 114 (76%) of the 150 women completed this phase. Weight loss during the first 2 weeks predicted adherence during phase 1 (P less than .001), and the mean weight loss of women who completed phase 1 was 8.9 kg. Only systolic blood pressure was associated with weight loss at week 16; higher blood pressure was linked to greater weight loss (Diabetes Obes. Metab. 2005;7:439–47).

Seventy participants achieved the target weight loss of at least 9% of initial weight, and 46 of them completed phase 2, which lasted 12 months. Maintaining weight loss by not gaining more than 3% of their weight at the start of phase 2 was predicted by cholesterol and triglyceride levels; higher cholesterol and lower triglycerides were linked to lower risk of regaining weight, the investigators said.

Abdominal Diameter Index

Abdominal diameter index may be the anthropometric measure of choice to gauge prevalent coronary heart disease risk in men, reported Donald A. Smith, M.D., of Mount Sinai School of Medicine, New York, and his associates.

Prevalent coronary heart disease (CHD) was found in 29 of 466 middle-aged men (mean age 45 years). The investigators assessed body mass index (BMI); waist, hip, and thigh circumferences; waist-hip ratio; waist-thigh ratio; sagittal abdominal diameter; and abdominal diameter index. They found that abdominal diameter index had the largest and most significant standardized odds ratio (1.80) for prevalent CHD, which was equivalent to 10-year Framingham CHD risk. The latter is the 10-year probability of developing CHD based on the Framingham algorithm (Diabetes Obes. Metab. 2005;7:370–80).

Subjects in the highest third for abdominal diameter index had a univariate odds ratio of 5.47 for CHD, compared with those in the lowest third of the index, which suggests that abdominal diameter index is the only anthropometric measure that adds information “beyond that provided by a 10-year Framingham risk score,” the authors said.

Obese Men Getting PSA Test

Overweight and obese men aged 50 years and older in the United States were significantly more likely to have had a prostate-specific antigen test than men of healthy weight, reported Kevin Fontaine, Ph.D., of Johns Hopkins University, Baltimore, and his associates.

In an observational study based on the self-reported 2001 Behavioral Risk Factor Surveillance Survey, the median age of the 30,871 subjects was 61 years; nearly 76% reported having had a screening PSA test within the past year (Public Health 2005;119:694–8).

Men who were overweight (BMI of 25–29 kg/m

Other factors associated with PSA testing were having health insurance (OR = 1.73), a high school education or more (OR = 1.35), and an income of at least $25,000 (OR = 1.25).

Parents of Sick Children

Parents of children who were recently diagnosed with cancer report significant psychological distress and weight gain, compared with parents of healthy children, reported A.W. Smith of the University of Pittsburgh Cancer Institute and associates.

In a longitudinal, case-control study, 49 parents of healthy children and 49 parents of cancer patients were evaluated for weight gain and psychological distress within 2 weeks of their child's diagnosis and again 3 months later (Int. J. Obes. Relat. Metab. Disord. 2005;29:244–50).

Among parents of cancer patients, 63% gained weight (mean change, 1.76 kg) over the 3-month study, compared with 31% of controls (mean change, 0.16 kg) who gained weight.

Weight change among parents of cancer patients was strongly associated with the impact of caregiving for a sick child and the severity of life events at baseline, the investigators said.

Parents of cancer patients reported far less physical activity than controls, at 400–500 kcal/wk vs. 1,400–1,500 kcal/wk, respectively, and reported consuming fewer calories than control parents; the latter finding was unexpected.

Predicting Metabolic Syndrome

The energy patients expend during physical activity helps predict progression to the metabolic syndrome independent of aerobic fitness, obesity, and other confounding factors, reported Ulf Ekelund, Ph.D., of the Elsie Widdowson Laboratory, Cambridge, England, and his associates.

In a study of 605 healthy middle-aged adults (41% of whom were men), nearly 11% had the metabolic syndrome at a median 5.6 years of follow-up.

After adjustment for age, sex, smoking, socioeconomic status, fasting insulin levels, aerobic fitness, and duration of follow-up, baseline physical activity energy expenditure was significantly associated with fasting insulin at follow-up (Diabetes Care 2005;28:1195–200).

Baseline energy expenditure predicted systolic blood pressure at follow-up independently of potential confounders and predicted progression to metabolic syndrome.

Aerobic fitness was not significantly associated with any characteristics of the metabolic syndrome.

The data suggested that “physical activity is an important etiological factor in the development of the metabolic syndrome,” they said.

Sibutramine Metaanalysis

Sibutramine use was significantly associated with weight loss and appears to improve glycemic control and lipid profile in type 2 diabetics, reported Roberto Vettor, M.D., of the University of Padova, Italy, and his colleagues.

In a metaanalysis of eight placebo-controlled, double-blind trials, 552 obese patients with type 2 diabetes were randomized to sibutramine treatment, and 541 were randomized to placebo. Body weight decreased by a mean of 5.5 kg in sibutramine users and by 0.9 kg in placebo users. Waist circumference decreased a mean of 5.3 cm in treated patients and by 1.1 cm with placebo (Diabetes Care 2005;28:942–9).

Mean changes in basal blood glucose were small, but the difference between the two groups was statistically significant, the investigators said.

BMI Tied to Meniscal Tears

Knee meniscal tears are associated with obesity and overweight status in older men and women, reported Gregory M. Ford of the University of Utah, Salt Lake City, and his associates.

In a retrospective, case-control study of two Utah hospitals, body mass index (BMI) data were obtained for 231 men and 260 women ages 50–79 years who had meniscal surgeries, and for 786 healthy men and 846 healthy women who served as controls.

Elevated age-adjusted odds ratios for knee meniscal surgery were statistically significant at a BMI of at least 27.5 kg/m

Because 57% of the U.S. adult population is overweight or obese, the observed relationship between BMI and meniscal surgery in older Americans has potentially large implications, as the average cost of meniscal surgery was $3,000 in the study, Mr. Ford and his associates said.

Predicting Stroke Mortality

Subscapular skinfold thickness, an indicator of trunk versus peripheral distribution of fat, helped predict long-term stroke mortality in middle-aged men free of heart disease at baseline 23 years earlier, reported David Tanne, M.D., of the Chaim Sheba Medical Center, Tel-Hashomer, Israel.

Dr. Tanne and his associates used stratified sampling to find 8,638 healthy male civil servants and municipal employees aged 40 years or older at baseline, who were participating in the Israeli Ischemic Heart Disease project. The men were evaluated in 1963, 1965, and 1968, and had no history of myocardial infarction or chest pain. The mean body mass index (BMI) was 25.6 kg/m

During the 23-year follow-up, 316 men died of stroke, and 865 died of coronary heart disease. As BMI rose, stroke mortality rates per 10,000 person-years of follow-up went from 15.7 at a BMI less than 23. 4 to 21.9 at a BMI greater than 27.7. Stroke mortality rates per 10,000 person- years of follow-up increased as SSF did, rising from 15.1 at an SSF of less than 13 mm to 20.6 at an SSF greater than 24 mm. Stroke mortality rates also increased with greater SFR, going from 13.4 at an SFR of less than 1.12 to 22.3 at an SFR greater than 1.95 (Stroke 2005;36:1012–5).

Predicting Metabolic Syndrome

The energy patients expend during physical activity helps predict progression to the metabolic syndrome independent of aerobic fitness, obesity, and other confounding factors, reported Ulf Ekelund, Ph.D., of the Elsie Widdowson Laboratory, Cambridge, England, and his associates.

In a study of 605 healthy middle-aged adults (41% of whom were men), nearly 11% had the metabolic syndrome at a median 5.6 years of follow-up.

After adjustment for age, sex, smoking, socioeconomic status, fasting insulin levels, aerobic fitness, and duration of follow-up, baseline physical activity energy expenditure was significantly associated with fasting insulin at follow-up (Diabetes Care 2005;28:1195–200).

Baseline energy expenditure predicted systolic blood pressure at follow-up independently of potential confounders and predicted progression to metabolic syndrome.

Aerobic fitness was not significantly associated with any characteristics of the metabolic syndrome.

The data suggested that “physical activity is an important etiological factor in the development of the metabolic syndrome,” they said.

Sibutramine Metaanalysis

Sibutramine use was significantly associated with weight loss and appears to improve glycemic control and lipid profile in type 2 diabetics, reported Roberto Vettor, M.D., of the University of Padova, Italy, and his colleagues.

In a metaanalysis of eight placebo-controlled, double-blind trials, 552 obese patients with type 2 diabetes were randomized to sibutramine treatment, and 541 were randomized to placebo. Body weight decreased by a mean of 5.5 kg in sibutramine users and by 0.9 kg in placebo users. Waist circumference decreased a mean of 5.3 cm in treated patients and by 1.1 cm with placebo (Diabetes Care 2005;28:942–9).

Mean changes in basal blood glucose were small, but the difference between the two groups was statistically significant, the investigators said.

BMI Tied to Meniscal Tears

Knee meniscal tears are associated with obesity and overweight status in older men and women, reported Gregory M. Ford of the University of Utah, Salt Lake City, and his associates.

In a retrospective, case-control study of two Utah hospitals, body mass index (BMI) data were obtained for 231 men and 260 women ages 50–79 years who had meniscal surgeries, and for 786 healthy men and 846 healthy women who served as controls.

Elevated age-adjusted odds ratios for knee meniscal surgery were statistically significant at a BMI of at least 27.5 kg/m

Because 57% of the U.S. adult population is overweight or obese, the observed relationship between BMI and meniscal surgery in older Americans has potentially large implications, as the average cost of meniscal surgery was $3,000 in the study, Mr. Ford and his associates said.

Predicting Stroke Mortality

Subscapular skinfold thickness, an indicator of trunk versus peripheral distribution of fat, helped predict long-term stroke mortality in middle-aged men free of heart disease at baseline 23 years earlier, reported David Tanne, M.D., of the Chaim Sheba Medical Center, Tel-Hashomer, Israel.

Dr. Tanne and his associates used stratified sampling to find 8,638 healthy male civil servants and municipal employees aged 40 years or older at baseline, who were participating in the Israeli Ischemic Heart Disease project. The men were evaluated in 1963, 1965, and 1968, and had no history of myocardial infarction or chest pain. The mean body mass index (BMI) was 25.6 kg/m

During the 23-year follow-up, 316 men died of stroke, and 865 died of coronary heart disease. As BMI rose, stroke mortality rates per 10,000 person-years of follow-up went from 15.7 at a BMI less than 23. 4 to 21.9 at a BMI greater than 27.7. Stroke mortality rates per 10,000 person- years of follow-up increased as SSF did, rising from 15.1 at an SSF of less than 13 mm to 20.6 at an SSF greater than 24 mm. Stroke mortality rates also increased with greater SFR, going from 13.4 at an SFR of less than 1.12 to 22.3 at an SFR greater than 1.95 (Stroke 2005;36:1012–5).

Predicting Metabolic Syndrome

The energy patients expend during physical activity helps predict progression to the metabolic syndrome independent of aerobic fitness, obesity, and other confounding factors, reported Ulf Ekelund, Ph.D., of the Elsie Widdowson Laboratory, Cambridge, England, and his associates.

In a study of 605 healthy middle-aged adults (41% of whom were men), nearly 11% had the metabolic syndrome at a median 5.6 years of follow-up.

After adjustment for age, sex, smoking, socioeconomic status, fasting insulin levels, aerobic fitness, and duration of follow-up, baseline physical activity energy expenditure was significantly associated with fasting insulin at follow-up (Diabetes Care 2005;28:1195–200).

Baseline energy expenditure predicted systolic blood pressure at follow-up independently of potential confounders and predicted progression to metabolic syndrome.

Aerobic fitness was not significantly associated with any characteristics of the metabolic syndrome.

The data suggested that “physical activity is an important etiological factor in the development of the metabolic syndrome,” they said.

Sibutramine Metaanalysis

Sibutramine use was significantly associated with weight loss and appears to improve glycemic control and lipid profile in type 2 diabetics, reported Roberto Vettor, M.D., of the University of Padova, Italy, and his colleagues.

In a metaanalysis of eight placebo-controlled, double-blind trials, 552 obese patients with type 2 diabetes were randomized to sibutramine treatment, and 541 were randomized to placebo. Body weight decreased by a mean of 5.5 kg in sibutramine users and by 0.9 kg in placebo users. Waist circumference decreased a mean of 5.3 cm in treated patients and by 1.1 cm with placebo (Diabetes Care 2005;28:942–9).

Mean changes in basal blood glucose were small, but the difference between the two groups was statistically significant, the investigators said.

BMI Tied to Meniscal Tears

Knee meniscal tears are associated with obesity and overweight status in older men and women, reported Gregory M. Ford of the University of Utah, Salt Lake City, and his associates.

In a retrospective, case-control study of two Utah hospitals, body mass index (BMI) data were obtained for 231 men and 260 women ages 50–79 years who had meniscal surgeries, and for 786 healthy men and 846 healthy women who served as controls.

Elevated age-adjusted odds ratios for knee meniscal surgery were statistically significant at a BMI of at least 27.5 kg/m

Because 57% of the U.S. adult population is overweight or obese, the observed relationship between BMI and meniscal surgery in older Americans has potentially large implications, as the average cost of meniscal surgery was $3,000 in the study, Mr. Ford and his associates said.

Predicting Stroke Mortality

Subscapular skinfold thickness, an indicator of trunk versus peripheral distribution of fat, helped predict long-term stroke mortality in middle-aged men free of heart disease at baseline 23 years earlier, reported David Tanne, M.D., of the Chaim Sheba Medical Center, Tel-Hashomer, Israel.

Dr. Tanne and his associates used stratified sampling to find 8,638 healthy male civil servants and municipal employees aged 40 years or older at baseline, who were participating in the Israeli Ischemic Heart Disease project. The men were evaluated in 1963, 1965, and 1968, and had no history of myocardial infarction or chest pain. The mean body mass index (BMI) was 25.6 kg/m

During the 23-year follow-up, 316 men died of stroke, and 865 died of coronary heart disease. As BMI rose, stroke mortality rates per 10,000 person-years of follow-up went from 15.7 at a BMI less than 23. 4 to 21.9 at a BMI greater than 27.7. Stroke mortality rates per 10,000 person- years of follow-up increased as SSF did, rising from 15.1 at an SSF of less than 13 mm to 20.6 at an SSF greater than 24 mm. Stroke mortality rates also increased with greater SFR, going from 13.4 at an SFR of less than 1.12 to 22.3 at an SFR greater than 1.95 (Stroke 2005;36:1012–5).

Guidelines for treating a first urinary tract infection were not followed in more than half of Medicaid-enrolled infants in Washington State, reported Adam L. Cohen, M.D., and his colleagues at the University of Washington, Seattle.

Although recent studies have questioned the guidelines from the American Academy of Pediatrics, they are “nevertheless generally accepted as recommended care, particularly in high-risk populations in which medical follow-up is uncertain,” Dr. Cohen said (Pediatrics 2005;115:1474–8).

Adhering to the guidelines requires three things: anatomic imaging (urinary tract ultrasonography or renal scan within 3 months of diagnosis), imaging for reflux (voiding cystourethrography or renal scan within 3 months of diagnosis), and antimicrobial prophylaxis (antibiotic therapy after diagnosis until imaging for reflux is performed).

In a retrospective cohort study of Washington's Medicaid data, 780 patients (2.1% of eligible patients in their first year of life) were diagnosed with a first urinary tract infection, and 302 (38.7%) were hospitalized.

Of those who were diagnosed with a urinary tract infection, 28.2% of patients received both anatomic imaging and imaging for reflux, 15.8% received only anatomic imaging, and 11.3% received only imaging for reflux. Of those who received imaging for reflux, more than half (51%) had adequate antibiotics between diagnosis and imaging.

Hospitalization was associated with better adherence to imaging recommendations, perhaps because these patients were more acutely ill or because hospitals may have policies in place to ensure guideline compliance, the investigators said. In a controlled, multivariate analysis, hospitalized patients were significantly more likely than were outpatients to get anatomic imaging (relative risk 1.38) and imaging for reflux (relative risk 1.62).

And patients 90 days or younger were less likely to receive antimicrobial prophylaxis than were older patients (relative risk 0.59).

Guidelines for treating a first urinary tract infection were not followed in more than half of Medicaid-enrolled infants in Washington State, reported Adam L. Cohen, M.D., and his colleagues at the University of Washington, Seattle.

Although recent studies have questioned the guidelines from the American Academy of Pediatrics, they are “nevertheless generally accepted as recommended care, particularly in high-risk populations in which medical follow-up is uncertain,” Dr. Cohen said (Pediatrics 2005;115:1474–8).

Adhering to the guidelines requires three things: anatomic imaging (urinary tract ultrasonography or renal scan within 3 months of diagnosis), imaging for reflux (voiding cystourethrography or renal scan within 3 months of diagnosis), and antimicrobial prophylaxis (antibiotic therapy after diagnosis until imaging for reflux is performed).

In a retrospective cohort study of Washington's Medicaid data, 780 patients (2.1% of eligible patients in their first year of life) were diagnosed with a first urinary tract infection, and 302 (38.7%) were hospitalized.

Of those who were diagnosed with a urinary tract infection, 28.2% of patients received both anatomic imaging and imaging for reflux, 15.8% received only anatomic imaging, and 11.3% received only imaging for reflux. Of those who received imaging for reflux, more than half (51%) had adequate antibiotics between diagnosis and imaging.

Hospitalization was associated with better adherence to imaging recommendations, perhaps because these patients were more acutely ill or because hospitals may have policies in place to ensure guideline compliance, the investigators said. In a controlled, multivariate analysis, hospitalized patients were significantly more likely than were outpatients to get anatomic imaging (relative risk 1.38) and imaging for reflux (relative risk 1.62).

And patients 90 days or younger were less likely to receive antimicrobial prophylaxis than were older patients (relative risk 0.59).

Guidelines for treating a first urinary tract infection were not followed in more than half of Medicaid-enrolled infants in Washington State, reported Adam L. Cohen, M.D., and his colleagues at the University of Washington, Seattle.

Although recent studies have questioned the guidelines from the American Academy of Pediatrics, they are “nevertheless generally accepted as recommended care, particularly in high-risk populations in which medical follow-up is uncertain,” Dr. Cohen said (Pediatrics 2005;115:1474–8).

Adhering to the guidelines requires three things: anatomic imaging (urinary tract ultrasonography or renal scan within 3 months of diagnosis), imaging for reflux (voiding cystourethrography or renal scan within 3 months of diagnosis), and antimicrobial prophylaxis (antibiotic therapy after diagnosis until imaging for reflux is performed).

In a retrospective cohort study of Washington's Medicaid data, 780 patients (2.1% of eligible patients in their first year of life) were diagnosed with a first urinary tract infection, and 302 (38.7%) were hospitalized.

Of those who were diagnosed with a urinary tract infection, 28.2% of patients received both anatomic imaging and imaging for reflux, 15.8% received only anatomic imaging, and 11.3% received only imaging for reflux. Of those who received imaging for reflux, more than half (51%) had adequate antibiotics between diagnosis and imaging.

Hospitalization was associated with better adherence to imaging recommendations, perhaps because these patients were more acutely ill or because hospitals may have policies in place to ensure guideline compliance, the investigators said. In a controlled, multivariate analysis, hospitalized patients were significantly more likely than were outpatients to get anatomic imaging (relative risk 1.38) and imaging for reflux (relative risk 1.62).

And patients 90 days or younger were less likely to receive antimicrobial prophylaxis than were older patients (relative risk 0.59).

Varicella vaccination was found to be highly effective during an outbreak of varicella among elementary school children in Utah, reported Maryam B. Haddad of the Centers for Disease Control and Prevention, Atlanta, and associates.

The outbreak occurred from October 2002 until February 2003 in two schools, one with 597 students (school A) and another with 952 students (school B). Most parents returned a questionnaire about their children's health. Parents who reported varicella symptoms in their children were interviewed, their children's vaccination records were verified, and they were asked to submit any existing lesions for polymerase chain reaction (PCR) testing.

“Health care providers should verify the vaccination status of older children who are not subject to a school-entry requirement and might remain susceptible during adulthood,” Ms. Haddad and associates recommended.

During the outbreak, 57 unvaccinated and 26 vaccinated children were reported to have varicella, with 17 more cases among household contacts, they said. PCR analysis found wild-type varicella in five unvaccinated and three vaccinated children (specimens from two other vaccinated children were insufficient for testing). Nine unvaccinated children with varicella reported that it was a second occurrence of the disease.

In school A, 27% of the 66 unvaccinated children acquired varicella, while only 4% of the 223 vaccinated children did. In school B, 41% of the 74 unvaccinated children reported varicella, while only 5% of the 348 vaccinated children did (Pediatrics 2005;115:1488–93).

The varicella vaccine overall was 87% effective. It was 90% effective against moderate or severe disease in school A and 99% effective in school B. Among the nine unvaccinated children with a history of varicella, the attack rate was 0.4% in school A and 1.4% in school B. Mild varicella was more common among vaccinated children (69%) than unvaccinated children (15%).

Risk factors for breakthrough varicella included a history of eczema (3.8 times greater risk), time since vaccination (relative risk 3.0 if vaccinated 5 or more years before the outbreak), and age at vaccination (relative risk 2.6 if vaccinated at age 18 months or less). Among the 163 children vaccinated 5 or more years before the outbreak, children vaccinated at age 18 months or less were 9.3 times more likely than those vaccinated after age 18 months to develop breakthrough varicella.

Varicella vaccination was found to be highly effective during an outbreak of varicella among elementary school children in Utah, reported Maryam B. Haddad of the Centers for Disease Control and Prevention, Atlanta, and associates.

The outbreak occurred from October 2002 until February 2003 in two schools, one with 597 students (school A) and another with 952 students (school B). Most parents returned a questionnaire about their children's health. Parents who reported varicella symptoms in their children were interviewed, their children's vaccination records were verified, and they were asked to submit any existing lesions for polymerase chain reaction (PCR) testing.

“Health care providers should verify the vaccination status of older children who are not subject to a school-entry requirement and might remain susceptible during adulthood,” Ms. Haddad and associates recommended.

During the outbreak, 57 unvaccinated and 26 vaccinated children were reported to have varicella, with 17 more cases among household contacts, they said. PCR analysis found wild-type varicella in five unvaccinated and three vaccinated children (specimens from two other vaccinated children were insufficient for testing). Nine unvaccinated children with varicella reported that it was a second occurrence of the disease.

In school A, 27% of the 66 unvaccinated children acquired varicella, while only 4% of the 223 vaccinated children did. In school B, 41% of the 74 unvaccinated children reported varicella, while only 5% of the 348 vaccinated children did (Pediatrics 2005;115:1488–93).

The varicella vaccine overall was 87% effective. It was 90% effective against moderate or severe disease in school A and 99% effective in school B. Among the nine unvaccinated children with a history of varicella, the attack rate was 0.4% in school A and 1.4% in school B. Mild varicella was more common among vaccinated children (69%) than unvaccinated children (15%).

Risk factors for breakthrough varicella included a history of eczema (3.8 times greater risk), time since vaccination (relative risk 3.0 if vaccinated 5 or more years before the outbreak), and age at vaccination (relative risk 2.6 if vaccinated at age 18 months or less). Among the 163 children vaccinated 5 or more years before the outbreak, children vaccinated at age 18 months or less were 9.3 times more likely than those vaccinated after age 18 months to develop breakthrough varicella.

Varicella vaccination was found to be highly effective during an outbreak of varicella among elementary school children in Utah, reported Maryam B. Haddad of the Centers for Disease Control and Prevention, Atlanta, and associates.

The outbreak occurred from October 2002 until February 2003 in two schools, one with 597 students (school A) and another with 952 students (school B). Most parents returned a questionnaire about their children's health. Parents who reported varicella symptoms in their children were interviewed, their children's vaccination records were verified, and they were asked to submit any existing lesions for polymerase chain reaction (PCR) testing.

“Health care providers should verify the vaccination status of older children who are not subject to a school-entry requirement and might remain susceptible during adulthood,” Ms. Haddad and associates recommended.

During the outbreak, 57 unvaccinated and 26 vaccinated children were reported to have varicella, with 17 more cases among household contacts, they said. PCR analysis found wild-type varicella in five unvaccinated and three vaccinated children (specimens from two other vaccinated children were insufficient for testing). Nine unvaccinated children with varicella reported that it was a second occurrence of the disease.

In school A, 27% of the 66 unvaccinated children acquired varicella, while only 4% of the 223 vaccinated children did. In school B, 41% of the 74 unvaccinated children reported varicella, while only 5% of the 348 vaccinated children did (Pediatrics 2005;115:1488–93).

The varicella vaccine overall was 87% effective. It was 90% effective against moderate or severe disease in school A and 99% effective in school B. Among the nine unvaccinated children with a history of varicella, the attack rate was 0.4% in school A and 1.4% in school B. Mild varicella was more common among vaccinated children (69%) than unvaccinated children (15%).

Risk factors for breakthrough varicella included a history of eczema (3.8 times greater risk), time since vaccination (relative risk 3.0 if vaccinated 5 or more years before the outbreak), and age at vaccination (relative risk 2.6 if vaccinated at age 18 months or less). Among the 163 children vaccinated 5 or more years before the outbreak, children vaccinated at age 18 months or less were 9.3 times more likely than those vaccinated after age 18 months to develop breakthrough varicella.

Obesity-Related Mortality

Obesity was associated with an estimated 111,909 excess deaths in the United States in the year 2000, reported Katherine M. Flegal, Ph.D., of the National Center for Health Statistics, Hyattsville, Md., and her associates.

A study by the Centers for Disease Control and Prevention published last year in the Journal of the American Medical Association erroneously reported that obesity-related deaths reached 400,000 per year between 1990 and 2000.

Dr. Flegal and her associates estimated relative risks of mortality using National Health and Nutrition Examination Survey (NHANES) data (JAMA 2005;293:1861–7).

Most of the excess deaths (82,066) occurred in people with a body mass index (BMI) of at least 35 kg/m2, compared with normal-weight people. Among overweight people, the estimated number of deaths was 86,094 fewer than among normal-weight people. When mortality was calculated for overweight people combined with obese people, the estimated number of excess deaths was 25,814, compared with people of normal weight.

Predicting Postmenopausal CV Risk

Screening for an enlarged waist in combination with elevated triglycerides appears to be a simple, effective tool to flag postmenopausal women at increased risk for accelerated atherogenesis and related adverse outcomes, reported Laszlo B. Tanko, M.D., and his associates at the Center for Clinical and Basic Research, Ballerup, Denmark.

In a study of 557 Copenhagen-area women aged 48–76 years followed for an average of 8.5 years, 16% of the women had enlarged waist (at least 88 cm) with elevated triglyceride levels (EWET), and 18% had metabolic syndrome, defined as having at least three of five criteria: enlarged waist, elevated triglycerides, elevated blood pressure, low HDL cholesterol, and impaired fasting glucose (Circulation 2005;111:1883–90).

EWET was linked to a nearly fivefold increased risk for fatal cardiovascular events, while metabolic syndrome was linked to a more than threefold increased risk. Excluding women with diabetes at baseline did not change the pattern. EWET also was better than metabolic syndrome for predicting annual progression of aortic calcification, Dr. Tanko and his associates said.

Middle-Aged Obesity and Dementia

People who are obese or overweight at middle age are at significantly greater risk for dementia in later life than normal-weight people, reported Rachel A. Whitmer, Ph.D., of the division of research, Kaiser Permanente, Oakland, Calif.

The investigators prospectively followed 10,276 people enrolled in the Kaiser Permanente medical program of northern California who were 40–45 years old between 1964 and 1973. At midlife, 10% were obese (BMI of 30 kg/m2 or greater), 36% overweight (BMI 25–29.9 kg/m2), and 53% normal weight (BMI 18.6–24.9 kg/m2).

From January 1994 to April 2003, people who were obese at midlife had a 74% greater risk of dementia, compared with people who had been of normal weight, while overweight people had a 35% greater risk.

In women, the corresponding increases were 107% for obesity and 55% for overweight; no significant differences were found in men.

People in the highest quintile of subscapular skinfold at midlife had a 72% increased risk of dementia, while people in the highest quintile of tricep skinfold had a 59% increased risk of dementia, compared with people in the lowest fifth of the two measures, Dr. Whitmer reported in the April 29 online edition of the British Medical Journal.

Obesity Rising for All Income Levels

Obesity has largely been considered a problem for people with lower income levels, but new data suggest that the waistlines of people with higher income levels are catching up, reported Nidhi Maheshwari, M.B., of the University of Iowa College of Public Health, Iowa City.

For Americans making more than $60,000 a year (adjusted to 2000 dollars), the prevalence of obesity was 9.7% in 1971–1974 and rose significantly to 26.8% in 2001–2002, based on data on people 20 years old or older who were interviewed for NHANES between 1971 and 2002, according to the study, presented at a conference on cardiovascular disease epidemiology and prevention sponsored by the American Heart Association.

The prevalence of obesity among Americans making less than $25,000 a year was 22.5% in 1971–1974 and 32.5% in 2001–2002. Among Americans making $25,000 to $39,999 a year, the prevalence was 16.1% in 1971–1974 and 31.3% in 2001–2002. The prevalence among those making $40,000–$60,000 a year was 14.5% in 1971–1974 and 30.3% in 2001–2002.

Obesity-Related Mortality

Obesity was associated with an estimated 111,909 excess deaths in the United States in the year 2000, reported Katherine M. Flegal, Ph.D., of the National Center for Health Statistics, Hyattsville, Md., and her associates.

A study by the Centers for Disease Control and Prevention published last year in the Journal of the American Medical Association erroneously reported that obesity-related deaths reached 400,000 per year between 1990 and 2000.

Dr. Flegal and her associates estimated relative risks of mortality using National Health and Nutrition Examination Survey (NHANES) data (JAMA 2005;293:1861–7).

Most of the excess deaths (82,066) occurred in people with a body mass index (BMI) of at least 35 kg/m2, compared with normal-weight people. Among overweight people, the estimated number of deaths was 86,094 fewer than among normal-weight people. When mortality was calculated for overweight people combined with obese people, the estimated number of excess deaths was 25,814, compared with people of normal weight.

Predicting Postmenopausal CV Risk

Screening for an enlarged waist in combination with elevated triglycerides appears to be a simple, effective tool to flag postmenopausal women at increased risk for accelerated atherogenesis and related adverse outcomes, reported Laszlo B. Tanko, M.D., and his associates at the Center for Clinical and Basic Research, Ballerup, Denmark.

In a study of 557 Copenhagen-area women aged 48–76 years followed for an average of 8.5 years, 16% of the women had enlarged waist (at least 88 cm) with elevated triglyceride levels (EWET), and 18% had metabolic syndrome, defined as having at least three of five criteria: enlarged waist, elevated triglycerides, elevated blood pressure, low HDL cholesterol, and impaired fasting glucose (Circulation 2005;111:1883–90).

EWET was linked to a nearly fivefold increased risk for fatal cardiovascular events, while metabolic syndrome was linked to a more than threefold increased risk. Excluding women with diabetes at baseline did not change the pattern. EWET also was better than metabolic syndrome for predicting annual progression of aortic calcification, Dr. Tanko and his associates said.

Middle-Aged Obesity and Dementia

People who are obese or overweight at middle age are at significantly greater risk for dementia in later life than normal-weight people, reported Rachel A. Whitmer, Ph.D., of the division of research, Kaiser Permanente, Oakland, Calif.

The investigators prospectively followed 10,276 people enrolled in the Kaiser Permanente medical program of northern California who were 40–45 years old between 1964 and 1973. At midlife, 10% were obese (BMI of 30 kg/m2 or greater), 36% overweight (BMI 25–29.9 kg/m2), and 53% normal weight (BMI 18.6–24.9 kg/m2).

From January 1994 to April 2003, people who were obese at midlife had a 74% greater risk of dementia, compared with people who had been of normal weight, while overweight people had a 35% greater risk.

In women, the corresponding increases were 107% for obesity and 55% for overweight; no significant differences were found in men.

People in the highest quintile of subscapular skinfold at midlife had a 72% increased risk of dementia, while people in the highest quintile of tricep skinfold had a 59% increased risk of dementia, compared with people in the lowest fifth of the two measures, Dr. Whitmer reported in the April 29 online edition of the British Medical Journal.

Obesity Rising for All Income Levels

Obesity has largely been considered a problem for people with lower income levels, but new data suggest that the waistlines of people with higher income levels are catching up, reported Nidhi Maheshwari, M.B., of the University of Iowa College of Public Health, Iowa City.

For Americans making more than $60,000 a year (adjusted to 2000 dollars), the prevalence of obesity was 9.7% in 1971–1974 and rose significantly to 26.8% in 2001–2002, based on data on people 20 years old or older who were interviewed for NHANES between 1971 and 2002, according to the study, presented at a conference on cardiovascular disease epidemiology and prevention sponsored by the American Heart Association.

The prevalence of obesity among Americans making less than $25,000 a year was 22.5% in 1971–1974 and 32.5% in 2001–2002. Among Americans making $25,000 to $39,999 a year, the prevalence was 16.1% in 1971–1974 and 31.3% in 2001–2002. The prevalence among those making $40,000–$60,000 a year was 14.5% in 1971–1974 and 30.3% in 2001–2002.

Obesity-Related Mortality

Obesity was associated with an estimated 111,909 excess deaths in the United States in the year 2000, reported Katherine M. Flegal, Ph.D., of the National Center for Health Statistics, Hyattsville, Md., and her associates.

A study by the Centers for Disease Control and Prevention published last year in the Journal of the American Medical Association erroneously reported that obesity-related deaths reached 400,000 per year between 1990 and 2000.

Dr. Flegal and her associates estimated relative risks of mortality using National Health and Nutrition Examination Survey (NHANES) data (JAMA 2005;293:1861–7).

Most of the excess deaths (82,066) occurred in people with a body mass index (BMI) of at least 35 kg/m2, compared with normal-weight people. Among overweight people, the estimated number of deaths was 86,094 fewer than among normal-weight people. When mortality was calculated for overweight people combined with obese people, the estimated number of excess deaths was 25,814, compared with people of normal weight.

Predicting Postmenopausal CV Risk

Screening for an enlarged waist in combination with elevated triglycerides appears to be a simple, effective tool to flag postmenopausal women at increased risk for accelerated atherogenesis and related adverse outcomes, reported Laszlo B. Tanko, M.D., and his associates at the Center for Clinical and Basic Research, Ballerup, Denmark.

In a study of 557 Copenhagen-area women aged 48–76 years followed for an average of 8.5 years, 16% of the women had enlarged waist (at least 88 cm) with elevated triglyceride levels (EWET), and 18% had metabolic syndrome, defined as having at least three of five criteria: enlarged waist, elevated triglycerides, elevated blood pressure, low HDL cholesterol, and impaired fasting glucose (Circulation 2005;111:1883–90).

EWET was linked to a nearly fivefold increased risk for fatal cardiovascular events, while metabolic syndrome was linked to a more than threefold increased risk. Excluding women with diabetes at baseline did not change the pattern. EWET also was better than metabolic syndrome for predicting annual progression of aortic calcification, Dr. Tanko and his associates said.

Middle-Aged Obesity and Dementia

People who are obese or overweight at middle age are at significantly greater risk for dementia in later life than normal-weight people, reported Rachel A. Whitmer, Ph.D., of the division of research, Kaiser Permanente, Oakland, Calif.

The investigators prospectively followed 10,276 people enrolled in the Kaiser Permanente medical program of northern California who were 40–45 years old between 1964 and 1973. At midlife, 10% were obese (BMI of 30 kg/m2 or greater), 36% overweight (BMI 25–29.9 kg/m2), and 53% normal weight (BMI 18.6–24.9 kg/m2).

From January 1994 to April 2003, people who were obese at midlife had a 74% greater risk of dementia, compared with people who had been of normal weight, while overweight people had a 35% greater risk.

In women, the corresponding increases were 107% for obesity and 55% for overweight; no significant differences were found in men.

People in the highest quintile of subscapular skinfold at midlife had a 72% increased risk of dementia, while people in the highest quintile of tricep skinfold had a 59% increased risk of dementia, compared with people in the lowest fifth of the two measures, Dr. Whitmer reported in the April 29 online edition of the British Medical Journal.

Obesity Rising for All Income Levels

Obesity has largely been considered a problem for people with lower income levels, but new data suggest that the waistlines of people with higher income levels are catching up, reported Nidhi Maheshwari, M.B., of the University of Iowa College of Public Health, Iowa City.

For Americans making more than $60,000 a year (adjusted to 2000 dollars), the prevalence of obesity was 9.7% in 1971–1974 and rose significantly to 26.8% in 2001–2002, based on data on people 20 years old or older who were interviewed for NHANES between 1971 and 2002, according to the study, presented at a conference on cardiovascular disease epidemiology and prevention sponsored by the American Heart Association.

The prevalence of obesity among Americans making less than $25,000 a year was 22.5% in 1971–1974 and 32.5% in 2001–2002. Among Americans making $25,000 to $39,999 a year, the prevalence was 16.1% in 1971–1974 and 31.3% in 2001–2002. The prevalence among those making $40,000–$60,000 a year was 14.5% in 1971–1974 and 30.3% in 2001–2002.

Benefits of Moderate Drinking

Moderate alcohol consumption is associated with an approximately 30% reduction in the risk of type 2 diabetes in women and men, regardless of body mass index, reported Lando L.J. Koppes, Ph.D., of the Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam.

In a metaanalysis of 15 prospective cohort studies of 11,959 incident cases of type 2 diabetes among 369,862 adults, light drinkers (<6 g/day of alcohol) had a 0.87 relative risk (RR) of type 2 diabetes, similar to the 1.04 RR of heavy drinkers >48 g/day of alcohol). Moderate drinkers fared better (0.70 for 6–12 g/day of alcohol, 0.69 for 12–24 g/day, 0.72 for 24–48 g/day).

The researchers found no sex differences in RR for diabetes, except for alcohol consumption of 6–12 g/day (0.80 for men, 0.59 in women). In the six studies that reported body mass index, it was not related to RR for diabetes (Diabetes Care 2005;28:719–25).

Decline in Life Expectancy?

Life expectancy may decline because of the obesity epidemic, with important implications for the solvency of age-entitlement programs, said S. Jay Olshansky, Ph.D., of the University of Illinois at Chicago.

Obesity prevalence in adults increased by about 50% per decade in the 1980s and 1990s, the investigators reported. Today, two-thirds of adults are obese or overweight, with 34% of women, 28% of men, and nearly 50% of black women classified as obese. Evidence suggests that disability rates have risen as fitness levels have declined, and this has occurred at younger ages they added (N. Engl. J. Med. 2005;352:1138–45).

Obesity has been shown to reduce life expectancy by an estimated 5–20 years, Dr. Olshansky said. “If left unchecked, the rising prevalence of obesity that has already occurred in the past 30 years is expected to lead to an elevated risk of a range of fatal and nonfatal conditions for these cohorts as they age.” If the trend continues, especially at younger ages, the negative effect on longevity “could be much worse.”

The obesity epidemic's impact could improve the solvency of Social Security, but the cost of treating related illnesses may increase the burden on Medicare, they said.

Relatives of Type 2 Diabetics

Lifestyle interventions can significantly improve risk factors associated with insulin resistance and cardiovascular disease in healthy first-degree relatives (FDRs) of patients with type 2 diabetes, according to Hilde K. Brekke of Sahlgrenska Academy at Göteburg University, Sweden.

In a 16-week study of 72 nondiabetic FDRs aged 25–55 years, 25 patients were assigned to the diet-only group, 25 were in the diet-and-exercise group, and 22 controls were told to continue their current lifestyle. Group nutrition counseling was given twice, with telephone follow-up every 10 days, to the two groups with a diet component. The exercise goal was to increase physical activity for at least 30 minutes, 4–5 times per week.

In the diet-only group, total cholesterol was reduced significantly by 0.31 mmol/L, LDL cholesterol was reduced by 0.22 mmol/L, and apolipoprotein B was reduced by 9.5 mg/dL on average, compared with controls. The diet-and-exercise group had significant reductions in body weight (2.1%) and waist circumference (3.0 cm), compared with controls (Diabetes Res. Clin. Pract. 2005;68:18–28).

The diet-and-exercise group also had a significant 13% reduction in fasting insulin, compared with controls, but both the diet-only and diet-and-exercise groups showed no significant changes in fasting glucose, insulin or insulin sensitivity index. A subgroup of 13 patients who were particularly compliant with dietary goals and exercise targets had significantly improved insulin sensitivity index and lipid profiles.

Leukemia Drug and Diabetes

Imatinib (Gleevec), an antineoplastic agent used to treat chronic myeloid leukemia, may help to put type 2 diabetes mellitus in regression, according to Dino Veneri, M.D., of the University of Verona (Italy).

The investigators reported on a 70-year-old woman with an 8-year history of type 2 diabetes who was diagnosed with chronic myeloid leukemia. She began imatinib 400 mg/day, which resulted in hematologic remission 2 months later. Her blood glucose levels declined during treatment, and insulin was discontinued 3 months after her leukemia was diagnosed. Regression of diabetes was confirmed over the following months. “During the past year, the patient's diet, physical activity, and weight have not changed, and she has not taken any medication known to affect glucose metabolism,” Dr. Veneri said (N. Engl. J. Med. 2005;352:1049–50).

Imatinib inhibits phosphorylation, which may improve signaling and the function of effectors such as enzymes; this may enhance insulin sensitivity.

Benefits of Moderate Drinking

Moderate alcohol consumption is associated with an approximately 30% reduction in the risk of type 2 diabetes in women and men, regardless of body mass index, reported Lando L.J. Koppes, Ph.D., of the Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam.

In a metaanalysis of 15 prospective cohort studies of 11,959 incident cases of type 2 diabetes among 369,862 adults, light drinkers (<6 g/day of alcohol) had a 0.87 relative risk (RR) of type 2 diabetes, similar to the 1.04 RR of heavy drinkers >48 g/day of alcohol). Moderate drinkers fared better (0.70 for 6–12 g/day of alcohol, 0.69 for 12–24 g/day, 0.72 for 24–48 g/day).

The researchers found no sex differences in RR for diabetes, except for alcohol consumption of 6–12 g/day (0.80 for men, 0.59 in women). In the six studies that reported body mass index, it was not related to RR for diabetes (Diabetes Care 2005;28:719–25).

Decline in Life Expectancy?

Life expectancy may decline because of the obesity epidemic, with important implications for the solvency of age-entitlement programs, said S. Jay Olshansky, Ph.D., of the University of Illinois at Chicago.

Obesity prevalence in adults increased by about 50% per decade in the 1980s and 1990s, the investigators reported. Today, two-thirds of adults are obese or overweight, with 34% of women, 28% of men, and nearly 50% of black women classified as obese. Evidence suggests that disability rates have risen as fitness levels have declined, and this has occurred at younger ages they added (N. Engl. J. Med. 2005;352:1138–45).

Obesity has been shown to reduce life expectancy by an estimated 5–20 years, Dr. Olshansky said. “If left unchecked, the rising prevalence of obesity that has already occurred in the past 30 years is expected to lead to an elevated risk of a range of fatal and nonfatal conditions for these cohorts as they age.” If the trend continues, especially at younger ages, the negative effect on longevity “could be much worse.”

The obesity epidemic's impact could improve the solvency of Social Security, but the cost of treating related illnesses may increase the burden on Medicare, they said.

Relatives of Type 2 Diabetics

Lifestyle interventions can significantly improve risk factors associated with insulin resistance and cardiovascular disease in healthy first-degree relatives (FDRs) of patients with type 2 diabetes, according to Hilde K. Brekke of Sahlgrenska Academy at Göteburg University, Sweden.

In a 16-week study of 72 nondiabetic FDRs aged 25–55 years, 25 patients were assigned to the diet-only group, 25 were in the diet-and-exercise group, and 22 controls were told to continue their current lifestyle. Group nutrition counseling was given twice, with telephone follow-up every 10 days, to the two groups with a diet component. The exercise goal was to increase physical activity for at least 30 minutes, 4–5 times per week.

In the diet-only group, total cholesterol was reduced significantly by 0.31 mmol/L, LDL cholesterol was reduced by 0.22 mmol/L, and apolipoprotein B was reduced by 9.5 mg/dL on average, compared with controls. The diet-and-exercise group had significant reductions in body weight (2.1%) and waist circumference (3.0 cm), compared with controls (Diabetes Res. Clin. Pract. 2005;68:18–28).

The diet-and-exercise group also had a significant 13% reduction in fasting insulin, compared with controls, but both the diet-only and diet-and-exercise groups showed no significant changes in fasting glucose, insulin or insulin sensitivity index. A subgroup of 13 patients who were particularly compliant with dietary goals and exercise targets had significantly improved insulin sensitivity index and lipid profiles.

Leukemia Drug and Diabetes

Imatinib (Gleevec), an antineoplastic agent used to treat chronic myeloid leukemia, may help to put type 2 diabetes mellitus in regression, according to Dino Veneri, M.D., of the University of Verona (Italy).

The investigators reported on a 70-year-old woman with an 8-year history of type 2 diabetes who was diagnosed with chronic myeloid leukemia. She began imatinib 400 mg/day, which resulted in hematologic remission 2 months later. Her blood glucose levels declined during treatment, and insulin was discontinued 3 months after her leukemia was diagnosed. Regression of diabetes was confirmed over the following months. “During the past year, the patient's diet, physical activity, and weight have not changed, and she has not taken any medication known to affect glucose metabolism,” Dr. Veneri said (N. Engl. J. Med. 2005;352:1049–50).

Imatinib inhibits phosphorylation, which may improve signaling and the function of effectors such as enzymes; this may enhance insulin sensitivity.

Benefits of Moderate Drinking

Moderate alcohol consumption is associated with an approximately 30% reduction in the risk of type 2 diabetes in women and men, regardless of body mass index, reported Lando L.J. Koppes, Ph.D., of the Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam.

In a metaanalysis of 15 prospective cohort studies of 11,959 incident cases of type 2 diabetes among 369,862 adults, light drinkers (<6 g/day of alcohol) had a 0.87 relative risk (RR) of type 2 diabetes, similar to the 1.04 RR of heavy drinkers >48 g/day of alcohol). Moderate drinkers fared better (0.70 for 6–12 g/day of alcohol, 0.69 for 12–24 g/day, 0.72 for 24–48 g/day).

The researchers found no sex differences in RR for diabetes, except for alcohol consumption of 6–12 g/day (0.80 for men, 0.59 in women). In the six studies that reported body mass index, it was not related to RR for diabetes (Diabetes Care 2005;28:719–25).

Decline in Life Expectancy?

Life expectancy may decline because of the obesity epidemic, with important implications for the solvency of age-entitlement programs, said S. Jay Olshansky, Ph.D., of the University of Illinois at Chicago.

Obesity prevalence in adults increased by about 50% per decade in the 1980s and 1990s, the investigators reported. Today, two-thirds of adults are obese or overweight, with 34% of women, 28% of men, and nearly 50% of black women classified as obese. Evidence suggests that disability rates have risen as fitness levels have declined, and this has occurred at younger ages they added (N. Engl. J. Med. 2005;352:1138–45).

Obesity has been shown to reduce life expectancy by an estimated 5–20 years, Dr. Olshansky said. “If left unchecked, the rising prevalence of obesity that has already occurred in the past 30 years is expected to lead to an elevated risk of a range of fatal and nonfatal conditions for these cohorts as they age.” If the trend continues, especially at younger ages, the negative effect on longevity “could be much worse.”

The obesity epidemic's impact could improve the solvency of Social Security, but the cost of treating related illnesses may increase the burden on Medicare, they said.

Relatives of Type 2 Diabetics

Lifestyle interventions can significantly improve risk factors associated with insulin resistance and cardiovascular disease in healthy first-degree relatives (FDRs) of patients with type 2 diabetes, according to Hilde K. Brekke of Sahlgrenska Academy at Göteburg University, Sweden.

In a 16-week study of 72 nondiabetic FDRs aged 25–55 years, 25 patients were assigned to the diet-only group, 25 were in the diet-and-exercise group, and 22 controls were told to continue their current lifestyle. Group nutrition counseling was given twice, with telephone follow-up every 10 days, to the two groups with a diet component. The exercise goal was to increase physical activity for at least 30 minutes, 4–5 times per week.

In the diet-only group, total cholesterol was reduced significantly by 0.31 mmol/L, LDL cholesterol was reduced by 0.22 mmol/L, and apolipoprotein B was reduced by 9.5 mg/dL on average, compared with controls. The diet-and-exercise group had significant reductions in body weight (2.1%) and waist circumference (3.0 cm), compared with controls (Diabetes Res. Clin. Pract. 2005;68:18–28).

The diet-and-exercise group also had a significant 13% reduction in fasting insulin, compared with controls, but both the diet-only and diet-and-exercise groups showed no significant changes in fasting glucose, insulin or insulin sensitivity index. A subgroup of 13 patients who were particularly compliant with dietary goals and exercise targets had significantly improved insulin sensitivity index and lipid profiles.

Leukemia Drug and Diabetes

Imatinib (Gleevec), an antineoplastic agent used to treat chronic myeloid leukemia, may help to put type 2 diabetes mellitus in regression, according to Dino Veneri, M.D., of the University of Verona (Italy).

The investigators reported on a 70-year-old woman with an 8-year history of type 2 diabetes who was diagnosed with chronic myeloid leukemia. She began imatinib 400 mg/day, which resulted in hematologic remission 2 months later. Her blood glucose levels declined during treatment, and insulin was discontinued 3 months after her leukemia was diagnosed. Regression of diabetes was confirmed over the following months. “During the past year, the patient's diet, physical activity, and weight have not changed, and she has not taken any medication known to affect glucose metabolism,” Dr. Veneri said (N. Engl. J. Med. 2005;352:1049–50).

Imatinib inhibits phosphorylation, which may improve signaling and the function of effectors such as enzymes; this may enhance insulin sensitivity.

Estimating Energy Intake

Patients with type 2 diabetes who accurately estimate their energy intake appear to have better controlled disease than do those who do not, said Yumi Matsushita of the Tokyo Medical and Dental University.

In a cross-sectional study of 46 men and 16 women with diabetes treated as outpatients in two Tokyo hospitals in 1999, a dietician had the patients estimate their recent dietary intake and expenditure. Patients then completed a self-reported survey of food intake for 3 days, and wore a pedometer for 1 week to measure physical activity.

Patients were broken into three groups based on hemoglobin A_1c levels (HbA_1c): low (6.6% or lower), medium (6.7%-7.5%), and high (7.6% or higher), the researchers said (Diabetes Res. Clin. Pract. 2005;67:220-6).

The mean energy intake was higher than recommended in all three groups, and the mean fat/energy ratio exceeded the recommended range of 25% or less in all groups. Total energy expenditure was significantly higher in the well-controlled group: 1,983 kcal/day versus 1,876 in the poorly controlled tertile, the researchers said. Physical activity intensity was similar in the three groups.

Patients whose estimated energy intake closely matched that recorded by dieticians tended to have better diabetes control. More than 35% of low HbA1c patients had a “close match” between estimated and real energy intake, compared with 13% and 11% of those in the medium and high HbA1c groups, respectively.

Costs of Diabetes Complications

Preventing hospitalizations for diabetes complications could save the health care system up to $2.5 billion of the approximately $3.8 billion in costs of such complications in 2001, including $1.3 billion paid by Medicare and $386 million paid by Medicaid, according to a report from the Agency for Healthcare Research and Quality.

Nearly one-third of all diabetes patients are hospitalized at least twice a year for complications. Patients who are racial/ethnic minorities, enrolled in public insurance, or living in low-income areas are especially likely to experience multiple hospitalizations and have higher hospital costs. Nonelderly adults on Medicaid have 55% more multiple hospitalizations than do privately insured diabetics, and Medicare patients have 48% more multiple hospitalizations, based on 2001 data.

Among all diabetics who are hospitalized, 30% are rehospitalized within a year, accounting for more than half of all diabetes-related hospital costs. “The total annual hospital cost per patient for all stays is nearly three times as high for patients with multiple hospitalizations as compared to patients with a single stay—$23,100 versus $8,500,” the researchers said.

Providers and policy makers should offer interventions for cardiovascular disease to diabetics, carefully monitor diabetics with a prior admission for diabetes complications, and consider enhanced interventions for vulnerable diabetes populations, such as minorities, low-income patients, and those on public health coverage, according to the report.

Drinking Patterns Matter

High body mass index is associated with heavy drinking sessions, but not with frequent drinking, reported Rosalind A. Breslow and Barbara A. Smothers of the division of epidemiology and prevention research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Md.

The researchers reviewed data obtained from the National Health Interview Survey on 37,103 (17,151 men and 19,952 women) current drinkers who had never smoked and whose mean age was 41 years. Men drank a mean of 73 days per year, while women drank 43.5 days per year. The mean number of drinks consumed per drinking day was 2.5 for men and 1.7 for women (Am. J. Epidemiol. 2005;161:368-76).

Among all drinkers, those who consumed at least four drinks per drinking day had significantly higher BMI than did those who consumed just one drink per drinking day.

BMI increased across all drinkers as alcohol intake per drinking day increased, from 26.5 kg/m

“BMI was significantly lower among the most frequent drinkers as compared with the least frequent drinkers” for both women and men, but the effect was more pronounced in women than in men, the investigators said.

Estimating Energy Intake

Patients with type 2 diabetes who accurately estimate their energy intake appear to have better controlled disease than do those who do not, said Yumi Matsushita of the Tokyo Medical and Dental University.

In a cross-sectional study of 46 men and 16 women with diabetes treated as outpatients in two Tokyo hospitals in 1999, a dietician had the patients estimate their recent dietary intake and expenditure. Patients then completed a self-reported survey of food intake for 3 days, and wore a pedometer for 1 week to measure physical activity.

Patients were broken into three groups based on hemoglobin A_1c levels (HbA_1c): low (6.6% or lower), medium (6.7%-7.5%), and high (7.6% or higher), the researchers said (Diabetes Res. Clin. Pract. 2005;67:220-6).

The mean energy intake was higher than recommended in all three groups, and the mean fat/energy ratio exceeded the recommended range of 25% or less in all groups. Total energy expenditure was significantly higher in the well-controlled group: 1,983 kcal/day versus 1,876 in the poorly controlled tertile, the researchers said. Physical activity intensity was similar in the three groups.

Patients whose estimated energy intake closely matched that recorded by dieticians tended to have better diabetes control. More than 35% of low HbA1c patients had a “close match” between estimated and real energy intake, compared with 13% and 11% of those in the medium and high HbA1c groups, respectively.

Costs of Diabetes Complications

Preventing hospitalizations for diabetes complications could save the health care system up to $2.5 billion of the approximately $3.8 billion in costs of such complications in 2001, including $1.3 billion paid by Medicare and $386 million paid by Medicaid, according to a report from the Agency for Healthcare Research and Quality.

Nearly one-third of all diabetes patients are hospitalized at least twice a year for complications. Patients who are racial/ethnic minorities, enrolled in public insurance, or living in low-income areas are especially likely to experience multiple hospitalizations and have higher hospital costs. Nonelderly adults on Medicaid have 55% more multiple hospitalizations than do privately insured diabetics, and Medicare patients have 48% more multiple hospitalizations, based on 2001 data.

Among all diabetics who are hospitalized, 30% are rehospitalized within a year, accounting for more than half of all diabetes-related hospital costs. “The total annual hospital cost per patient for all stays is nearly three times as high for patients with multiple hospitalizations as compared to patients with a single stay—$23,100 versus $8,500,” the researchers said.

Providers and policy makers should offer interventions for cardiovascular disease to diabetics, carefully monitor diabetics with a prior admission for diabetes complications, and consider enhanced interventions for vulnerable diabetes populations, such as minorities, low-income patients, and those on public health coverage, according to the report.

Drinking Patterns Matter

High body mass index is associated with heavy drinking sessions, but not with frequent drinking, reported Rosalind A. Breslow and Barbara A. Smothers of the division of epidemiology and prevention research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Md.

The researchers reviewed data obtained from the National Health Interview Survey on 37,103 (17,151 men and 19,952 women) current drinkers who had never smoked and whose mean age was 41 years. Men drank a mean of 73 days per year, while women drank 43.5 days per year. The mean number of drinks consumed per drinking day was 2.5 for men and 1.7 for women (Am. J. Epidemiol. 2005;161:368-76).

Among all drinkers, those who consumed at least four drinks per drinking day had significantly higher BMI than did those who consumed just one drink per drinking day.

BMI increased across all drinkers as alcohol intake per drinking day increased, from 26.5 kg/m

“BMI was significantly lower among the most frequent drinkers as compared with the least frequent drinkers” for both women and men, but the effect was more pronounced in women than in men, the investigators said.

Estimating Energy Intake

Patients with type 2 diabetes who accurately estimate their energy intake appear to have better controlled disease than do those who do not, said Yumi Matsushita of the Tokyo Medical and Dental University.

In a cross-sectional study of 46 men and 16 women with diabetes treated as outpatients in two Tokyo hospitals in 1999, a dietician had the patients estimate their recent dietary intake and expenditure. Patients then completed a self-reported survey of food intake for 3 days, and wore a pedometer for 1 week to measure physical activity.

Patients were broken into three groups based on hemoglobin A_1c levels (HbA_1c): low (6.6% or lower), medium (6.7%-7.5%), and high (7.6% or higher), the researchers said (Diabetes Res. Clin. Pract. 2005;67:220-6).

The mean energy intake was higher than recommended in all three groups, and the mean fat/energy ratio exceeded the recommended range of 25% or less in all groups. Total energy expenditure was significantly higher in the well-controlled group: 1,983 kcal/day versus 1,876 in the poorly controlled tertile, the researchers said. Physical activity intensity was similar in the three groups.

Patients whose estimated energy intake closely matched that recorded by dieticians tended to have better diabetes control. More than 35% of low HbA1c patients had a “close match” between estimated and real energy intake, compared with 13% and 11% of those in the medium and high HbA1c groups, respectively.

Costs of Diabetes Complications

Preventing hospitalizations for diabetes complications could save the health care system up to $2.5 billion of the approximately $3.8 billion in costs of such complications in 2001, including $1.3 billion paid by Medicare and $386 million paid by Medicaid, according to a report from the Agency for Healthcare Research and Quality.

Nearly one-third of all diabetes patients are hospitalized at least twice a year for complications. Patients who are racial/ethnic minorities, enrolled in public insurance, or living in low-income areas are especially likely to experience multiple hospitalizations and have higher hospital costs. Nonelderly adults on Medicaid have 55% more multiple hospitalizations than do privately insured diabetics, and Medicare patients have 48% more multiple hospitalizations, based on 2001 data.

Among all diabetics who are hospitalized, 30% are rehospitalized within a year, accounting for more than half of all diabetes-related hospital costs. “The total annual hospital cost per patient for all stays is nearly three times as high for patients with multiple hospitalizations as compared to patients with a single stay—$23,100 versus $8,500,” the researchers said.

Providers and policy makers should offer interventions for cardiovascular disease to diabetics, carefully monitor diabetics with a prior admission for diabetes complications, and consider enhanced interventions for vulnerable diabetes populations, such as minorities, low-income patients, and those on public health coverage, according to the report.

Drinking Patterns Matter

High body mass index is associated with heavy drinking sessions, but not with frequent drinking, reported Rosalind A. Breslow and Barbara A. Smothers of the division of epidemiology and prevention research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Md.

The researchers reviewed data obtained from the National Health Interview Survey on 37,103 (17,151 men and 19,952 women) current drinkers who had never smoked and whose mean age was 41 years. Men drank a mean of 73 days per year, while women drank 43.5 days per year. The mean number of drinks consumed per drinking day was 2.5 for men and 1.7 for women (Am. J. Epidemiol. 2005;161:368-76).

Among all drinkers, those who consumed at least four drinks per drinking day had significantly higher BMI than did those who consumed just one drink per drinking day.

BMI increased across all drinkers as alcohol intake per drinking day increased, from 26.5 kg/m

“BMI was significantly lower among the most frequent drinkers as compared with the least frequent drinkers” for both women and men, but the effect was more pronounced in women than in men, the investigators said.

Psychosocial risk factors such as stress, depression, and low generalized locus of control are associated with an increased risk of acute MI among patients of all ages and of both sexes from every region of the world, according to two reports from the INTERHEART study.

By determining the role of risk factors across sociocultural conditions, the study may help researchers and policy makers in designing effective prevention programs to reduce the burden of MI all over the world, said Salim Yusuf, D.Phil., of the Population Health Research Institute, Hamilton (Ont.) General Hospital, and his associates.

The INTERHEART investigators gathered data from a total of 262 centers in 52 countries.

In the first study of 11,119 patients enrolled within 24 hours of acute MI and 13,648 controls matched by age and sex, the researchers assessed psychosocial stress using four simple questions about stress at work and home, financial stress, and major life events in the past year. They also asked about locus of control and depression symptoms (Lancet 2004;364:953-62).

MI patients reported higher prevalence rates of all four stress factors in the past 12 months. Of the MI patients still working, 23% reported several periods of work-related stress, compared with 18% of controls still working; 10% of working MI patients also reported permanent work-related stress, compared with 5% of working controls.

The population adjusted risk (PAR) among those working was 9%, said Annika Rosengren, M.D., of Sahlgrenska University Hospital/Ostra, Göteborg, Sweden, and her associates.

MI patients also reported more frequent periods of stress at home during the previous 12 months than did controls. Compared with controls, more MI patients experienced several periods of home-related stress, and more MI patients reported permanent home-related stress than did controls. The PAR for home-related stress was 8%, they said.

High locus of control demonstrated a protective factor, as the PAR for low locus of control was 16%, the researchers said.

For those who reported general stress—a combination of home- and work-related stress—the PAR was 12%. After adjustment for all factors, including financial stress, depression, and smoking, the PAR was 33%, Dr. Rosengren and her associates said.

For women, unlike in men, work stress did not seem to be associated with an increased risk of MI, but these data should be interpreted with caution as several subgroup analyses were performed, they said. Women and men were similar in all other effects.

Stress was more common among MI patients than controls in all geographic regions, even though the prevalence of moderate or severe general stress ranged from 8% among Chinese controls to 35% in North American controls.

“If this effect is truly causal, the importance of psychosocial factors is much more important than commonly recognized, and might contribute to a substantial proportion of acute myocardial infarction,” the investigators concluded.

In a related editorial, Majid Ezzati of the Harvard School of Public Health, Boston, said, “The major step taken by INTERHEART is to confirm the similarly large role of multiple risks across populations.” He added that the study “strengthens the broad conclusions that adverse and positive psychosocial factors are important determinants of physical health, irrespective of the sociocultural context” (Lancet 2004;364:912-4).

In a second, related study, the researchers enrolled 12,461 patients within 24 hours of acute MI and 14,637 controls matched by age and sex.

Next, they determined the relationship between MI and nine easily measured protective or risk factors for a first MI: smoking, lipids, self-reported hypertension (HT), diabetes, obesity, diet, physical activity, alcohol consumption, and psychosocial factors.

These nine risk factors, according to Dr. Yusuf and his associates, “are associated with more than 90% of the risk of an acute myocardial infarction in this large, global, case-control study” (Lancet 2004; 364:937-52).

When broken out by sex, the population-associated risk (PAR) for the nine factors was 90% in men and 94% in women, according to the researchers. Overall, 76% of MI patients were men, as were 74% of controls. All of the risk factors were significantly associated with acute MI, except for alcohol, which had a weaker association.

Smoking and raised ApoB/ApoA1 ratio (top vs. lowest quintile) were the strongest risk factors for MI after multivariate analysis.

Smoking increased the PAR by 36% for current and former smokers, compared with those who had never smoked, Dr. Yusuf said, while raised blood apolipoproteins raised the PAR by 49% for the top four quintiles versus the lowest quintile.

The next strongest risk factors for MI were history of hypertension, which added an 18% PAR, and diabetes, which added an additional PAR of 10%. The next riskiest factor was abdominal obesity, with a PAR of 20% for the top two tertiles versus the lowest tertile, followed by psychosocial factors, with a PAR of 32.5%.

Failing to consume fruit and vegetables every day was associated with a PAR of 14%, regular moderate alcohol consumption was linked to a protective effect of 7% in the PAR, and regular physical activity had a protective effect on PAR of 12%.

“One of the most important risk factors for acute myocardial infarction in our study was smoking, which accounts for about 36% of the PAR of acute myocardial infraction worldwide (and about 44% in men). Regular consumption of fruits and vegetables was associated with a 30% relative risk reduction,” Dr. Yusuf and his associates said.

“Thus, eating fruit and vegetables, taking exercise, and avoiding smoking could lead to about 80% lower relative risk for myocardial infarction,” the researchers added.

The researchers noticed a “clear, significant, and consistent excess risk” of acute MI in most regions of the world and in every ethnic group for most of these risk factors, with the exceptions of alcohol consumption, exercise, and diet.

Among all regions, the nine risk factors accounted for between three-quarters and nearly all of the PAR for acute MI. “However, raised lipids, smoking, and psychosocial factors were the most important risk factors in all regions of the world,” Dr. Yusuf reported.

Although geographic priorities can differ by region because of differences in prevalence of risk factors such as diet, disease, and economic circumstances, the approaches to prevention can be based on similar principles throughout the world, the researchers said.

This study will probably inspire much more research in these areas and “contribute to an aura of legitimacy for behavioral research studies” and “make it easier for future behavioral research to reach a wider medical audience,” David S. Sheps, M.D., of the University of Florida, Gainesville, and his associates said in an accompanying editorial (Psychosomatic Medicine 2004;66:797-8).

Psychosocial risk factors such as stress, depression, and low generalized locus of control are associated with an increased risk of acute MI among patients of all ages and of both sexes from every region of the world, according to two reports from the INTERHEART study.

By determining the role of risk factors across sociocultural conditions, the study may help researchers and policy makers in designing effective prevention programs to reduce the burden of MI all over the world, said Salim Yusuf, D.Phil., of the Population Health Research Institute, Hamilton (Ont.) General Hospital, and his associates.

The INTERHEART investigators gathered data from a total of 262 centers in 52 countries.

In the first study of 11,119 patients enrolled within 24 hours of acute MI and 13,648 controls matched by age and sex, the researchers assessed psychosocial stress using four simple questions about stress at work and home, financial stress, and major life events in the past year. They also asked about locus of control and depression symptoms (Lancet 2004;364:953-62).

MI patients reported higher prevalence rates of all four stress factors in the past 12 months. Of the MI patients still working, 23% reported several periods of work-related stress, compared with 18% of controls still working; 10% of working MI patients also reported permanent work-related stress, compared with 5% of working controls.

The population adjusted risk (PAR) among those working was 9%, said Annika Rosengren, M.D., of Sahlgrenska University Hospital/Ostra, Göteborg, Sweden, and her associates.

MI patients also reported more frequent periods of stress at home during the previous 12 months than did controls. Compared with controls, more MI patients experienced several periods of home-related stress, and more MI patients reported permanent home-related stress than did controls. The PAR for home-related stress was 8%, they said.

High locus of control demonstrated a protective factor, as the PAR for low locus of control was 16%, the researchers said.

For those who reported general stress—a combination of home- and work-related stress—the PAR was 12%. After adjustment for all factors, including financial stress, depression, and smoking, the PAR was 33%, Dr. Rosengren and her associates said.

For women, unlike in men, work stress did not seem to be associated with an increased risk of MI, but these data should be interpreted with caution as several subgroup analyses were performed, they said. Women and men were similar in all other effects.

Stress was more common among MI patients than controls in all geographic regions, even though the prevalence of moderate or severe general stress ranged from 8% among Chinese controls to 35% in North American controls.

“If this effect is truly causal, the importance of psychosocial factors is much more important than commonly recognized, and might contribute to a substantial proportion of acute myocardial infarction,” the investigators concluded.

In a related editorial, Majid Ezzati of the Harvard School of Public Health, Boston, said, “The major step taken by INTERHEART is to confirm the similarly large role of multiple risks across populations.” He added that the study “strengthens the broad conclusions that adverse and positive psychosocial factors are important determinants of physical health, irrespective of the sociocultural context” (Lancet 2004;364:912-4).

In a second, related study, the researchers enrolled 12,461 patients within 24 hours of acute MI and 14,637 controls matched by age and sex.

Next, they determined the relationship between MI and nine easily measured protective or risk factors for a first MI: smoking, lipids, self-reported hypertension (HT), diabetes, obesity, diet, physical activity, alcohol consumption, and psychosocial factors.

These nine risk factors, according to Dr. Yusuf and his associates, “are associated with more than 90% of the risk of an acute myocardial infarction in this large, global, case-control study” (Lancet 2004; 364:937-52).

When broken out by sex, the population-associated risk (PAR) for the nine factors was 90% in men and 94% in women, according to the researchers. Overall, 76% of MI patients were men, as were 74% of controls. All of the risk factors were significantly associated with acute MI, except for alcohol, which had a weaker association.

Smoking and raised ApoB/ApoA1 ratio (top vs. lowest quintile) were the strongest risk factors for MI after multivariate analysis.

Smoking increased the PAR by 36% for current and former smokers, compared with those who had never smoked, Dr. Yusuf said, while raised blood apolipoproteins raised the PAR by 49% for the top four quintiles versus the lowest quintile.

The next strongest risk factors for MI were history of hypertension, which added an 18% PAR, and diabetes, which added an additional PAR of 10%. The next riskiest factor was abdominal obesity, with a PAR of 20% for the top two tertiles versus the lowest tertile, followed by psychosocial factors, with a PAR of 32.5%.

Failing to consume fruit and vegetables every day was associated with a PAR of 14%, regular moderate alcohol consumption was linked to a protective effect of 7% in the PAR, and regular physical activity had a protective effect on PAR of 12%.

“One of the most important risk factors for acute myocardial infarction in our study was smoking, which accounts for about 36% of the PAR of acute myocardial infraction worldwide (and about 44% in men). Regular consumption of fruits and vegetables was associated with a 30% relative risk reduction,” Dr. Yusuf and his associates said.

“Thus, eating fruit and vegetables, taking exercise, and avoiding smoking could lead to about 80% lower relative risk for myocardial infarction,” the researchers added.

The researchers noticed a “clear, significant, and consistent excess risk” of acute MI in most regions of the world and in every ethnic group for most of these risk factors, with the exceptions of alcohol consumption, exercise, and diet.

Among all regions, the nine risk factors accounted for between three-quarters and nearly all of the PAR for acute MI. “However, raised lipids, smoking, and psychosocial factors were the most important risk factors in all regions of the world,” Dr. Yusuf reported.

Although geographic priorities can differ by region because of differences in prevalence of risk factors such as diet, disease, and economic circumstances, the approaches to prevention can be based on similar principles throughout the world, the researchers said.

This study will probably inspire much more research in these areas and “contribute to an aura of legitimacy for behavioral research studies” and “make it easier for future behavioral research to reach a wider medical audience,” David S. Sheps, M.D., of the University of Florida, Gainesville, and his associates said in an accompanying editorial (Psychosomatic Medicine 2004;66:797-8).

Psychosocial risk factors such as stress, depression, and low generalized locus of control are associated with an increased risk of acute MI among patients of all ages and of both sexes from every region of the world, according to two reports from the INTERHEART study.

By determining the role of risk factors across sociocultural conditions, the study may help researchers and policy makers in designing effective prevention programs to reduce the burden of MI all over the world, said Salim Yusuf, D.Phil., of the Population Health Research Institute, Hamilton (Ont.) General Hospital, and his associates.

The INTERHEART investigators gathered data from a total of 262 centers in 52 countries.

In the first study of 11,119 patients enrolled within 24 hours of acute MI and 13,648 controls matched by age and sex, the researchers assessed psychosocial stress using four simple questions about stress at work and home, financial stress, and major life events in the past year. They also asked about locus of control and depression symptoms (Lancet 2004;364:953-62).

MI patients reported higher prevalence rates of all four stress factors in the past 12 months. Of the MI patients still working, 23% reported several periods of work-related stress, compared with 18% of controls still working; 10% of working MI patients also reported permanent work-related stress, compared with 5% of working controls.

The population adjusted risk (PAR) among those working was 9%, said Annika Rosengren, M.D., of Sahlgrenska University Hospital/Ostra, Göteborg, Sweden, and her associates.

MI patients also reported more frequent periods of stress at home during the previous 12 months than did controls. Compared with controls, more MI patients experienced several periods of home-related stress, and more MI patients reported permanent home-related stress than did controls. The PAR for home-related stress was 8%, they said.

High locus of control demonstrated a protective factor, as the PAR for low locus of control was 16%, the researchers said.

For those who reported general stress—a combination of home- and work-related stress—the PAR was 12%. After adjustment for all factors, including financial stress, depression, and smoking, the PAR was 33%, Dr. Rosengren and her associates said.

For women, unlike in men, work stress did not seem to be associated with an increased risk of MI, but these data should be interpreted with caution as several subgroup analyses were performed, they said. Women and men were similar in all other effects.

Stress was more common among MI patients than controls in all geographic regions, even though the prevalence of moderate or severe general stress ranged from 8% among Chinese controls to 35% in North American controls.

“If this effect is truly causal, the importance of psychosocial factors is much more important than commonly recognized, and might contribute to a substantial proportion of acute myocardial infarction,” the investigators concluded.

In a related editorial, Majid Ezzati of the Harvard School of Public Health, Boston, said, “The major step taken by INTERHEART is to confirm the similarly large role of multiple risks across populations.” He added that the study “strengthens the broad conclusions that adverse and positive psychosocial factors are important determinants of physical health, irrespective of the sociocultural context” (Lancet 2004;364:912-4).

In a second, related study, the researchers enrolled 12,461 patients within 24 hours of acute MI and 14,637 controls matched by age and sex.

Next, they determined the relationship between MI and nine easily measured protective or risk factors for a first MI: smoking, lipids, self-reported hypertension (HT), diabetes, obesity, diet, physical activity, alcohol consumption, and psychosocial factors.

These nine risk factors, according to Dr. Yusuf and his associates, “are associated with more than 90% of the risk of an acute myocardial infarction in this large, global, case-control study” (Lancet 2004; 364:937-52).

When broken out by sex, the population-associated risk (PAR) for the nine factors was 90% in men and 94% in women, according to the researchers. Overall, 76% of MI patients were men, as were 74% of controls. All of the risk factors were significantly associated with acute MI, except for alcohol, which had a weaker association.

Smoking and raised ApoB/ApoA1 ratio (top vs. lowest quintile) were the strongest risk factors for MI after multivariate analysis.

Smoking increased the PAR by 36% for current and former smokers, compared with those who had never smoked, Dr. Yusuf said, while raised blood apolipoproteins raised the PAR by 49% for the top four quintiles versus the lowest quintile.

The next strongest risk factors for MI were history of hypertension, which added an 18% PAR, and diabetes, which added an additional PAR of 10%. The next riskiest factor was abdominal obesity, with a PAR of 20% for the top two tertiles versus the lowest tertile, followed by psychosocial factors, with a PAR of 32.5%.

Failing to consume fruit and vegetables every day was associated with a PAR of 14%, regular moderate alcohol consumption was linked to a protective effect of 7% in the PAR, and regular physical activity had a protective effect on PAR of 12%.

“One of the most important risk factors for acute myocardial infarction in our study was smoking, which accounts for about 36% of the PAR of acute myocardial infraction worldwide (and about 44% in men). Regular consumption of fruits and vegetables was associated with a 30% relative risk reduction,” Dr. Yusuf and his associates said.

“Thus, eating fruit and vegetables, taking exercise, and avoiding smoking could lead to about 80% lower relative risk for myocardial infarction,” the researchers added.

The researchers noticed a “clear, significant, and consistent excess risk” of acute MI in most regions of the world and in every ethnic group for most of these risk factors, with the exceptions of alcohol consumption, exercise, and diet.

Among all regions, the nine risk factors accounted for between three-quarters and nearly all of the PAR for acute MI. “However, raised lipids, smoking, and psychosocial factors were the most important risk factors in all regions of the world,” Dr. Yusuf reported.

Although geographic priorities can differ by region because of differences in prevalence of risk factors such as diet, disease, and economic circumstances, the approaches to prevention can be based on similar principles throughout the world, the researchers said.

This study will probably inspire much more research in these areas and “contribute to an aura of legitimacy for behavioral research studies” and “make it easier for future behavioral research to reach a wider medical audience,” David S. Sheps, M.D., of the University of Florida, Gainesville, and his associates said in an accompanying editorial (Psychosomatic Medicine 2004;66:797-8).