Jennie Smith

The clinical effectiveness agency for England and Wales said it plans to formally recommend three tumor necrosis factor inhibitors – etanercept, infliximab, and adalimumab – interchangeably for the treatment of psoriatic arthritis, saying the evidence suggests that they are equally safe and work equally well.

Current National Institute for Health and Clinical Excellence guidance mandates that infliximab be prescribed only in the event that etanercept or adalimumab (the two less expensive drugs) were contraindicated.

In draft guidance published June 11, NICE reviewers proposed that all three drugs be made available according to which is cheapest in a particular treatment setting.

People with active and progressive psoriatic arthritis who have peripheral arthritis with three or more tender joints, three or more swollen joints, and no response to at least two standard disease-modifying antirheumatic drugs (usually methotrexate and sulfasalazine, alone or in combination) are eligible for the treatments.

After examining data from randomized, controlled trials, the NICE reviewers determined that infliximab was associated with the highest probability of achieving a response for both the skin and joint symptoms in people with psoriatic arthritis.

The probability of response in joint disease was higher with etanercept than with adalimumab, they noted, and the probability of response in skin disease was higher with adalimumab than with etanercept. However, they urged that price be the sole determinant of TNF-inhibitor choice in each clinical setting.

Etanercept and adalimumab carry a similar price tag of about £9,300 each for the first treatment year, compared with £10,910 for infliximab. However, the NICE reviewers noted, “vial sharing arrangements for infliximab are available in some clinical settings and may reduce drug wastage by up to 50%,” and may make infliximab the cost-effective choice.

With any of the three drugs, NICE said, treatment should be terminated after 12 weeks if there is no adequate joint response, according to established criteria for psoriatic arthritis, although a dermatologist may find continuing treatment to be appropriate on the basis of skin response.

Final guidance on etanercept, infliximab, and adalimumab is expected in July, the agency said.

The clinical effectiveness agency for England and Wales said it plans to formally recommend three tumor necrosis factor inhibitors – etanercept, infliximab, and adalimumab – interchangeably for the treatment of psoriatic arthritis, saying the evidence suggests that they are equally safe and work equally well.

Current National Institute for Health and Clinical Excellence guidance mandates that infliximab be prescribed only in the event that etanercept or adalimumab (the two less expensive drugs) were contraindicated.

In draft guidance published June 11, NICE reviewers proposed that all three drugs be made available according to which is cheapest in a particular treatment setting.

People with active and progressive psoriatic arthritis who have peripheral arthritis with three or more tender joints, three or more swollen joints, and no response to at least two standard disease-modifying antirheumatic drugs (usually methotrexate and sulfasalazine, alone or in combination) are eligible for the treatments.

After examining data from randomized, controlled trials, the NICE reviewers determined that infliximab was associated with the highest probability of achieving a response for both the skin and joint symptoms in people with psoriatic arthritis.

The probability of response in joint disease was higher with etanercept than with adalimumab, they noted, and the probability of response in skin disease was higher with adalimumab than with etanercept. However, they urged that price be the sole determinant of TNF-inhibitor choice in each clinical setting.

Etanercept and adalimumab carry a similar price tag of about £9,300 each for the first treatment year, compared with £10,910 for infliximab. However, the NICE reviewers noted, “vial sharing arrangements for infliximab are available in some clinical settings and may reduce drug wastage by up to 50%,” and may make infliximab the cost-effective choice.

With any of the three drugs, NICE said, treatment should be terminated after 12 weeks if there is no adequate joint response, according to established criteria for psoriatic arthritis, although a dermatologist may find continuing treatment to be appropriate on the basis of skin response.

Final guidance on etanercept, infliximab, and adalimumab is expected in July, the agency said.

The clinical effectiveness agency for England and Wales said it plans to formally recommend three tumor necrosis factor inhibitors – etanercept, infliximab, and adalimumab – interchangeably for the treatment of psoriatic arthritis, saying the evidence suggests that they are equally safe and work equally well.

Current National Institute for Health and Clinical Excellence guidance mandates that infliximab be prescribed only in the event that etanercept or adalimumab (the two less expensive drugs) were contraindicated.

In draft guidance published June 11, NICE reviewers proposed that all three drugs be made available according to which is cheapest in a particular treatment setting.

People with active and progressive psoriatic arthritis who have peripheral arthritis with three or more tender joints, three or more swollen joints, and no response to at least two standard disease-modifying antirheumatic drugs (usually methotrexate and sulfasalazine, alone or in combination) are eligible for the treatments.

After examining data from randomized, controlled trials, the NICE reviewers determined that infliximab was associated with the highest probability of achieving a response for both the skin and joint symptoms in people with psoriatic arthritis.

The probability of response in joint disease was higher with etanercept than with adalimumab, they noted, and the probability of response in skin disease was higher with adalimumab than with etanercept. However, they urged that price be the sole determinant of TNF-inhibitor choice in each clinical setting.

Etanercept and adalimumab carry a similar price tag of about £9,300 each for the first treatment year, compared with £10,910 for infliximab. However, the NICE reviewers noted, “vial sharing arrangements for infliximab are available in some clinical settings and may reduce drug wastage by up to 50%,” and may make infliximab the cost-effective choice.

With any of the three drugs, NICE said, treatment should be terminated after 12 weeks if there is no adequate joint response, according to established criteria for psoriatic arthritis, although a dermatologist may find continuing treatment to be appropriate on the basis of skin response.

Final guidance on etanercept, infliximab, and adalimumab is expected in July, the agency said.

Major Finding: Of the pupils who had taken oseltamivir, 41% reported adverse effects, most often nausea (26%), abdominal pain (20%), and headache (12%); nearly half of the staff who took the drug reported adverse effects.

Data Source: A single-school study of 53 staff and 273 students who were given a questionnaire regarding flulike illness and adverse effects following oseltamivir prophylaxis.

Disclosures: None was reported.

British schoolchildren and staff given oseltamivir as prophylaxis during the start of the influenza A(H1N1) pandemic reacted poorly to the medication, yet this study's lead author says the findings do not diminish the potential value of the strategy during a pandemic.

“If another pandemic of unknown severity comes along, we will probably do the same,” Dr. Mark Strong of the University of Sheffield (England) said in an interview.

“We will act cautiously and use prophylaxis widely in the initial stages if we expect it to be protective. We will only stop doing this when either the strategy no longer has any hope of controlling spread, or if the disease is found to be mild.”

In June 2009, 10 laboratory-confirmed cases of pandemic influenza were identified at a primary school in Sheffield. Representatives of the National Health Service (NHS) in Sheffield offered all the school's students and staff age-appropriate doses of oseltamivir (60 mg for pupils; 75 mg for adults; Tamiflu) twice daily for 5 days prior to closing the school for a week. A total of 53 staff members (91%) and 273 students (92%) accepted.

For their research, Dr. Strong and his colleagues at the university and the NHS distributed a questionnaire 2 weeks after the outbreak to identify the incidence of influenzalike illness and adverse drug effects after the intervention. Response rates were 84% for staff and 62% for pupils.

Of the respondents, 17% of pupils and 17% of staff said they had developed an influenzalike illness, with headache, cough, fever, tiredness, sore throat, and nausea the most common symptoms reported (Euro. Surveill. 2010;15:pii=19565).

Forty-one percent of the 273 pupils who had taken the drug reported adverse effects, most commonly nausea (26%), abdominal pain (20%), and headache (12%); nearly half the 53 adult staff reported adverse effects. Fourteen percent of pupils and 20% of staff reported not completing the course of medication because of adverse effects.

The findings of adverse effects differed slightly from those of two earlier observational studies of oseltamivir prophylaxis in British schoolchildren at the start of the 2009 pandemic (Euro. Surveill. 2009;14:pii=19285; Euro. Surveill. 2009;14:pii=19287). These studies reported adverse effects among more than half of pupils at two different schools.

However, Dr. Strong and his colleagues noted, “the majority of children in the previous studies were of secondary school age, and therefore older than our cohort,” which included pupils between the ages of 7 and 12 (mean age 9.5). “It is possible that older children are more likely to either experience, or report experiencing, adverse effects following the use of oseltamivir,” they wrote.

Because a number of reported adverse effects overlapped with symptoms of influenza-like illness (for example, nausea), Dr. Strong and colleagues acknowledged in their analysis that it was not possible to determine whether the reported symptoms comprised flulike illness or drug reactions.

A further limitation of their study, they noted, was that it relied heavily on self-reporting by children—the questionnaire included, among other things, a series of smiling or frowning cartoon faces that children could choose from to describe their health state. Moreover, determining the efficacy of the intervention in containing a flu outbreak was not possible in such a study.

The adverse effects, however, were shown to be significant and added weight to the earlier studies, leading investigators to conclude that any prophylaxis attempt had to be balanced against the severity of the targeted disease.

At the time of the intervention, Dr. Strong said, the potential severity of the H1N1 pandemic was unknown, “and though we explained to the children and the families that there could be adverse effects, the uncertainty was such that people were more than happy to take the medication.” Had the pandemic proven more severe, Dr. Strong said, the interventions may have seemed more reasonable in hindsight, and “it is all about trading off benefits and harms in the face of uncertainty.”

In the case of 2009 H1N1, however, the adverse effects seem to have outweighed the benefits.

“Our findings have two important implications,” Dr. Strong and colleagues concluded in their analysis. “Firstly, the benefits of mass treatment in an outbreak setting must clearly be greater than the benefits of targeted treatment. Secondly, any large scale regional or state level system for distribution of antiviral drugs for treatment should ideally include a robust quantification of an individual's probability of infection with influenza virus in order to avoid unnecessary treatment.”

In an editorial accompanying Dr. Strong and collegues' findings, epidemiologist Johan Giesecke of the European Centre for Disease Prevention and Control wrote that though the British school studies “add to our knowledge of the spectrum of adverse events when oseltamivir is used for treatment and/or prophylaxis in large groups of children,” they also demonstrate “that expected benefits must be weighed carefully against side effects when this drug is considered for outbreak situations.”

For future outbreaks, Dr. Giesecke cautioned, it may be best to try to develop “a simple instrument to decide who in the group would be at the highest risk of exposure and infection.”

Also, he wrote, “even if antivirals are given to school children in order to diminish spread in society, the studies cited here indicate that this effect is limited—influenza is spreading also outside the school yards.”

Major Finding: Of the pupils who had taken oseltamivir, 41% reported adverse effects, most often nausea (26%), abdominal pain (20%), and headache (12%); nearly half of the staff who took the drug reported adverse effects.

Data Source: A single-school study of 53 staff and 273 students who were given a questionnaire regarding flulike illness and adverse effects following oseltamivir prophylaxis.

Disclosures: None was reported.

British schoolchildren and staff given oseltamivir as prophylaxis during the start of the influenza A(H1N1) pandemic reacted poorly to the medication, yet this study's lead author says the findings do not diminish the potential value of the strategy during a pandemic.

“If another pandemic of unknown severity comes along, we will probably do the same,” Dr. Mark Strong of the University of Sheffield (England) said in an interview.

“We will act cautiously and use prophylaxis widely in the initial stages if we expect it to be protective. We will only stop doing this when either the strategy no longer has any hope of controlling spread, or if the disease is found to be mild.”

In June 2009, 10 laboratory-confirmed cases of pandemic influenza were identified at a primary school in Sheffield. Representatives of the National Health Service (NHS) in Sheffield offered all the school's students and staff age-appropriate doses of oseltamivir (60 mg for pupils; 75 mg for adults; Tamiflu) twice daily for 5 days prior to closing the school for a week. A total of 53 staff members (91%) and 273 students (92%) accepted.

For their research, Dr. Strong and his colleagues at the university and the NHS distributed a questionnaire 2 weeks after the outbreak to identify the incidence of influenzalike illness and adverse drug effects after the intervention. Response rates were 84% for staff and 62% for pupils.

Of the respondents, 17% of pupils and 17% of staff said they had developed an influenzalike illness, with headache, cough, fever, tiredness, sore throat, and nausea the most common symptoms reported (Euro. Surveill. 2010;15:pii=19565).

Forty-one percent of the 273 pupils who had taken the drug reported adverse effects, most commonly nausea (26%), abdominal pain (20%), and headache (12%); nearly half the 53 adult staff reported adverse effects. Fourteen percent of pupils and 20% of staff reported not completing the course of medication because of adverse effects.

The findings of adverse effects differed slightly from those of two earlier observational studies of oseltamivir prophylaxis in British schoolchildren at the start of the 2009 pandemic (Euro. Surveill. 2009;14:pii=19285; Euro. Surveill. 2009;14:pii=19287). These studies reported adverse effects among more than half of pupils at two different schools.

However, Dr. Strong and his colleagues noted, “the majority of children in the previous studies were of secondary school age, and therefore older than our cohort,” which included pupils between the ages of 7 and 12 (mean age 9.5). “It is possible that older children are more likely to either experience, or report experiencing, adverse effects following the use of oseltamivir,” they wrote.

Because a number of reported adverse effects overlapped with symptoms of influenza-like illness (for example, nausea), Dr. Strong and colleagues acknowledged in their analysis that it was not possible to determine whether the reported symptoms comprised flulike illness or drug reactions.

A further limitation of their study, they noted, was that it relied heavily on self-reporting by children—the questionnaire included, among other things, a series of smiling or frowning cartoon faces that children could choose from to describe their health state. Moreover, determining the efficacy of the intervention in containing a flu outbreak was not possible in such a study.

The adverse effects, however, were shown to be significant and added weight to the earlier studies, leading investigators to conclude that any prophylaxis attempt had to be balanced against the severity of the targeted disease.

At the time of the intervention, Dr. Strong said, the potential severity of the H1N1 pandemic was unknown, “and though we explained to the children and the families that there could be adverse effects, the uncertainty was such that people were more than happy to take the medication.” Had the pandemic proven more severe, Dr. Strong said, the interventions may have seemed more reasonable in hindsight, and “it is all about trading off benefits and harms in the face of uncertainty.”

In the case of 2009 H1N1, however, the adverse effects seem to have outweighed the benefits.

“Our findings have two important implications,” Dr. Strong and colleagues concluded in their analysis. “Firstly, the benefits of mass treatment in an outbreak setting must clearly be greater than the benefits of targeted treatment. Secondly, any large scale regional or state level system for distribution of antiviral drugs for treatment should ideally include a robust quantification of an individual's probability of infection with influenza virus in order to avoid unnecessary treatment.”

In an editorial accompanying Dr. Strong and collegues' findings, epidemiologist Johan Giesecke of the European Centre for Disease Prevention and Control wrote that though the British school studies “add to our knowledge of the spectrum of adverse events when oseltamivir is used for treatment and/or prophylaxis in large groups of children,” they also demonstrate “that expected benefits must be weighed carefully against side effects when this drug is considered for outbreak situations.”

For future outbreaks, Dr. Giesecke cautioned, it may be best to try to develop “a simple instrument to decide who in the group would be at the highest risk of exposure and infection.”

Also, he wrote, “even if antivirals are given to school children in order to diminish spread in society, the studies cited here indicate that this effect is limited—influenza is spreading also outside the school yards.”

Major Finding: Of the pupils who had taken oseltamivir, 41% reported adverse effects, most often nausea (26%), abdominal pain (20%), and headache (12%); nearly half of the staff who took the drug reported adverse effects.

Data Source: A single-school study of 53 staff and 273 students who were given a questionnaire regarding flulike illness and adverse effects following oseltamivir prophylaxis.

Disclosures: None was reported.

British schoolchildren and staff given oseltamivir as prophylaxis during the start of the influenza A(H1N1) pandemic reacted poorly to the medication, yet this study's lead author says the findings do not diminish the potential value of the strategy during a pandemic.

“If another pandemic of unknown severity comes along, we will probably do the same,” Dr. Mark Strong of the University of Sheffield (England) said in an interview.

“We will act cautiously and use prophylaxis widely in the initial stages if we expect it to be protective. We will only stop doing this when either the strategy no longer has any hope of controlling spread, or if the disease is found to be mild.”

In June 2009, 10 laboratory-confirmed cases of pandemic influenza were identified at a primary school in Sheffield. Representatives of the National Health Service (NHS) in Sheffield offered all the school's students and staff age-appropriate doses of oseltamivir (60 mg for pupils; 75 mg for adults; Tamiflu) twice daily for 5 days prior to closing the school for a week. A total of 53 staff members (91%) and 273 students (92%) accepted.

For their research, Dr. Strong and his colleagues at the university and the NHS distributed a questionnaire 2 weeks after the outbreak to identify the incidence of influenzalike illness and adverse drug effects after the intervention. Response rates were 84% for staff and 62% for pupils.

Of the respondents, 17% of pupils and 17% of staff said they had developed an influenzalike illness, with headache, cough, fever, tiredness, sore throat, and nausea the most common symptoms reported (Euro. Surveill. 2010;15:pii=19565).

Forty-one percent of the 273 pupils who had taken the drug reported adverse effects, most commonly nausea (26%), abdominal pain (20%), and headache (12%); nearly half the 53 adult staff reported adverse effects. Fourteen percent of pupils and 20% of staff reported not completing the course of medication because of adverse effects.

The findings of adverse effects differed slightly from those of two earlier observational studies of oseltamivir prophylaxis in British schoolchildren at the start of the 2009 pandemic (Euro. Surveill. 2009;14:pii=19285; Euro. Surveill. 2009;14:pii=19287). These studies reported adverse effects among more than half of pupils at two different schools.

However, Dr. Strong and his colleagues noted, “the majority of children in the previous studies were of secondary school age, and therefore older than our cohort,” which included pupils between the ages of 7 and 12 (mean age 9.5). “It is possible that older children are more likely to either experience, or report experiencing, adverse effects following the use of oseltamivir,” they wrote.

Because a number of reported adverse effects overlapped with symptoms of influenza-like illness (for example, nausea), Dr. Strong and colleagues acknowledged in their analysis that it was not possible to determine whether the reported symptoms comprised flulike illness or drug reactions.

A further limitation of their study, they noted, was that it relied heavily on self-reporting by children—the questionnaire included, among other things, a series of smiling or frowning cartoon faces that children could choose from to describe their health state. Moreover, determining the efficacy of the intervention in containing a flu outbreak was not possible in such a study.

The adverse effects, however, were shown to be significant and added weight to the earlier studies, leading investigators to conclude that any prophylaxis attempt had to be balanced against the severity of the targeted disease.

At the time of the intervention, Dr. Strong said, the potential severity of the H1N1 pandemic was unknown, “and though we explained to the children and the families that there could be adverse effects, the uncertainty was such that people were more than happy to take the medication.” Had the pandemic proven more severe, Dr. Strong said, the interventions may have seemed more reasonable in hindsight, and “it is all about trading off benefits and harms in the face of uncertainty.”

In the case of 2009 H1N1, however, the adverse effects seem to have outweighed the benefits.

“Our findings have two important implications,” Dr. Strong and colleagues concluded in their analysis. “Firstly, the benefits of mass treatment in an outbreak setting must clearly be greater than the benefits of targeted treatment. Secondly, any large scale regional or state level system for distribution of antiviral drugs for treatment should ideally include a robust quantification of an individual's probability of infection with influenza virus in order to avoid unnecessary treatment.”

In an editorial accompanying Dr. Strong and collegues' findings, epidemiologist Johan Giesecke of the European Centre for Disease Prevention and Control wrote that though the British school studies “add to our knowledge of the spectrum of adverse events when oseltamivir is used for treatment and/or prophylaxis in large groups of children,” they also demonstrate “that expected benefits must be weighed carefully against side effects when this drug is considered for outbreak situations.”

For future outbreaks, Dr. Giesecke cautioned, it may be best to try to develop “a simple instrument to decide who in the group would be at the highest risk of exposure and infection.”

Also, he wrote, “even if antivirals are given to school children in order to diminish spread in society, the studies cited here indicate that this effect is limited—influenza is spreading also outside the school yards.”

Patients with Barrett's esophagus who took statin drugs had a 45% lower risk of developing esophageal adenocarcinoma than did similar patients not taking statins, and patients taking aspirin or NSAIDs also had a reduced risk, Dr. Hashem B. El-Serag and his colleagues reported.

To learn more about the effect of statins, proton pump inhibitors, aspirin, and NSAIDs on progression of Barrett's esophagus (BE) to cancer, researchers at the Department of Veterans Affairs Medical Center and Baylor College of Medicine, both in Houston, used a national VA database to identify 11,823 records of people diagnosed with Barrett's between 2000 and 2002 (Gastroenterology 2010 June [doi: 10.1053/j.gastro.2010.02.045]).

Among these records, they identified 116 cases of esophageal adenocarcinoma and 696 controls who had BE but not adenocarcinoma. The controls and cases were matched for age (within 5 years), race (78% of cases and 73% of controls were white), and sex (97% of both cases and controls were men). Data were subsequently adjusted for frequency of outpatient visits and socioeconomic status.

All of the controls had been diagnosed with BE on the same date (plus or minus 14 days) as the cases. The researchers examined records of prescriptions filled by the cancer patients between their BE diagnosis and cancer diagnosis, and looked at prescriptions filled by controls for 2 years after BE diagnosis.

Filled prescriptions for statins and aspirin/NSAIDs were associated, to different degrees, with a decreased risk of developing esophageal adenocarcinoma in people with BE.

A 36% decrease in cancer risk was found for aspirin/NSAIDs, and this “was largely expected although not previously shown in a cohort of BE patients,” Dr. El-Serag said in an interview. With the statins, however, a hypothesis of chemopreventive effects in esophageal adenocarcinoma was based on in vitro studies, “and we were surprised,” he said, about the 45% decrease in risk.

The investigators could not conclude anything about proton pump inhibitors, because use of those drugs was nearly universal among cases and controls. This, said Dr. El-Serag, was not necessarily a bad thing, as it removed a potential confounding factor.

“The key point of the study is that, unlike any previous studies that examined the effect of NSAIDs on esophageal cancer, all the subjects had BE,” Dr. El-Serag said. “Everyone started on an equal playing field. We had pooled data from 128 hospitals, so to my knowledge this is the largest cohort assembled to date.”

Dr. El-Serag and his coauthors wrote in their analysis that the study's limitations included its relatively brief length, using only 2 years of prescribing data, and the fact that the records of prescriptions filled through the VA system likely presented only a partial picture of medications taken.

For the purposes of the study, the actual number of prescriptions filled did not matter—even one fill of a statin drug was considered statin use. “Biologically, it seems implausible that one fill of a statin could have an effect, but we regard one fill as a potential indicator of other fills,” he said.

Also, since NSAIDs and aspirin are readily available over the counter, patients of lower socioeconomic status would likely be the only users of the VA prescriptions to obtain these, presenting another problem for the researchers. “One cannot capture OTC medication with a study like this,” Dr. El-Serag said.

Disclosures: The study was funded in part by a grant from the National Institutes of Health; none of the investigators declared conflicts of interest.

Unlike previous studies examining NSAIDs' effects on esophageal cancer, all the subjects had Barrett's.

Source DR. EL-SERAG

Patients with Barrett's esophagus who took statin drugs had a 45% lower risk of developing esophageal adenocarcinoma than did similar patients not taking statins, and patients taking aspirin or NSAIDs also had a reduced risk, Dr. Hashem B. El-Serag and his colleagues reported.

To learn more about the effect of statins, proton pump inhibitors, aspirin, and NSAIDs on progression of Barrett's esophagus (BE) to cancer, researchers at the Department of Veterans Affairs Medical Center and Baylor College of Medicine, both in Houston, used a national VA database to identify 11,823 records of people diagnosed with Barrett's between 2000 and 2002 (Gastroenterology 2010 June [doi: 10.1053/j.gastro.2010.02.045]).

Among these records, they identified 116 cases of esophageal adenocarcinoma and 696 controls who had BE but not adenocarcinoma. The controls and cases were matched for age (within 5 years), race (78% of cases and 73% of controls were white), and sex (97% of both cases and controls were men). Data were subsequently adjusted for frequency of outpatient visits and socioeconomic status.

All of the controls had been diagnosed with BE on the same date (plus or minus 14 days) as the cases. The researchers examined records of prescriptions filled by the cancer patients between their BE diagnosis and cancer diagnosis, and looked at prescriptions filled by controls for 2 years after BE diagnosis.

Filled prescriptions for statins and aspirin/NSAIDs were associated, to different degrees, with a decreased risk of developing esophageal adenocarcinoma in people with BE.

A 36% decrease in cancer risk was found for aspirin/NSAIDs, and this “was largely expected although not previously shown in a cohort of BE patients,” Dr. El-Serag said in an interview. With the statins, however, a hypothesis of chemopreventive effects in esophageal adenocarcinoma was based on in vitro studies, “and we were surprised,” he said, about the 45% decrease in risk.

The investigators could not conclude anything about proton pump inhibitors, because use of those drugs was nearly universal among cases and controls. This, said Dr. El-Serag, was not necessarily a bad thing, as it removed a potential confounding factor.

“The key point of the study is that, unlike any previous studies that examined the effect of NSAIDs on esophageal cancer, all the subjects had BE,” Dr. El-Serag said. “Everyone started on an equal playing field. We had pooled data from 128 hospitals, so to my knowledge this is the largest cohort assembled to date.”

Dr. El-Serag and his coauthors wrote in their analysis that the study's limitations included its relatively brief length, using only 2 years of prescribing data, and the fact that the records of prescriptions filled through the VA system likely presented only a partial picture of medications taken.

For the purposes of the study, the actual number of prescriptions filled did not matter—even one fill of a statin drug was considered statin use. “Biologically, it seems implausible that one fill of a statin could have an effect, but we regard one fill as a potential indicator of other fills,” he said.

Also, since NSAIDs and aspirin are readily available over the counter, patients of lower socioeconomic status would likely be the only users of the VA prescriptions to obtain these, presenting another problem for the researchers. “One cannot capture OTC medication with a study like this,” Dr. El-Serag said.

Disclosures: The study was funded in part by a grant from the National Institutes of Health; none of the investigators declared conflicts of interest.

Unlike previous studies examining NSAIDs' effects on esophageal cancer, all the subjects had Barrett's.

Source DR. EL-SERAG

Patients with Barrett's esophagus who took statin drugs had a 45% lower risk of developing esophageal adenocarcinoma than did similar patients not taking statins, and patients taking aspirin or NSAIDs also had a reduced risk, Dr. Hashem B. El-Serag and his colleagues reported.

To learn more about the effect of statins, proton pump inhibitors, aspirin, and NSAIDs on progression of Barrett's esophagus (BE) to cancer, researchers at the Department of Veterans Affairs Medical Center and Baylor College of Medicine, both in Houston, used a national VA database to identify 11,823 records of people diagnosed with Barrett's between 2000 and 2002 (Gastroenterology 2010 June [doi: 10.1053/j.gastro.2010.02.045]).

Among these records, they identified 116 cases of esophageal adenocarcinoma and 696 controls who had BE but not adenocarcinoma. The controls and cases were matched for age (within 5 years), race (78% of cases and 73% of controls were white), and sex (97% of both cases and controls were men). Data were subsequently adjusted for frequency of outpatient visits and socioeconomic status.

All of the controls had been diagnosed with BE on the same date (plus or minus 14 days) as the cases. The researchers examined records of prescriptions filled by the cancer patients between their BE diagnosis and cancer diagnosis, and looked at prescriptions filled by controls for 2 years after BE diagnosis.

Filled prescriptions for statins and aspirin/NSAIDs were associated, to different degrees, with a decreased risk of developing esophageal adenocarcinoma in people with BE.

A 36% decrease in cancer risk was found for aspirin/NSAIDs, and this “was largely expected although not previously shown in a cohort of BE patients,” Dr. El-Serag said in an interview. With the statins, however, a hypothesis of chemopreventive effects in esophageal adenocarcinoma was based on in vitro studies, “and we were surprised,” he said, about the 45% decrease in risk.

The investigators could not conclude anything about proton pump inhibitors, because use of those drugs was nearly universal among cases and controls. This, said Dr. El-Serag, was not necessarily a bad thing, as it removed a potential confounding factor.

“The key point of the study is that, unlike any previous studies that examined the effect of NSAIDs on esophageal cancer, all the subjects had BE,” Dr. El-Serag said. “Everyone started on an equal playing field. We had pooled data from 128 hospitals, so to my knowledge this is the largest cohort assembled to date.”

Dr. El-Serag and his coauthors wrote in their analysis that the study's limitations included its relatively brief length, using only 2 years of prescribing data, and the fact that the records of prescriptions filled through the VA system likely presented only a partial picture of medications taken.

For the purposes of the study, the actual number of prescriptions filled did not matter—even one fill of a statin drug was considered statin use. “Biologically, it seems implausible that one fill of a statin could have an effect, but we regard one fill as a potential indicator of other fills,” he said.

Also, since NSAIDs and aspirin are readily available over the counter, patients of lower socioeconomic status would likely be the only users of the VA prescriptions to obtain these, presenting another problem for the researchers. “One cannot capture OTC medication with a study like this,” Dr. El-Serag said.

Disclosures: The study was funded in part by a grant from the National Institutes of Health; none of the investigators declared conflicts of interest.

Unlike previous studies examining NSAIDs' effects on esophageal cancer, all the subjects had Barrett's.

Source DR. EL-SERAG

Major Finding: Evidence of small intestinal bacterial overgrowth was found in 50% of patients on proton pump inhibitors, 24.5% of patients with irritable bowel syndrome, and only 6% of controls.

Data Source: Two hundred gastroesophageal reflux disease patients who were taking PPIs, 200 IBS patients not taking PPIs, and 50 healthy controls.

Disclosures: The study was not funded by outside grants, and neither Dr. Lombardo nor his colleagues reported any competing interests.

Fifty percent of the people taking proton pump inhibitors to treat gastroesophageal reflux disease develop small intestinal bacterial overgrowth, compared with a quarter of the patients with irritable bowel syndrome who are not taking PPIs, according to a study conducted by Dr. Lucio Lombardo and his colleagues.

In the study, 450 consecutive patients underwent glucose hydrogen breath tests, which measure the metabolic activity of enteric bacteria (Clin. Gastroenterol. Hepatol. 2010 [doi:10.1016/j.cgh.2009. 12.022]).

Two hundred of the patients had been diagnosed with gastroesophageal reflux disease and had been taking one of several PPIs for a median of 36 months, although some had taken the medication for as little as 2 months.

The investigators recruited an additional 200 study subjects who had been diagnosed with irritable bowel syndrome (IBS) and were not taking PPIs. Dr. Lombardo and his colleagues noted that the symptoms of IBS—including bloating, diarrhea, and constipation—frequently overlap with the symptoms of small intestinal bacterial overgrowth (SIBO). They also recruited 50 healthy controls who did not have symptoms of either IBS or SIBO and had not taken a PPI for at least 3 years.

Patients with other gastric diseases, who had recent gastric surgery, who were taking antibiotics, or had other potentially confounding factors were excluded.

Evidence of SIBO was found in 50% of the patients on PPIs, 24.5% of patients with IBS, and only 6% of healthy controls, wrote Dr. Lombardo, of the gastroenterology department of Mauriziano U.I. Hospital, Turin, and his colleagues.

Moreover, the researchers found a correlation between the duration of PPI treatment and the detection of SIBO, with more than 70% of the PPI group testing positive for SIBO after 13 months of PPI use—more than triple the proportion of positives among those taking PPIs for a year or less.

Although several studies have used breath-based tests to assess the prevalence of SIBO in patients with IBS, few have been designed to assess the independent influence of PPIs, the investigators wrote. This, they said, is as an “important oversight,” as PPI use is widespread in patients with IBS.

The authors cited a recent study reporting that IBS patients not taking PPIs and GERD patients on PPIs have roughly equal rates of SIBO, as assessed by lactulose breath tests. However, the researchers wrote that no mention was made in that study of the duration of PPI treatment, while their own study showed that PPI treatment increased the incidence of SIBO drastically after the first year.

Dr. Lombardo and his colleagues speculated that PPI-related SIBO might be frequently underdiagnosed or misdiagnosed as IBS because of the overlap of common symptoms.

Patients in the investigation with SIBO were treated with the antibiotic rifaximin 400 mg three times daily for 14 days. Eradication of SIBO, as confirmed by a glucose hydrogen breath test, occurred in 87% of the PPI group and 91% in the IBS group.

In the PPI arm of the study, eradication was more successful among subjects who had taken PPIs for less than a year, which suggested “a more profound or qualitatively different alteration in enteric microflora after a year of treatment,” according to the investigators.

In both the PPI and IBS groups, symptom severity was reduced by more than 90% in subjects whose SIBO eradication had been confirmed by breath testing and to a lesser but measurable degree in those subjects whose SIBO had not been eradicated after the same course of rifaximin.

The investigators did not seek to learn whether SIBO returned after eradication in patients who continued PPI therapy but cited another study suggesting that such an outcome was likely.

The authors noted a few limitations of the study, which included a lack of distinction between specific PPIs taken by the patients, the observational open-label study design, and that fact that Helicobacter pylori was not investigated as an independent contributor (although all 450 patients were tested, with 68% found to be negative).

Major Finding: Evidence of small intestinal bacterial overgrowth was found in 50% of patients on proton pump inhibitors, 24.5% of patients with irritable bowel syndrome, and only 6% of controls.

Data Source: Two hundred gastroesophageal reflux disease patients who were taking PPIs, 200 IBS patients not taking PPIs, and 50 healthy controls.

Disclosures: The study was not funded by outside grants, and neither Dr. Lombardo nor his colleagues reported any competing interests.

Fifty percent of the people taking proton pump inhibitors to treat gastroesophageal reflux disease develop small intestinal bacterial overgrowth, compared with a quarter of the patients with irritable bowel syndrome who are not taking PPIs, according to a study conducted by Dr. Lucio Lombardo and his colleagues.

In the study, 450 consecutive patients underwent glucose hydrogen breath tests, which measure the metabolic activity of enteric bacteria (Clin. Gastroenterol. Hepatol. 2010 [doi:10.1016/j.cgh.2009. 12.022]).

Two hundred of the patients had been diagnosed with gastroesophageal reflux disease and had been taking one of several PPIs for a median of 36 months, although some had taken the medication for as little as 2 months.

The investigators recruited an additional 200 study subjects who had been diagnosed with irritable bowel syndrome (IBS) and were not taking PPIs. Dr. Lombardo and his colleagues noted that the symptoms of IBS—including bloating, diarrhea, and constipation—frequently overlap with the symptoms of small intestinal bacterial overgrowth (SIBO). They also recruited 50 healthy controls who did not have symptoms of either IBS or SIBO and had not taken a PPI for at least 3 years.

Patients with other gastric diseases, who had recent gastric surgery, who were taking antibiotics, or had other potentially confounding factors were excluded.

Evidence of SIBO was found in 50% of the patients on PPIs, 24.5% of patients with IBS, and only 6% of healthy controls, wrote Dr. Lombardo, of the gastroenterology department of Mauriziano U.I. Hospital, Turin, and his colleagues.

Moreover, the researchers found a correlation between the duration of PPI treatment and the detection of SIBO, with more than 70% of the PPI group testing positive for SIBO after 13 months of PPI use—more than triple the proportion of positives among those taking PPIs for a year or less.

Although several studies have used breath-based tests to assess the prevalence of SIBO in patients with IBS, few have been designed to assess the independent influence of PPIs, the investigators wrote. This, they said, is as an “important oversight,” as PPI use is widespread in patients with IBS.

The authors cited a recent study reporting that IBS patients not taking PPIs and GERD patients on PPIs have roughly equal rates of SIBO, as assessed by lactulose breath tests. However, the researchers wrote that no mention was made in that study of the duration of PPI treatment, while their own study showed that PPI treatment increased the incidence of SIBO drastically after the first year.

Dr. Lombardo and his colleagues speculated that PPI-related SIBO might be frequently underdiagnosed or misdiagnosed as IBS because of the overlap of common symptoms.

Patients in the investigation with SIBO were treated with the antibiotic rifaximin 400 mg three times daily for 14 days. Eradication of SIBO, as confirmed by a glucose hydrogen breath test, occurred in 87% of the PPI group and 91% in the IBS group.

In the PPI arm of the study, eradication was more successful among subjects who had taken PPIs for less than a year, which suggested “a more profound or qualitatively different alteration in enteric microflora after a year of treatment,” according to the investigators.

In both the PPI and IBS groups, symptom severity was reduced by more than 90% in subjects whose SIBO eradication had been confirmed by breath testing and to a lesser but measurable degree in those subjects whose SIBO had not been eradicated after the same course of rifaximin.

The investigators did not seek to learn whether SIBO returned after eradication in patients who continued PPI therapy but cited another study suggesting that such an outcome was likely.

The authors noted a few limitations of the study, which included a lack of distinction between specific PPIs taken by the patients, the observational open-label study design, and that fact that Helicobacter pylori was not investigated as an independent contributor (although all 450 patients were tested, with 68% found to be negative).

Major Finding: Evidence of small intestinal bacterial overgrowth was found in 50% of patients on proton pump inhibitors, 24.5% of patients with irritable bowel syndrome, and only 6% of controls.

Data Source: Two hundred gastroesophageal reflux disease patients who were taking PPIs, 200 IBS patients not taking PPIs, and 50 healthy controls.

Disclosures: The study was not funded by outside grants, and neither Dr. Lombardo nor his colleagues reported any competing interests.

Fifty percent of the people taking proton pump inhibitors to treat gastroesophageal reflux disease develop small intestinal bacterial overgrowth, compared with a quarter of the patients with irritable bowel syndrome who are not taking PPIs, according to a study conducted by Dr. Lucio Lombardo and his colleagues.

In the study, 450 consecutive patients underwent glucose hydrogen breath tests, which measure the metabolic activity of enteric bacteria (Clin. Gastroenterol. Hepatol. 2010 [doi:10.1016/j.cgh.2009. 12.022]).

Two hundred of the patients had been diagnosed with gastroesophageal reflux disease and had been taking one of several PPIs for a median of 36 months, although some had taken the medication for as little as 2 months.

The investigators recruited an additional 200 study subjects who had been diagnosed with irritable bowel syndrome (IBS) and were not taking PPIs. Dr. Lombardo and his colleagues noted that the symptoms of IBS—including bloating, diarrhea, and constipation—frequently overlap with the symptoms of small intestinal bacterial overgrowth (SIBO). They also recruited 50 healthy controls who did not have symptoms of either IBS or SIBO and had not taken a PPI for at least 3 years.

Patients with other gastric diseases, who had recent gastric surgery, who were taking antibiotics, or had other potentially confounding factors were excluded.

Evidence of SIBO was found in 50% of the patients on PPIs, 24.5% of patients with IBS, and only 6% of healthy controls, wrote Dr. Lombardo, of the gastroenterology department of Mauriziano U.I. Hospital, Turin, and his colleagues.

Moreover, the researchers found a correlation between the duration of PPI treatment and the detection of SIBO, with more than 70% of the PPI group testing positive for SIBO after 13 months of PPI use—more than triple the proportion of positives among those taking PPIs for a year or less.

Although several studies have used breath-based tests to assess the prevalence of SIBO in patients with IBS, few have been designed to assess the independent influence of PPIs, the investigators wrote. This, they said, is as an “important oversight,” as PPI use is widespread in patients with IBS.

The authors cited a recent study reporting that IBS patients not taking PPIs and GERD patients on PPIs have roughly equal rates of SIBO, as assessed by lactulose breath tests. However, the researchers wrote that no mention was made in that study of the duration of PPI treatment, while their own study showed that PPI treatment increased the incidence of SIBO drastically after the first year.

Dr. Lombardo and his colleagues speculated that PPI-related SIBO might be frequently underdiagnosed or misdiagnosed as IBS because of the overlap of common symptoms.

Patients in the investigation with SIBO were treated with the antibiotic rifaximin 400 mg three times daily for 14 days. Eradication of SIBO, as confirmed by a glucose hydrogen breath test, occurred in 87% of the PPI group and 91% in the IBS group.

In the PPI arm of the study, eradication was more successful among subjects who had taken PPIs for less than a year, which suggested “a more profound or qualitatively different alteration in enteric microflora after a year of treatment,” according to the investigators.

In both the PPI and IBS groups, symptom severity was reduced by more than 90% in subjects whose SIBO eradication had been confirmed by breath testing and to a lesser but measurable degree in those subjects whose SIBO had not been eradicated after the same course of rifaximin.

The investigators did not seek to learn whether SIBO returned after eradication in patients who continued PPI therapy but cited another study suggesting that such an outcome was likely.

The authors noted a few limitations of the study, which included a lack of distinction between specific PPIs taken by the patients, the observational open-label study design, and that fact that Helicobacter pylori was not investigated as an independent contributor (although all 450 patients were tested, with 68% found to be negative).

Major Finding: Overtime work of 3–4 hours per day was associated with a 1.6-fold increase in the risk of CHD.

Data Source: A study of 4,262 men and 1,752 women.

Disclosures: Dr. McInnes declared no conflicts of interest. The Whitehall II study was funded by the Academy of Finland and grants from the British Heart Foundation, the European Science Foundation, and the BUPA foundation; none of its authors declared conflicts of interest.

People who work 11 or more hours per day have a 60% higher risk of developing coronary heart disease than do those who work normal 7- or 8-hour workdays, according to researchers in Finland and Britain.

The findings were derived from the Whitehall II study, a long-running cohort of civil-service workers in London. The cohort included people at all occupational grades and levels of responsibility; however, none of the labor was considered blue collar.

For their research, epidemiologist Marianna Virtanen, Ph.D., of the Finnish Institute of Occupational Health, Helsinki, and University College London, and her colleagues examined data from 4,262 men and 1,752 women, aged 39–61 years (mean age 48.7 years), who were recruited into the Whitehall II cohort between 1991 and 1994 and followed for an average of 11.2 years.

All the study subjects, in addition to answering detailed questionnaires on health and lifestyle factors and undergoing clinical examinations, answered questions about their work schedules and habits. Slightly less than half (46%) reported working one or more hours a day of overtime, with 617 (10%) working 3–4 hours overtime (between 11 and 12 hours total, per day).

Investigators identified 369 cases of incident fatal CHD, nonfatal myocardial infarctions, or angina in the total group of 6,014 subjects. Overtime work of 3–4 hours per day was associated with a 1.6-fold increase in the risk of CHD, and after researchers adjusted for a host of 21 social, demographic and physical risk factors (including gender, marital status, smoking, overweight, type A behavior, occupational grade, diabetes, exercise, sleep habits, alcohol intake, fruit and vegetable consumption, and high cholesterol) the researchers still found that working more than 11 hours daily contributed independently to a 1.56-fold in risk of CHD (Eur. Heart J. 2010 May 12 [doi:10.1093/eurheartj/ehq124]).

The researchers noted several other commonalities in the high-overtime group with the potential to bear on results. One was the greater incidence of type A behavior patterns and psychological distress; another was elevated levels of alcohol use.

While older research had reported an association between occupations with reported long working hours and myocardial infarction in women but not men (Int. J. Epidemiol. 1985;14:378-88), Dr. Virtanen and her colleagues found no differences in the incidence of CHD between men and women working long hours—however, “the majority of our subjects were men,” Dr. Virtanen said in an interview. “Because women usually had lower rates of cardiovascular disease, we didn't make separate analyses but rather adjusted for gender.” The people most likely to report 11-hour or longer workday, Dr. Virtanen noted, were most often men in higher-level positions.

Though Dr. Virtanen and her colleagues saw no relationship between hypertension and long working hours, they did not discount that possibility, since they had recourse only to baseline blood pressure measurements and not ambulatory blood pressure readings. They cited two Japanese studies: one indicating that work and stress-related changes in ambulatory blood pressure might be a key contributing factor to cardiovascular risk (BMJ 1998;317:775-80), and another that suggested overtime work affected ambulatory blood pressure (J. Occ. Environ. Med. 1996;38:1007-11).

Also, Dr. Virtanen said, “What we may be seeing may be extended working hours as a proxy for a kind of lifestyle in which people are competitive and want to achieve. This type A behavior reflects that pattern but of course there might be other things [that] are related—what you cannot do if you work long hours, such as make and keep doctor appointments or sleep.”

In an editorial accompanying Dr. Virtanen's study, Dr. Gordon McInnes, professor of clinical pharmacology at the University of Glasgow, Scotland, wrote that the findings “reinforce the notion that work stress attributable to overtime is associated, apparently independently, with an increased risk of coronary heart disease. A trend for risk to be related to hours of overtime worked supports this conclusion. If the effect is truly causal, the importance is much greater than commonly recognized” (Eur. Heart J. 2010 [doi:10.1093/eurheartj/ehq116]).

Work stress attributable to overtime is associated with an increased risk of coronary heart disease.

Source DR. MCINNES

Major Finding: Overtime work of 3–4 hours per day was associated with a 1.6-fold increase in the risk of CHD.

Data Source: A study of 4,262 men and 1,752 women.

Disclosures: Dr. McInnes declared no conflicts of interest. The Whitehall II study was funded by the Academy of Finland and grants from the British Heart Foundation, the European Science Foundation, and the BUPA foundation; none of its authors declared conflicts of interest.

People who work 11 or more hours per day have a 60% higher risk of developing coronary heart disease than do those who work normal 7- or 8-hour workdays, according to researchers in Finland and Britain.

The findings were derived from the Whitehall II study, a long-running cohort of civil-service workers in London. The cohort included people at all occupational grades and levels of responsibility; however, none of the labor was considered blue collar.

For their research, epidemiologist Marianna Virtanen, Ph.D., of the Finnish Institute of Occupational Health, Helsinki, and University College London, and her colleagues examined data from 4,262 men and 1,752 women, aged 39–61 years (mean age 48.7 years), who were recruited into the Whitehall II cohort between 1991 and 1994 and followed for an average of 11.2 years.

All the study subjects, in addition to answering detailed questionnaires on health and lifestyle factors and undergoing clinical examinations, answered questions about their work schedules and habits. Slightly less than half (46%) reported working one or more hours a day of overtime, with 617 (10%) working 3–4 hours overtime (between 11 and 12 hours total, per day).

Investigators identified 369 cases of incident fatal CHD, nonfatal myocardial infarctions, or angina in the total group of 6,014 subjects. Overtime work of 3–4 hours per day was associated with a 1.6-fold increase in the risk of CHD, and after researchers adjusted for a host of 21 social, demographic and physical risk factors (including gender, marital status, smoking, overweight, type A behavior, occupational grade, diabetes, exercise, sleep habits, alcohol intake, fruit and vegetable consumption, and high cholesterol) the researchers still found that working more than 11 hours daily contributed independently to a 1.56-fold in risk of CHD (Eur. Heart J. 2010 May 12 [doi:10.1093/eurheartj/ehq124]).

The researchers noted several other commonalities in the high-overtime group with the potential to bear on results. One was the greater incidence of type A behavior patterns and psychological distress; another was elevated levels of alcohol use.

While older research had reported an association between occupations with reported long working hours and myocardial infarction in women but not men (Int. J. Epidemiol. 1985;14:378-88), Dr. Virtanen and her colleagues found no differences in the incidence of CHD between men and women working long hours—however, “the majority of our subjects were men,” Dr. Virtanen said in an interview. “Because women usually had lower rates of cardiovascular disease, we didn't make separate analyses but rather adjusted for gender.” The people most likely to report 11-hour or longer workday, Dr. Virtanen noted, were most often men in higher-level positions.

Though Dr. Virtanen and her colleagues saw no relationship between hypertension and long working hours, they did not discount that possibility, since they had recourse only to baseline blood pressure measurements and not ambulatory blood pressure readings. They cited two Japanese studies: one indicating that work and stress-related changes in ambulatory blood pressure might be a key contributing factor to cardiovascular risk (BMJ 1998;317:775-80), and another that suggested overtime work affected ambulatory blood pressure (J. Occ. Environ. Med. 1996;38:1007-11).

Also, Dr. Virtanen said, “What we may be seeing may be extended working hours as a proxy for a kind of lifestyle in which people are competitive and want to achieve. This type A behavior reflects that pattern but of course there might be other things [that] are related—what you cannot do if you work long hours, such as make and keep doctor appointments or sleep.”

In an editorial accompanying Dr. Virtanen's study, Dr. Gordon McInnes, professor of clinical pharmacology at the University of Glasgow, Scotland, wrote that the findings “reinforce the notion that work stress attributable to overtime is associated, apparently independently, with an increased risk of coronary heart disease. A trend for risk to be related to hours of overtime worked supports this conclusion. If the effect is truly causal, the importance is much greater than commonly recognized” (Eur. Heart J. 2010 [doi:10.1093/eurheartj/ehq116]).

Work stress attributable to overtime is associated with an increased risk of coronary heart disease.

Source DR. MCINNES

Major Finding: Overtime work of 3–4 hours per day was associated with a 1.6-fold increase in the risk of CHD.

Data Source: A study of 4,262 men and 1,752 women.

Disclosures: Dr. McInnes declared no conflicts of interest. The Whitehall II study was funded by the Academy of Finland and grants from the British Heart Foundation, the European Science Foundation, and the BUPA foundation; none of its authors declared conflicts of interest.

People who work 11 or more hours per day have a 60% higher risk of developing coronary heart disease than do those who work normal 7- or 8-hour workdays, according to researchers in Finland and Britain.

The findings were derived from the Whitehall II study, a long-running cohort of civil-service workers in London. The cohort included people at all occupational grades and levels of responsibility; however, none of the labor was considered blue collar.

For their research, epidemiologist Marianna Virtanen, Ph.D., of the Finnish Institute of Occupational Health, Helsinki, and University College London, and her colleagues examined data from 4,262 men and 1,752 women, aged 39–61 years (mean age 48.7 years), who were recruited into the Whitehall II cohort between 1991 and 1994 and followed for an average of 11.2 years.

All the study subjects, in addition to answering detailed questionnaires on health and lifestyle factors and undergoing clinical examinations, answered questions about their work schedules and habits. Slightly less than half (46%) reported working one or more hours a day of overtime, with 617 (10%) working 3–4 hours overtime (between 11 and 12 hours total, per day).

Investigators identified 369 cases of incident fatal CHD, nonfatal myocardial infarctions, or angina in the total group of 6,014 subjects. Overtime work of 3–4 hours per day was associated with a 1.6-fold increase in the risk of CHD, and after researchers adjusted for a host of 21 social, demographic and physical risk factors (including gender, marital status, smoking, overweight, type A behavior, occupational grade, diabetes, exercise, sleep habits, alcohol intake, fruit and vegetable consumption, and high cholesterol) the researchers still found that working more than 11 hours daily contributed independently to a 1.56-fold in risk of CHD (Eur. Heart J. 2010 May 12 [doi:10.1093/eurheartj/ehq124]).

The researchers noted several other commonalities in the high-overtime group with the potential to bear on results. One was the greater incidence of type A behavior patterns and psychological distress; another was elevated levels of alcohol use.

While older research had reported an association between occupations with reported long working hours and myocardial infarction in women but not men (Int. J. Epidemiol. 1985;14:378-88), Dr. Virtanen and her colleagues found no differences in the incidence of CHD between men and women working long hours—however, “the majority of our subjects were men,” Dr. Virtanen said in an interview. “Because women usually had lower rates of cardiovascular disease, we didn't make separate analyses but rather adjusted for gender.” The people most likely to report 11-hour or longer workday, Dr. Virtanen noted, were most often men in higher-level positions.

Though Dr. Virtanen and her colleagues saw no relationship between hypertension and long working hours, they did not discount that possibility, since they had recourse only to baseline blood pressure measurements and not ambulatory blood pressure readings. They cited two Japanese studies: one indicating that work and stress-related changes in ambulatory blood pressure might be a key contributing factor to cardiovascular risk (BMJ 1998;317:775-80), and another that suggested overtime work affected ambulatory blood pressure (J. Occ. Environ. Med. 1996;38:1007-11).

Also, Dr. Virtanen said, “What we may be seeing may be extended working hours as a proxy for a kind of lifestyle in which people are competitive and want to achieve. This type A behavior reflects that pattern but of course there might be other things [that] are related—what you cannot do if you work long hours, such as make and keep doctor appointments or sleep.”

In an editorial accompanying Dr. Virtanen's study, Dr. Gordon McInnes, professor of clinical pharmacology at the University of Glasgow, Scotland, wrote that the findings “reinforce the notion that work stress attributable to overtime is associated, apparently independently, with an increased risk of coronary heart disease. A trend for risk to be related to hours of overtime worked supports this conclusion. If the effect is truly causal, the importance is much greater than commonly recognized” (Eur. Heart J. 2010 [doi:10.1093/eurheartj/ehq116]).

Work stress attributable to overtime is associated with an increased risk of coronary heart disease.

Source DR. MCINNES

Major Finding: Hypertensive disorders were seen in nearly 10% of 316 women who became pregnant after bariatric surgery and in 31% of 269 women who delivered before having surgery.

Data Source: A study of claims data from 585 women in seven private insurance plans who had undergone bariatric surgery for weight loss and had at least one prior pregnancy and delivery.

Disclosures: No conflicts were reported.

Women who have had bariatric surgery are far less likely to experience serious hypertensive disorders during pregnancy, including preeclampsia and eclampsia, than are women who have yet to undergo the surgery, according to new research.

Investigators found a 75% reduction in the odds of being diagnosed with a hypertensive disorder in pregnancy in those who had undergone the surgery, compared with their counterparts.

For their study, Dr. Wendy L. Bennett and her colleagues at Johns Hopkins University, Baltimore, evaluated claims data from seven private insurance plans to find 585 U.S. women between the ages of 16 and 45 who had undergone bariatric surgery for weight loss and had at least one prior pregnancy and delivery (BMJ 2010;340:c1662).

A total of 269 of the women delivered their babies before gastric bypass surgery or another weight-loss surgery, and 316 delivered afterward. For the first group, the mean time from delivery to surgery was 17.9 months, and for the second, the mean time from surgery to delivery was 23.6 months.

Gastric bypass surgery accounted for 81.5% of procedures overall, with other surgeries, such as adjustable gastric banding, making up the rest.

The mean age of the women was 31.9 years at delivery and 31.5 years at surgery.

In the group that delivered before having surgery, 31.2% of the women were diagnosed with a hypertensive disorder—from chronic and gestational hypertension to preeclampsia and eclampsia alone or superimposed on hypertension—between the start of pregnancy and 2 weeks after birth, while only 9.8% of the postsurgery group did, even after adjusting for factors such as age at delivery, multiple pregnancy, the type of surgery, and preexisting diabetes.

Preeclampsia or eclampsia was diagnosed in 14.5% of women in the presurgery group and 2.5% in the postsurgery group. “We went 2 weeks post partum, because we wanted to make sure we got all the diagnoses,” Dr. Bennett said in an interview. “Women can get postpartum preeclampsia.”

The Hopkins findings confirm those from an earlier Israeli study of similar design (Int. J. Gynecol. Obstet. 2008;103:246-51), which found the rate of a composite of hypertensive disorders during pregnancy to be more than halved after bariatric surgery.

The Hopkins team saw an even more dramatic reduction—about 75%—in the odds of all hypertensive disorders in pregnancy, and was able to isolate all severities of hypertensive disorders by analyzing outpatient and inpatient codes for each.

Further, Dr. Bennett and her colleagues wrote that they were “able to describe outcomes of chronic hypertension complicating a pregnancy and preeclampsia superimposed on chronic hypertension among women who have had bariatric surgery.” Chronic hypertension in pregnancy and preeclampsia, the authors noted, can increase the long-term risk of chronic disease in the mother, including cardiovascular and renal disease.

Dr. Bennett noted that her team reviewed relatively new and geographically diverse data (the claims were dated from 2002 to 2006, from more than one region of the United States), compared with other recent studies on bariatric surgery and pregnancy. This afforded the authors an up-to-date picture reflecting outcomes from surgeries currently performed, she said.

The team's dataset lacked height and weight information for the subjects before and after surgeries, though all had been diagnosed as obese (having a body mass index of 35 kg/m

The authors noted a further limitation to their study, which was the possibility of selection bias and confounding by indication. For example, they wrote, “an obese woman with gestational hypertension might have been more likely to subsequently undergo bariatric surgery if she developed chronic hypertension after her pregnancy or had other comorbidities associated with obesity making her eligible for bariatric surgery. If this occurred, the number of diagnoses of hypertensive disorder in pregnancy in the women who delivered before surgery could be increased and bias our results.”

Major Finding: Hypertensive disorders were seen in nearly 10% of 316 women who became pregnant after bariatric surgery and in 31% of 269 women who delivered before having surgery.

Data Source: A study of claims data from 585 women in seven private insurance plans who had undergone bariatric surgery for weight loss and had at least one prior pregnancy and delivery.

Disclosures: No conflicts were reported.

Women who have had bariatric surgery are far less likely to experience serious hypertensive disorders during pregnancy, including preeclampsia and eclampsia, than are women who have yet to undergo the surgery, according to new research.

Investigators found a 75% reduction in the odds of being diagnosed with a hypertensive disorder in pregnancy in those who had undergone the surgery, compared with their counterparts.

For their study, Dr. Wendy L. Bennett and her colleagues at Johns Hopkins University, Baltimore, evaluated claims data from seven private insurance plans to find 585 U.S. women between the ages of 16 and 45 who had undergone bariatric surgery for weight loss and had at least one prior pregnancy and delivery (BMJ 2010;340:c1662).

A total of 269 of the women delivered their babies before gastric bypass surgery or another weight-loss surgery, and 316 delivered afterward. For the first group, the mean time from delivery to surgery was 17.9 months, and for the second, the mean time from surgery to delivery was 23.6 months.

Gastric bypass surgery accounted for 81.5% of procedures overall, with other surgeries, such as adjustable gastric banding, making up the rest.

The mean age of the women was 31.9 years at delivery and 31.5 years at surgery.

In the group that delivered before having surgery, 31.2% of the women were diagnosed with a hypertensive disorder—from chronic and gestational hypertension to preeclampsia and eclampsia alone or superimposed on hypertension—between the start of pregnancy and 2 weeks after birth, while only 9.8% of the postsurgery group did, even after adjusting for factors such as age at delivery, multiple pregnancy, the type of surgery, and preexisting diabetes.

Preeclampsia or eclampsia was diagnosed in 14.5% of women in the presurgery group and 2.5% in the postsurgery group. “We went 2 weeks post partum, because we wanted to make sure we got all the diagnoses,” Dr. Bennett said in an interview. “Women can get postpartum preeclampsia.”

The Hopkins findings confirm those from an earlier Israeli study of similar design (Int. J. Gynecol. Obstet. 2008;103:246-51), which found the rate of a composite of hypertensive disorders during pregnancy to be more than halved after bariatric surgery.

The Hopkins team saw an even more dramatic reduction—about 75%—in the odds of all hypertensive disorders in pregnancy, and was able to isolate all severities of hypertensive disorders by analyzing outpatient and inpatient codes for each.

Further, Dr. Bennett and her colleagues wrote that they were “able to describe outcomes of chronic hypertension complicating a pregnancy and preeclampsia superimposed on chronic hypertension among women who have had bariatric surgery.” Chronic hypertension in pregnancy and preeclampsia, the authors noted, can increase the long-term risk of chronic disease in the mother, including cardiovascular and renal disease.

Dr. Bennett noted that her team reviewed relatively new and geographically diverse data (the claims were dated from 2002 to 2006, from more than one region of the United States), compared with other recent studies on bariatric surgery and pregnancy. This afforded the authors an up-to-date picture reflecting outcomes from surgeries currently performed, she said.

The team's dataset lacked height and weight information for the subjects before and after surgeries, though all had been diagnosed as obese (having a body mass index of 35 kg/m

The authors noted a further limitation to their study, which was the possibility of selection bias and confounding by indication. For example, they wrote, “an obese woman with gestational hypertension might have been more likely to subsequently undergo bariatric surgery if she developed chronic hypertension after her pregnancy or had other comorbidities associated with obesity making her eligible for bariatric surgery. If this occurred, the number of diagnoses of hypertensive disorder in pregnancy in the women who delivered before surgery could be increased and bias our results.”

Major Finding: Hypertensive disorders were seen in nearly 10% of 316 women who became pregnant after bariatric surgery and in 31% of 269 women who delivered before having surgery.

Data Source: A study of claims data from 585 women in seven private insurance plans who had undergone bariatric surgery for weight loss and had at least one prior pregnancy and delivery.

Disclosures: No conflicts were reported.

Women who have had bariatric surgery are far less likely to experience serious hypertensive disorders during pregnancy, including preeclampsia and eclampsia, than are women who have yet to undergo the surgery, according to new research.

Investigators found a 75% reduction in the odds of being diagnosed with a hypertensive disorder in pregnancy in those who had undergone the surgery, compared with their counterparts.

For their study, Dr. Wendy L. Bennett and her colleagues at Johns Hopkins University, Baltimore, evaluated claims data from seven private insurance plans to find 585 U.S. women between the ages of 16 and 45 who had undergone bariatric surgery for weight loss and had at least one prior pregnancy and delivery (BMJ 2010;340:c1662).

A total of 269 of the women delivered their babies before gastric bypass surgery or another weight-loss surgery, and 316 delivered afterward. For the first group, the mean time from delivery to surgery was 17.9 months, and for the second, the mean time from surgery to delivery was 23.6 months.

Gastric bypass surgery accounted for 81.5% of procedures overall, with other surgeries, such as adjustable gastric banding, making up the rest.

The mean age of the women was 31.9 years at delivery and 31.5 years at surgery.

In the group that delivered before having surgery, 31.2% of the women were diagnosed with a hypertensive disorder—from chronic and gestational hypertension to preeclampsia and eclampsia alone or superimposed on hypertension—between the start of pregnancy and 2 weeks after birth, while only 9.8% of the postsurgery group did, even after adjusting for factors such as age at delivery, multiple pregnancy, the type of surgery, and preexisting diabetes.

Preeclampsia or eclampsia was diagnosed in 14.5% of women in the presurgery group and 2.5% in the postsurgery group. “We went 2 weeks post partum, because we wanted to make sure we got all the diagnoses,” Dr. Bennett said in an interview. “Women can get postpartum preeclampsia.”

The Hopkins findings confirm those from an earlier Israeli study of similar design (Int. J. Gynecol. Obstet. 2008;103:246-51), which found the rate of a composite of hypertensive disorders during pregnancy to be more than halved after bariatric surgery.

The Hopkins team saw an even more dramatic reduction—about 75%—in the odds of all hypertensive disorders in pregnancy, and was able to isolate all severities of hypertensive disorders by analyzing outpatient and inpatient codes for each.

Further, Dr. Bennett and her colleagues wrote that they were “able to describe outcomes of chronic hypertension complicating a pregnancy and preeclampsia superimposed on chronic hypertension among women who have had bariatric surgery.” Chronic hypertension in pregnancy and preeclampsia, the authors noted, can increase the long-term risk of chronic disease in the mother, including cardiovascular and renal disease.

Dr. Bennett noted that her team reviewed relatively new and geographically diverse data (the claims were dated from 2002 to 2006, from more than one region of the United States), compared with other recent studies on bariatric surgery and pregnancy. This afforded the authors an up-to-date picture reflecting outcomes from surgeries currently performed, she said.

The team's dataset lacked height and weight information for the subjects before and after surgeries, though all had been diagnosed as obese (having a body mass index of 35 kg/m

The authors noted a further limitation to their study, which was the possibility of selection bias and confounding by indication. For example, they wrote, “an obese woman with gestational hypertension might have been more likely to subsequently undergo bariatric surgery if she developed chronic hypertension after her pregnancy or had other comorbidities associated with obesity making her eligible for bariatric surgery. If this occurred, the number of diagnoses of hypertensive disorder in pregnancy in the women who delivered before surgery could be increased and bias our results.”

Data from a large cohort study has shown that women who regularly eat fish, mayonnaise, and other foods rich in omega-3 fatty acids are at decreased risk of being diagnosed with endometriosis—and that women with diets rich in trans fats, by contrast, are much likelier to develop the disease.

The findings suggested no association between women's endometriosis risk and overall fat intake, but only associations by the type of dietary fats consumed. Women in the highest fifth of long-chain omega-3 fatty acid consumption were 22% less likely to be diagnosed with endometriosis, compared with those in the lowest fifth. Women in the highest fifth of trans fat consumption were 48% more likely to be diagnosed with endometriosis than those in the bottom fifth.

The results were adjusted for variables such as age at menarche, menstrual cycle length, and parity (Hum. Reprod. 2010 March 24 [doi:10.1093/humrep/deq044]).

“The message—and we stress that this is the first publication to address this—is that the findings affirm the benefits of a healthy-fat diet that has also been shown to be beneficial for cardiovascular health. Low-fat across the board is not the way to go,” Stacey A. Missmer, Sc.D., lead author of the study, said in an interview.

For their analysis, Dr. Missmer of Harvard Medical School, Boston, and colleagues examined 12 years of data (1989-2001) from 70,709 women who were registered nurses. Diet assessments were based on self-reported questionnaires, but diagnoses of endometriosis (with or without infertility) were confirmed through medical records. Women with prior endometriosis, who had undergone hysterectomy, were menopausal, or had prior cancer were excluded. The study participants updated their diet information at 4-year intervals over the course of the study period; by the final year of analysis, 1,199 cases of laparoscopically confirmed endometriosis were reported.

The researchers identified the major sources of long-chain omega-3 fatty acids in their diets as salad dressing and mayonnaise, tuna, and other dark fish, although Dr. Missmer said some women reported taking omega-3 supplements. The major sources of trans-unsaturated fatty acids were fried foods not cooked at home, “particularly french fries,” Dr. Missmer said, along with margarine and crackers.

Although trans-unsaturated fats proved an easily identified culprit, an increased risk of endometriosis—20%—was also seen in the quintile of subjects who had consumed the most animal fats. However, the researchers wrote, “intakes of saturated fat and monounsaturated fat, the major components of animal fat, were not associated with endometriosis risk. Interestingly, palmitic acid intake, a saturated fat primarily contributed by animal products, was significantly related to increased endometriosis risk when all other dietary components were held constant.”

The researchers were unable to draw any conclusions about the timing of dietary exposure (ranging from 2 to 10 years before diagnosis)—and endometriosis, finding the risk consistent across time. That does not mean, Dr. Missmer said, that adding omega-3 fatty acids and avoiding trans fats would not be helpful in preventing endometriosis. “We think that the more likely conclusion is that people don't tend to change their diets a lot,” she said.

Indeed, the researchers predicted that endometriosis risk could be slashed significantly by substituting omega-3 fatty acids for trans fats. “Each 1% of energy from omega-3 fatty acids rather than from trans fats was associated with nearly a 50% lower risk of endometriosis,” they wrote. “Also, each 1% of energy from trans fats rather than from any other type of fat was associated with a significantly higher risk of endometriosis.”

Disclosures: The study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Cancer Institute. Neither Dr. Missmer nor her colleagues reported conflicts of interest.

Regular consumption of tuna and other dark fish may prevent endometriosis.

Source © Flander/iStockphoto.com

Data from a large cohort study has shown that women who regularly eat fish, mayonnaise, and other foods rich in omega-3 fatty acids are at decreased risk of being diagnosed with endometriosis—and that women with diets rich in trans fats, by contrast, are much likelier to develop the disease.

The findings suggested no association between women's endometriosis risk and overall fat intake, but only associations by the type of dietary fats consumed. Women in the highest fifth of long-chain omega-3 fatty acid consumption were 22% less likely to be diagnosed with endometriosis, compared with those in the lowest fifth. Women in the highest fifth of trans fat consumption were 48% more likely to be diagnosed with endometriosis than those in the bottom fifth.

The results were adjusted for variables such as age at menarche, menstrual cycle length, and parity (Hum. Reprod. 2010 March 24 [doi:10.1093/humrep/deq044]).

“The message—and we stress that this is the first publication to address this—is that the findings affirm the benefits of a healthy-fat diet that has also been shown to be beneficial for cardiovascular health. Low-fat across the board is not the way to go,” Stacey A. Missmer, Sc.D., lead author of the study, said in an interview.

For their analysis, Dr. Missmer of Harvard Medical School, Boston, and colleagues examined 12 years of data (1989-2001) from 70,709 women who were registered nurses. Diet assessments were based on self-reported questionnaires, but diagnoses of endometriosis (with or without infertility) were confirmed through medical records. Women with prior endometriosis, who had undergone hysterectomy, were menopausal, or had prior cancer were excluded. The study participants updated their diet information at 4-year intervals over the course of the study period; by the final year of analysis, 1,199 cases of laparoscopically confirmed endometriosis were reported.

The researchers identified the major sources of long-chain omega-3 fatty acids in their diets as salad dressing and mayonnaise, tuna, and other dark fish, although Dr. Missmer said some women reported taking omega-3 supplements. The major sources of trans-unsaturated fatty acids were fried foods not cooked at home, “particularly french fries,” Dr. Missmer said, along with margarine and crackers.

Although trans-unsaturated fats proved an easily identified culprit, an increased risk of endometriosis—20%—was also seen in the quintile of subjects who had consumed the most animal fats. However, the researchers wrote, “intakes of saturated fat and monounsaturated fat, the major components of animal fat, were not associated with endometriosis risk. Interestingly, palmitic acid intake, a saturated fat primarily contributed by animal products, was significantly related to increased endometriosis risk when all other dietary components were held constant.”

The researchers were unable to draw any conclusions about the timing of dietary exposure (ranging from 2 to 10 years before diagnosis)—and endometriosis, finding the risk consistent across time. That does not mean, Dr. Missmer said, that adding omega-3 fatty acids and avoiding trans fats would not be helpful in preventing endometriosis. “We think that the more likely conclusion is that people don't tend to change their diets a lot,” she said.

Indeed, the researchers predicted that endometriosis risk could be slashed significantly by substituting omega-3 fatty acids for trans fats. “Each 1% of energy from omega-3 fatty acids rather than from trans fats was associated with nearly a 50% lower risk of endometriosis,” they wrote. “Also, each 1% of energy from trans fats rather than from any other type of fat was associated with a significantly higher risk of endometriosis.”

Disclosures: The study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Cancer Institute. Neither Dr. Missmer nor her colleagues reported conflicts of interest.

Regular consumption of tuna and other dark fish may prevent endometriosis.

Source © Flander/iStockphoto.com

Data from a large cohort study has shown that women who regularly eat fish, mayonnaise, and other foods rich in omega-3 fatty acids are at decreased risk of being diagnosed with endometriosis—and that women with diets rich in trans fats, by contrast, are much likelier to develop the disease.

The findings suggested no association between women's endometriosis risk and overall fat intake, but only associations by the type of dietary fats consumed. Women in the highest fifth of long-chain omega-3 fatty acid consumption were 22% less likely to be diagnosed with endometriosis, compared with those in the lowest fifth. Women in the highest fifth of trans fat consumption were 48% more likely to be diagnosed with endometriosis than those in the bottom fifth.

The results were adjusted for variables such as age at menarche, menstrual cycle length, and parity (Hum. Reprod. 2010 March 24 [doi:10.1093/humrep/deq044]).

“The message—and we stress that this is the first publication to address this—is that the findings affirm the benefits of a healthy-fat diet that has also been shown to be beneficial for cardiovascular health. Low-fat across the board is not the way to go,” Stacey A. Missmer, Sc.D., lead author of the study, said in an interview.

For their analysis, Dr. Missmer of Harvard Medical School, Boston, and colleagues examined 12 years of data (1989-2001) from 70,709 women who were registered nurses. Diet assessments were based on self-reported questionnaires, but diagnoses of endometriosis (with or without infertility) were confirmed through medical records. Women with prior endometriosis, who had undergone hysterectomy, were menopausal, or had prior cancer were excluded. The study participants updated their diet information at 4-year intervals over the course of the study period; by the final year of analysis, 1,199 cases of laparoscopically confirmed endometriosis were reported.

The researchers identified the major sources of long-chain omega-3 fatty acids in their diets as salad dressing and mayonnaise, tuna, and other dark fish, although Dr. Missmer said some women reported taking omega-3 supplements. The major sources of trans-unsaturated fatty acids were fried foods not cooked at home, “particularly french fries,” Dr. Missmer said, along with margarine and crackers.

Although trans-unsaturated fats proved an easily identified culprit, an increased risk of endometriosis—20%—was also seen in the quintile of subjects who had consumed the most animal fats. However, the researchers wrote, “intakes of saturated fat and monounsaturated fat, the major components of animal fat, were not associated with endometriosis risk. Interestingly, palmitic acid intake, a saturated fat primarily contributed by animal products, was significantly related to increased endometriosis risk when all other dietary components were held constant.”

The researchers were unable to draw any conclusions about the timing of dietary exposure (ranging from 2 to 10 years before diagnosis)—and endometriosis, finding the risk consistent across time. That does not mean, Dr. Missmer said, that adding omega-3 fatty acids and avoiding trans fats would not be helpful in preventing endometriosis. “We think that the more likely conclusion is that people don't tend to change their diets a lot,” she said.

Indeed, the researchers predicted that endometriosis risk could be slashed significantly by substituting omega-3 fatty acids for trans fats. “Each 1% of energy from omega-3 fatty acids rather than from trans fats was associated with nearly a 50% lower risk of endometriosis,” they wrote. “Also, each 1% of energy from trans fats rather than from any other type of fat was associated with a significantly higher risk of endometriosis.”

Disclosures: The study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Cancer Institute. Neither Dr. Missmer nor her colleagues reported conflicts of interest.

Regular consumption of tuna and other dark fish may prevent endometriosis.

Source © Flander/iStockphoto.com

Being overweight or obese is associated with a woman's higher risk of developing fibromyalgia, as is lack of exercise, according to findings from a team of researchers in Norway.

While frequent exercise may have analgesic effects of varying duration, the relationship between exercise and fibromyalgia remains unclear, investigators at the Norwegian University of Science and Technology in Trondheim said. “Regular physical exercise, and thereby improved physical fitness, may serve as a buffer against the perpetuation of musculoskeletal symptoms that eventually lead to the development of [fibromyalgia],” they hypothesized. “However, the results of this study do not indicate a strong effect of physical exercise” on development of the disorder.

Links between obesity and fibromyalgia have been described in previous studies, lead investigator Paul. J. Mork, Ph.D., and colleagues noted, though the reasons for such associations are as yet not well understood. Fibromyalgia and obesity share some known characteristics, such as elevated serum levels of certain proinflammatory cytokines, they said, and dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis.

For their study, published online ahead of print in the journal Arthritis Care and Research (doi: 10.1002/acr.20118), investigators used data from the Nord-Trndelag Health (HUNT) Study, a two-part, government-sponsored cohort first conducted between 1984 and 1986, and again in a follow-up between 1995 and 1997.

After excluding from the cohort women who had been ill at baseline or who had not supplied enough relevant information in study questionnaires, the researchers identified 15,990 women 20 years and older who initially reported no fibromyalgia or physical impairment. Of these, 380 reported physician-diagnosed fibromyalgia 11 years later during the follow-up part of the study. Each study phase included a series of physical examinations and measurements along with detailed self-reported questionnaires. At the time of follow-up, the study comprised 9,942 normal weight, 4,245 overweight, and 1,481 obese women.

The purpose of the study was “to investigate whether an inverse association exists between the level of leisure time physical exercise and the future development of [fibromyalgia] in a large unselected population of women,” Dr. Mork and colleagues wrote, and, separately, whether high body mass index contributed to the development of the disease.

Overall, women who reported that they exercised 4 or more times per week were 29% less likely to develop fibromyalgia than women who described themselves as inactive. Obese women (BMI of at least 30 kg/m

Among overweight and obese women (defined as any with a BMI of at least 25 kg/m

Among the study's limitations, the authors pointed out, was the fact that information about exercise habits was self-reported, not particularly detailed as to the type or intensity of activity, and not followed up in the second part of the cohort. Another limitation noted by the authors was that because participation in follow-up was voluntary, women with high BMI or sedentary lifestyles at baseline may have chosen not to participate in follow-up, making the actual relative risk higher than the study reflected.

Also, the large number of unknowns in the pathogenesis of fibromyalgia increased the potential for confounding, they acknowledged. “[G]enetic predisposition, sociopsychological factors, adverse life events and occupational exposures (eg., work stress), could be of importance,” they wrote, but none of these was included in their analysis.

Being overweight or obese is associated with a woman's higher risk of developing fibromyalgia, as is lack of exercise, according to findings from a team of researchers in Norway.

While frequent exercise may have analgesic effects of varying duration, the relationship between exercise and fibromyalgia remains unclear, investigators at the Norwegian University of Science and Technology in Trondheim said. “Regular physical exercise, and thereby improved physical fitness, may serve as a buffer against the perpetuation of musculoskeletal symptoms that eventually lead to the development of [fibromyalgia],” they hypothesized. “However, the results of this study do not indicate a strong effect of physical exercise” on development of the disorder.

Links between obesity and fibromyalgia have been described in previous studies, lead investigator Paul. J. Mork, Ph.D., and colleagues noted, though the reasons for such associations are as yet not well understood. Fibromyalgia and obesity share some known characteristics, such as elevated serum levels of certain proinflammatory cytokines, they said, and dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis.

For their study, published online ahead of print in the journal Arthritis Care and Research (doi: 10.1002/acr.20118), investigators used data from the Nord-Trndelag Health (HUNT) Study, a two-part, government-sponsored cohort first conducted between 1984 and 1986, and again in a follow-up between 1995 and 1997.

After excluding from the cohort women who had been ill at baseline or who had not supplied enough relevant information in study questionnaires, the researchers identified 15,990 women 20 years and older who initially reported no fibromyalgia or physical impairment. Of these, 380 reported physician-diagnosed fibromyalgia 11 years later during the follow-up part of the study. Each study phase included a series of physical examinations and measurements along with detailed self-reported questionnaires. At the time of follow-up, the study comprised 9,942 normal weight, 4,245 overweight, and 1,481 obese women.

The purpose of the study was “to investigate whether an inverse association exists between the level of leisure time physical exercise and the future development of [fibromyalgia] in a large unselected population of women,” Dr. Mork and colleagues wrote, and, separately, whether high body mass index contributed to the development of the disease.

Overall, women who reported that they exercised 4 or more times per week were 29% less likely to develop fibromyalgia than women who described themselves as inactive. Obese women (BMI of at least 30 kg/m

Among overweight and obese women (defined as any with a BMI of at least 25 kg/m

Among the study's limitations, the authors pointed out, was the fact that information about exercise habits was self-reported, not particularly detailed as to the type or intensity of activity, and not followed up in the second part of the cohort. Another limitation noted by the authors was that because participation in follow-up was voluntary, women with high BMI or sedentary lifestyles at baseline may have chosen not to participate in follow-up, making the actual relative risk higher than the study reflected.

Also, the large number of unknowns in the pathogenesis of fibromyalgia increased the potential for confounding, they acknowledged. “[G]enetic predisposition, sociopsychological factors, adverse life events and occupational exposures (eg., work stress), could be of importance,” they wrote, but none of these was included in their analysis.

Being overweight or obese is associated with a woman's higher risk of developing fibromyalgia, as is lack of exercise, according to findings from a team of researchers in Norway.

While frequent exercise may have analgesic effects of varying duration, the relationship between exercise and fibromyalgia remains unclear, investigators at the Norwegian University of Science and Technology in Trondheim said. “Regular physical exercise, and thereby improved physical fitness, may serve as a buffer against the perpetuation of musculoskeletal symptoms that eventually lead to the development of [fibromyalgia],” they hypothesized. “However, the results of this study do not indicate a strong effect of physical exercise” on development of the disorder.

Links between obesity and fibromyalgia have been described in previous studies, lead investigator Paul. J. Mork, Ph.D., and colleagues noted, though the reasons for such associations are as yet not well understood. Fibromyalgia and obesity share some known characteristics, such as elevated serum levels of certain proinflammatory cytokines, they said, and dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis.

For their study, published online ahead of print in the journal Arthritis Care and Research (doi: 10.1002/acr.20118), investigators used data from the Nord-Trndelag Health (HUNT) Study, a two-part, government-sponsored cohort first conducted between 1984 and 1986, and again in a follow-up between 1995 and 1997.

After excluding from the cohort women who had been ill at baseline or who had not supplied enough relevant information in study questionnaires, the researchers identified 15,990 women 20 years and older who initially reported no fibromyalgia or physical impairment. Of these, 380 reported physician-diagnosed fibromyalgia 11 years later during the follow-up part of the study. Each study phase included a series of physical examinations and measurements along with detailed self-reported questionnaires. At the time of follow-up, the study comprised 9,942 normal weight, 4,245 overweight, and 1,481 obese women.

The purpose of the study was “to investigate whether an inverse association exists between the level of leisure time physical exercise and the future development of [fibromyalgia] in a large unselected population of women,” Dr. Mork and colleagues wrote, and, separately, whether high body mass index contributed to the development of the disease.

Overall, women who reported that they exercised 4 or more times per week were 29% less likely to develop fibromyalgia than women who described themselves as inactive. Obese women (BMI of at least 30 kg/m

Among overweight and obese women (defined as any with a BMI of at least 25 kg/m

Among the study's limitations, the authors pointed out, was the fact that information about exercise habits was self-reported, not particularly detailed as to the type or intensity of activity, and not followed up in the second part of the cohort. Another limitation noted by the authors was that because participation in follow-up was voluntary, women with high BMI or sedentary lifestyles at baseline may have chosen not to participate in follow-up, making the actual relative risk higher than the study reflected.

Also, the large number of unknowns in the pathogenesis of fibromyalgia increased the potential for confounding, they acknowledged. “[G]enetic predisposition, sociopsychological factors, adverse life events and occupational exposures (eg., work stress), could be of importance,” they wrote, but none of these was included in their analysis.

Data from a large cohort study have shown that women who regularly eat fish, mayonnaise, and other foods that are rich in omega-3 fatty acids are at decreased risk of being diagnosed with endometriosis.

In contrast, women whose diets are rich in trans fats are much likelier to develop the disease.

The findings suggested no association between women's endometriosis risk and overall fat intake, but only associations by the type of dietary fats consumed.

Women in the highest fifth of long-chain omega-3 fatty acid consumption were 22% less likely to be diagnosed with endometriosis, compared with those in the lowest fifth.

Women in the highest fifth of trans fat consumption were 48% more likely to be diagnosed with endometriosis than were those in the bottom fifth.

The investigators adjusted the results for variables such as age at menarche, menstrual cycle length, and parity (Hum. Reprod. 2010 March 24 [doi:10.1093/humrep/deq044]).

“The message—and we stress that this is the first publication to address this—is that the findings affirm the benefits of a healthy-fat diet that has also been shown to be beneficial for cardiovascular health,” Stacey A. Missmer, Sc.D., the lead author of the study, said in an interview.

“Low-fat across the board is not the way to go,” she added.

For their analysis, Dr. Missmer of Harvard Medical School, Boston, and her colleagues examined 12 years of data (1989–2001) from 70,709 women who were registered nurses.

Diet assessments were based on self-reported questionnaires, but diagnoses of endometriosis (with or without infertility) were confirmed through medical records.

Women with prior endometriosis who had undergone hysterectomy, were menopausal, or had prior cancer were excluded.

The study participants updated their diet information at 4-year intervals over the course of the trial period.

By the final year of analysis, 1,199 cases of laparoscopically confirmed endometriosis had been reported.

The researchers identified the major sources of long-chain omega-3 fatty acids in the women's diets as salad dressing and mayonnaise, tuna, and other dark fish, although Dr. Missmer said some women reported taking omega-3 supplements.

The major sources of trans-unsaturated fatty acids were fried foods that were not cooked at home, “particularly french fries,” Dr. Missmer said, along with margarine and crackers.

Although trans-unsaturated fats proved to be an easily identified culprit, an increased risk of endometriosis—20%—was also seen in the quintile of subjects who had consumed the most animal fats.

However, the researchers wrote, “intakes of saturated fat and monounsaturated fat, the major components of animal fat, were not associated with endometriosis risk.

“Interestingly, palmitic acid intake, a saturated fat primarily contributed by animal products, was significantly related to increased endometriosis risk when all other dietary components were held constant.”

The researchers were unable to draw any conclusions about the timing of dietary exposure (ranging from 2 to 10 years before diagnosis) and endometriosis. They found that the risk was consistent across time.

That does not mean that adding omega-3 fatty acids and avoiding trans fats would not be helpful in preventing endometriosis, Dr. Missmer said.

“We think that the more likely conclusion is that people don't tend to change their diets a lot,” she pointed out.

Indeed, Dr. Missmer and her colleagues predicted that endometriosis risk could be slashed significantly by substituting omega-3 fatty acids for trans fats.

“Each 1% of energy from omega-3 fatty acids rather than from trans fats was associated with nearly a 50% lower risk of endometriosis,” they wrote.

“Also, each 1% of energy from trans fats rather than from any other type of fat was associated with a significantly higher risk of endometriosis.”

Dr. Missmer indicated that the next step would be to study whether an increase in omega-3 fatty acids in the diet, and a decrease in trans fats leads to reduction of endometriosis symptoms, as has been suggested in animal studies (Fertil. Steril. 2007;88:1108–19) and a report that links omega-3s to an alleviation of menstrual pain, which endometriosis is known to exacerbate (Eur. J. Clin. Nutr. 1995;49:508–16).

The study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Cancer Institute.

Neither Dr. Missmer nor her colleagues reported conflicts of interest.

A diet rich in omega-3 fatty acids includes tuna and other dark fish.

Source Flander/iStockphoto.com

Data from a large cohort study have shown that women who regularly eat fish, mayonnaise, and other foods that are rich in omega-3 fatty acids are at decreased risk of being diagnosed with endometriosis.

In contrast, women whose diets are rich in trans fats are much likelier to develop the disease.

The findings suggested no association between women's endometriosis risk and overall fat intake, but only associations by the type of dietary fats consumed.

Women in the highest fifth of long-chain omega-3 fatty acid consumption were 22% less likely to be diagnosed with endometriosis, compared with those in the lowest fifth.

Women in the highest fifth of trans fat consumption were 48% more likely to be diagnosed with endometriosis than were those in the bottom fifth.

The investigators adjusted the results for variables such as age at menarche, menstrual cycle length, and parity (Hum. Reprod. 2010 March 24 [doi:10.1093/humrep/deq044]).

“The message—and we stress that this is the first publication to address this—is that the findings affirm the benefits of a healthy-fat diet that has also been shown to be beneficial for cardiovascular health,” Stacey A. Missmer, Sc.D., the lead author of the study, said in an interview.

“Low-fat across the board is not the way to go,” she added.

For their analysis, Dr. Missmer of Harvard Medical School, Boston, and her colleagues examined 12 years of data (1989–2001) from 70,709 women who were registered nurses.

Diet assessments were based on self-reported questionnaires, but diagnoses of endometriosis (with or without infertility) were confirmed through medical records.

Women with prior endometriosis who had undergone hysterectomy, were menopausal, or had prior cancer were excluded.

The study participants updated their diet information at 4-year intervals over the course of the trial period.

By the final year of analysis, 1,199 cases of laparoscopically confirmed endometriosis had been reported.

The researchers identified the major sources of long-chain omega-3 fatty acids in the women's diets as salad dressing and mayonnaise, tuna, and other dark fish, although Dr. Missmer said some women reported taking omega-3 supplements.

The major sources of trans-unsaturated fatty acids were fried foods that were not cooked at home, “particularly french fries,” Dr. Missmer said, along with margarine and crackers.

Although trans-unsaturated fats proved to be an easily identified culprit, an increased risk of endometriosis—20%—was also seen in the quintile of subjects who had consumed the most animal fats.

However, the researchers wrote, “intakes of saturated fat and monounsaturated fat, the major components of animal fat, were not associated with endometriosis risk.

“Interestingly, palmitic acid intake, a saturated fat primarily contributed by animal products, was significantly related to increased endometriosis risk when all other dietary components were held constant.”

The researchers were unable to draw any conclusions about the timing of dietary exposure (ranging from 2 to 10 years before diagnosis) and endometriosis. They found that the risk was consistent across time.

That does not mean that adding omega-3 fatty acids and avoiding trans fats would not be helpful in preventing endometriosis, Dr. Missmer said.

“We think that the more likely conclusion is that people don't tend to change their diets a lot,” she pointed out.

Indeed, Dr. Missmer and her colleagues predicted that endometriosis risk could be slashed significantly by substituting omega-3 fatty acids for trans fats.

“Each 1% of energy from omega-3 fatty acids rather than from trans fats was associated with nearly a 50% lower risk of endometriosis,” they wrote.

“Also, each 1% of energy from trans fats rather than from any other type of fat was associated with a significantly higher risk of endometriosis.”

Dr. Missmer indicated that the next step would be to study whether an increase in omega-3 fatty acids in the diet, and a decrease in trans fats leads to reduction of endometriosis symptoms, as has been suggested in animal studies (Fertil. Steril. 2007;88:1108–19) and a report that links omega-3s to an alleviation of menstrual pain, which endometriosis is known to exacerbate (Eur. J. Clin. Nutr. 1995;49:508–16).

The study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Cancer Institute.

Neither Dr. Missmer nor her colleagues reported conflicts of interest.

A diet rich in omega-3 fatty acids includes tuna and other dark fish.

Source Flander/iStockphoto.com

Data from a large cohort study have shown that women who regularly eat fish, mayonnaise, and other foods that are rich in omega-3 fatty acids are at decreased risk of being diagnosed with endometriosis.

In contrast, women whose diets are rich in trans fats are much likelier to develop the disease.

The findings suggested no association between women's endometriosis risk and overall fat intake, but only associations by the type of dietary fats consumed.

Women in the highest fifth of long-chain omega-3 fatty acid consumption were 22% less likely to be diagnosed with endometriosis, compared with those in the lowest fifth.

Women in the highest fifth of trans fat consumption were 48% more likely to be diagnosed with endometriosis than were those in the bottom fifth.

The investigators adjusted the results for variables such as age at menarche, menstrual cycle length, and parity (Hum. Reprod. 2010 March 24 [doi:10.1093/humrep/deq044]).

“The message—and we stress that this is the first publication to address this—is that the findings affirm the benefits of a healthy-fat diet that has also been shown to be beneficial for cardiovascular health,” Stacey A. Missmer, Sc.D., the lead author of the study, said in an interview.

“Low-fat across the board is not the way to go,” she added.

For their analysis, Dr. Missmer of Harvard Medical School, Boston, and her colleagues examined 12 years of data (1989–2001) from 70,709 women who were registered nurses.

Diet assessments were based on self-reported questionnaires, but diagnoses of endometriosis (with or without infertility) were confirmed through medical records.

Women with prior endometriosis who had undergone hysterectomy, were menopausal, or had prior cancer were excluded.

The study participants updated their diet information at 4-year intervals over the course of the trial period.

By the final year of analysis, 1,199 cases of laparoscopically confirmed endometriosis had been reported.

The researchers identified the major sources of long-chain omega-3 fatty acids in the women's diets as salad dressing and mayonnaise, tuna, and other dark fish, although Dr. Missmer said some women reported taking omega-3 supplements.

The major sources of trans-unsaturated fatty acids were fried foods that were not cooked at home, “particularly french fries,” Dr. Missmer said, along with margarine and crackers.

Although trans-unsaturated fats proved to be an easily identified culprit, an increased risk of endometriosis—20%—was also seen in the quintile of subjects who had consumed the most animal fats.

However, the researchers wrote, “intakes of saturated fat and monounsaturated fat, the major components of animal fat, were not associated with endometriosis risk.

“Interestingly, palmitic acid intake, a saturated fat primarily contributed by animal products, was significantly related to increased endometriosis risk when all other dietary components were held constant.”

The researchers were unable to draw any conclusions about the timing of dietary exposure (ranging from 2 to 10 years before diagnosis) and endometriosis. They found that the risk was consistent across time.

That does not mean that adding omega-3 fatty acids and avoiding trans fats would not be helpful in preventing endometriosis, Dr. Missmer said.

“We think that the more likely conclusion is that people don't tend to change their diets a lot,” she pointed out.

Indeed, Dr. Missmer and her colleagues predicted that endometriosis risk could be slashed significantly by substituting omega-3 fatty acids for trans fats.

“Each 1% of energy from omega-3 fatty acids rather than from trans fats was associated with nearly a 50% lower risk of endometriosis,” they wrote.

“Also, each 1% of energy from trans fats rather than from any other type of fat was associated with a significantly higher risk of endometriosis.”

Dr. Missmer indicated that the next step would be to study whether an increase in omega-3 fatty acids in the diet, and a decrease in trans fats leads to reduction of endometriosis symptoms, as has been suggested in animal studies (Fertil. Steril. 2007;88:1108–19) and a report that links omega-3s to an alleviation of menstrual pain, which endometriosis is known to exacerbate (Eur. J. Clin. Nutr. 1995;49:508–16).

The study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Cancer Institute.

Neither Dr. Missmer nor her colleagues reported conflicts of interest.

A diet rich in omega-3 fatty acids includes tuna and other dark fish.

Source Flander/iStockphoto.com

Children of African, African Caribbean, and South Asian descent show precursors of type 2 diabetes risk that reflect the elevated risk patterns of adults in those ethnic groups, according to a new study of nearly 5,000 9- and 10-year-old schoolchildren living in three U.K. cities.

“The new epidemic of early onset type 2 diabetes occurring in many Western societies affects all sections of the population, and key preventive measures in childhood … are likely to be widely desirable. However, there is a particularly urgent need for preventive measures in high-risk ethnic groups, in which the benefits of prevention are potentially greater,” the study investigators reported (PLoS Medicine 2010 April 20 [doi:10.1371/journal.pmed.1000263]).

Peter Whincup, Ph.D., of St. George's, University of London, and colleagues took body measurements and blood samples from primary school students of 1,153 white European, 1,306 South Asian, and 1,215 African or African Caribbean descent, along with 294 children with roots in other parts of Asia and 828 mixed-race children, using ethnicity data reported by their parents. A total of 80% of the children in the three largest groups were U.K. born; all lived in Leicester, Birmingham, or London. The researchers measured the children's adiposity and recorded the socioeconomic status and immigration history of the children's families.

Children of South Asian descent, compared with their white peers, had significantly higher levels of glycated hemoglobin (2.1% higher), fasting insulin (30%), triglyceride (12.9%), and C-reactive protein (43%), along with lower levels of HDL cholesterol (2.9% lower). Children of African or African Caribbean descent had higher levels of glycated hemoglobin (1.9% higher), insulin (22.9%), C-reactive protein (21%), and—“paradoxically”—HDL cholesterol (1.9%), with lower levels of triglyceride (10.6% lower), they reported.

The remaining ethnic and mixed-race groups were not included in the comparative analysis.

The patterns seen among South Asian children closely mirrored those of adults in that U.K. ethnic group, which has roughly triple the diabetes risk of white U.K. citizens. The African and Caribbean children's patterns mirrored those of adult African Caribbeans, who also bear a risk significantly higher than that of white Europeans, the researchers noted.

The higher insulin and glycated hemoglobin levels seen among the black and South Asian children were particularly worrisome, Dr. Whincup said in an interview. “These are predictors in long-term diabetes risk, and the fact that the patterns are corresponding closely with the adult experience suggests that these new generations will be affected as well.”

None of the differences in risk profiles could be attributed to variations in adiposity among ethnic groups or to socioeconomic status.

Dr. Whincup said he did not view the differences in risk precursors as entirely hereditary. “It may be a complex interaction between genetics and environment.” He said his team hopes to study how childhood nutrition and physical activity, and early life factors, may influence ethnic differences in diabetes risk.

The research was funded by the Wellcome Trust and the British Heart Foundation. Dr. Whincup and his colleagues declared no conflicts of interest.

Children of African, African Caribbean, and South Asian descent show precursors of type 2 diabetes risk that reflect the elevated risk patterns of adults in those ethnic groups, according to a new study of nearly 5,000 9- and 10-year-old schoolchildren living in three U.K. cities.

“The new epidemic of early onset type 2 diabetes occurring in many Western societies affects all sections of the population, and key preventive measures in childhood … are likely to be widely desirable. However, there is a particularly urgent need for preventive measures in high-risk ethnic groups, in which the benefits of prevention are potentially greater,” the study investigators reported (PLoS Medicine 2010 April 20 [doi:10.1371/journal.pmed.1000263]).

Peter Whincup, Ph.D., of St. George's, University of London, and colleagues took body measurements and blood samples from primary school students of 1,153 white European, 1,306 South Asian, and 1,215 African or African Caribbean descent, along with 294 children with roots in other parts of Asia and 828 mixed-race children, using ethnicity data reported by their parents. A total of 80% of the children in the three largest groups were U.K. born; all lived in Leicester, Birmingham, or London. The researchers measured the children's adiposity and recorded the socioeconomic status and immigration history of the children's families.

Children of South Asian descent, compared with their white peers, had significantly higher levels of glycated hemoglobin (2.1% higher), fasting insulin (30%), triglyceride (12.9%), and C-reactive protein (43%), along with lower levels of HDL cholesterol (2.9% lower). Children of African or African Caribbean descent had higher levels of glycated hemoglobin (1.9% higher), insulin (22.9%), C-reactive protein (21%), and—“paradoxically”—HDL cholesterol (1.9%), with lower levels of triglyceride (10.6% lower), they reported.

The remaining ethnic and mixed-race groups were not included in the comparative analysis.

The patterns seen among South Asian children closely mirrored those of adults in that U.K. ethnic group, which has roughly triple the diabetes risk of white U.K. citizens. The African and Caribbean children's patterns mirrored those of adult African Caribbeans, who also bear a risk significantly higher than that of white Europeans, the researchers noted.

The higher insulin and glycated hemoglobin levels seen among the black and South Asian children were particularly worrisome, Dr. Whincup said in an interview. “These are predictors in long-term diabetes risk, and the fact that the patterns are corresponding closely with the adult experience suggests that these new generations will be affected as well.”

None of the differences in risk profiles could be attributed to variations in adiposity among ethnic groups or to socioeconomic status.

Dr. Whincup said he did not view the differences in risk precursors as entirely hereditary. “It may be a complex interaction between genetics and environment.” He said his team hopes to study how childhood nutrition and physical activity, and early life factors, may influence ethnic differences in diabetes risk.

The research was funded by the Wellcome Trust and the British Heart Foundation. Dr. Whincup and his colleagues declared no conflicts of interest.

Children of African, African Caribbean, and South Asian descent show precursors of type 2 diabetes risk that reflect the elevated risk patterns of adults in those ethnic groups, according to a new study of nearly 5,000 9- and 10-year-old schoolchildren living in three U.K. cities.

“The new epidemic of early onset type 2 diabetes occurring in many Western societies affects all sections of the population, and key preventive measures in childhood … are likely to be widely desirable. However, there is a particularly urgent need for preventive measures in high-risk ethnic groups, in which the benefits of prevention are potentially greater,” the study investigators reported (PLoS Medicine 2010 April 20 [doi:10.1371/journal.pmed.1000263]).

Peter Whincup, Ph.D., of St. George's, University of London, and colleagues took body measurements and blood samples from primary school students of 1,153 white European, 1,306 South Asian, and 1,215 African or African Caribbean descent, along with 294 children with roots in other parts of Asia and 828 mixed-race children, using ethnicity data reported by their parents. A total of 80% of the children in the three largest groups were U.K. born; all lived in Leicester, Birmingham, or London. The researchers measured the children's adiposity and recorded the socioeconomic status and immigration history of the children's families.

Children of South Asian descent, compared with their white peers, had significantly higher levels of glycated hemoglobin (2.1% higher), fasting insulin (30%), triglyceride (12.9%), and C-reactive protein (43%), along with lower levels of HDL cholesterol (2.9% lower). Children of African or African Caribbean descent had higher levels of glycated hemoglobin (1.9% higher), insulin (22.9%), C-reactive protein (21%), and—“paradoxically”—HDL cholesterol (1.9%), with lower levels of triglyceride (10.6% lower), they reported.

The remaining ethnic and mixed-race groups were not included in the comparative analysis.

The patterns seen among South Asian children closely mirrored those of adults in that U.K. ethnic group, which has roughly triple the diabetes risk of white U.K. citizens. The African and Caribbean children's patterns mirrored those of adult African Caribbeans, who also bear a risk significantly higher than that of white Europeans, the researchers noted.

The higher insulin and glycated hemoglobin levels seen among the black and South Asian children were particularly worrisome, Dr. Whincup said in an interview. “These are predictors in long-term diabetes risk, and the fact that the patterns are corresponding closely with the adult experience suggests that these new generations will be affected as well.”

None of the differences in risk profiles could be attributed to variations in adiposity among ethnic groups or to socioeconomic status.

Dr. Whincup said he did not view the differences in risk precursors as entirely hereditary. “It may be a complex interaction between genetics and environment.” He said his team hopes to study how childhood nutrition and physical activity, and early life factors, may influence ethnic differences in diabetes risk.

The research was funded by the Wellcome Trust and the British Heart Foundation. Dr. Whincup and his colleagues declared no conflicts of interest.