EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, NOVEMBER 10, 2003
To contact Martha L. Daviglus, M.D., Ph.D., call Elizabeth Crown at 312/503-8928.

BEING OVERWEIGHT IN MIDDLE-AGE LINKED TO POOR HEALTH IN LATER YEARS

CHICAGO—Having a higher body mass index in middle age may be associated with a poorer health and quality of life in older age, according to an article in the November 10 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

According to information in the article, overweight and obesity are associated with several health problems and shorter life expectancy, but the effect of body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) at middle age on the quality of life in later years is not known. The article states that approximately 108 million adults in the United States are overweight or obese.

Martha L. Daviglus, M.D., Ph.D., of Northwestern University Feinberg School of Medicine, Chicago, and colleagues investigated whether BMI at middle age is linked to health-related quality of life in older age.

The researchers studied 6,766 men and women who enrolled in the Chicago Heart Association Detection Project in Industry study between November 7, 1967 and January 8, 1973 and completed a 26-year follow up questionnaire in 1996 when they were 65 years or older. Participants were aged 36 to 64 years old, and were free of diabetes mellitus or myocardial infarction (heart attack) at the beginning of the study. The researchers calculated BMI (based on measured height and weight) at the beginning of the study, and the follow-up Health Status Questionnaire 12 (mailed 26 years after enrollment) asked several health related questions measuring physical, mental and social well-being. Higher scores on the questionnaire correlated with better health.

The researchers found that for both men and women, BMI had significant associations with all Health Status Questionnaire 12 scores. Scores were highest (best) in normal-weight individuals (BMI, 18.5 to 25) and decreased with higher BMI with the worst outcomes for obese participants (BMI of 30 or higher).

For women, 46.8 percent of participants who were of normal-weight at the beginning of the study reported excellent or very good health in later years compared with 37.9 percent of overweight women and 24.3 percent of obese women. For men, 53.8 percent of participants with normal weights at the beginning of the study reported excellent of very good health compared with 49.1 percent of overweight men, and 36.5 percent of obese men.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, NOVEMBER 10, 2003
To contact Paul W. Armstrong, M.D., call Michael Robb at 780/492-0647.

HEART ATTACKS APPEAR TO HAVE MORE SERIOUS IMPACT ON WOMEN THAN MEN

CHICAGO—Women who have heart attacks appear to be more seriously affected than men, according to an article in the November 10 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

Unstable angina (UA) is a heart condition caused by insufficient oxygen reaching the heart muscle and causing periodic severe, constricting pain in the chest. According to information in the article, gender has been shown to affect the probability of death from unstable angina or acute myocardial infarction (AMI, heart attack), but no studies have examined both UA and AMI to explain this variation.

Paul W. Armstrong, M.D., of the University of Alberta, Edmonton, Canada, and colleagues conducted a population-based study to explore differences in five-year death rates after UA and AMI in men and women.

The researchers used an administrative database of 22,967 patients with AMI and 8,441 patients with UA discharged from acute care hospitals in Alberta, Canada between April 1, 1993 and March 31, 2000.

The researchers found that women were older with more health problems and more frequently had a diagnosis of UA. Women were also 30 percent less likely to undergo revascularization (procedures to open up blocked vessels) than men. Estimates of five-year death rates were similar between men and women after UA (women vs. men, 21.6 percent vs. 19.5 percent) but higher for women after AMI (38.5 percent for women vs. 26.6 percent for men). After adjusting for other health problems and revascularization procedures, the researchers found that sex was a significant predictor of five-year death rates after UA but not after AMI.

The researchers also found that only women younger than 65 years were at a higher risk after AMI.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, NOVEMBER 10, 2003
To contact Jose C. Appolinario, M.D., D.Sc., e-mail appolinario{at}biohard.com.br.

ANTIOBESITY DRUG MAY HELP TREAT BINGE EATING DISORDER

CHICAGO—Sibutramine, a drug approved for the treatment of obesity, may be effective in treating binge eating disorder, according to an article in the November issue of The Archives of General Psychiatry, one of the JAMA/Archives journals.

Binge-eating disorder (BED) is characterized by episodes of uncontrolled consumption of large amounts of food without subsequent purging, according to the article. BED is a common diagnosis among patients seeking treatment for obesity, and patients with BED are also at a higher risk for depression. A previous small trial of patients with BED suggests that sibutramine, an anti-obesity agent approved by the U.S. Food and Drug Administration for treating obesity, may be a safe and effective treatment for BED.

Jose C. Appolinario, M.D., D.Sc., of Federal University of Rio de Janeiro, Brazil, and colleagues conducted a randomized placebo-controlled trial to evaluate the safety and effectiveness of sibutramine in obese patients with BED.

Sixty obese (body mass index, or BMI of 30-45) patients with diagnosed BED were randomly assigned to receive either 15 milligrams per day of sibutramine hydrochloride (n=30) or placebo (n=30) for 12 weeks. The researchers measured binge frequency (defined as the number of days on which at least one binge episode occurred in the past week) and analyzed self-reported evaluations by the participants on eating and depressive symptoms and weight changes.

The researchers found that the number of binge days per week decreased from about four binge days to two binge days in the sibutramine group after 12 weeks of treatment. The sibutramine group also lost an average of about 16 pounds compared with a small weight gain averaging about three pounds in the placebo group.

EMBARGOED UNTIL 3 P.M. (CT), NOVEMBER 10, 2003
To contact Dick Tibboel, M.D., Ph.D., e-mail j.illsley{at}erasmusmc.nl.

MANY PREMATURE BABIES UNDERGO PAINFUL MEDICAL PROCEDURES WITHOUT PAINKILLERS

CHICAGO—Despite undergoing many painful procedures, few hospitalized neonates (prematurely born, underweight babies) receive appropriate pain reducing drugs, according to an article in the November issue of The Archives of Pediatric & Adolescent Medicine, one of the JAMA/Archives journals.

Despite current knowledge that low birth weight infants are able to experience pain, many daily procedures are still performed without pain reducing drugs, according to the article. Previous studies have shown that neonates are highly sensitive to pain, and that undergoing many painful procedures may lead to short- and long-term detrimental effects.

Dick Tibboel, M.D., Ph.D., of Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands, and colleagues collected data on the number and type of daily painful procedures performed on 151 neonates during the first 14 days of care neonatal intensive care unit (NICU) admission, including failed procedures (for example, multiple attempts at inserting catheters). The data collected were linked to estimates of the pain of each procedure, obtained from the opinions of experienced clinicians. The researchers also evaluated the use of analgesic therapy and compared it with current guidelines.

The researchers found that on average, each neonate was subjected to an average of 14 procedures per day. The highest exposure to painful procedures occurred during the first day of admission, and most procedures (63.6 percent) consisted of suctioning (for example, removing mucous or fluids from the nose or throat). Many procedures (26 of 31 listed on a questionnaire) were estimated to be painful (pain scores of greater than 4 on a 10-point scale). Analgesic therapy (provided prior to the painful procedure) was provided to fewer than 35 percent of neonates per study day, while 39.7 percent of the neonates did not receive any analgesic therapy in the neonatal intensive care unit.

EMBARGOED UNTIL 3 P.M. (CT), MONDAY, NOVEMBER 10, 2003
To contact Evelyn Cohen Reis, M.D., call Melanie Finnigan at 412/692-5016.

INFANTS HELD DURING IMMUNIZATION SHOTS CRY LESS

CHICAGO—Infants held by a parent and given a bottle or pacifier during multiple immunization shots cried less than infants who were placed on an examination table for their immunizations, according to an article in the November issue of The Archives of Pediatric & Adolescent Medicine, one of the JAMA/Archives journals.

According to the article, routine immunization injections are the most common painful procedures of childhood. With the continued introduction of new vaccines, children may now receive up to 20 injections by their second birthday, and despite an increased focus on pain assessment and management, infant injection-related pain remains largely untreated. Preliminary data suggest that untreated pain early in life may have sustained negative effects on the developing central nervous system.

Evelyn Cohen Reis, M.D., of Children's Hospital of Pittsburgh, and colleagues conducted a randomized controlled trial of 116 infants (average age, 9.5 weeks old) to asses the effectiveness, feasibility, and parental acceptance of a pain reducing intervention for infants receiving multiple immunization shots.

Infants receiving their 2-month immunizations (consisting of 4 injections) were randomly assigned to the intervention or control group. Infants in the intervention group were given a bottle containing a sugar-water mixture two minutes before the injections. During injections, they were held by a parent, and were given a bottle of pacifier. Infants in the control group did not receive these interventions and were placed on an examination table to receive their immunizations.

The researchers audiotaped the procedures to record crying. Heart rate before, during and just after the procedures was also measured.

The researchers found that the median duration of the first cry (the middle value of crying durations recorded; half the durations were shorter, half were longer) after the first injection was 19 seconds for the intervention group compared with 57.5 seconds for the control group. Parents of infants in the intervention group reported a strong preference for using the pain reducing techniques for future injections.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, NOVEMBER 10, 2003
To contact Neil M. Bressler, M.D., call Karen Blum at 410/955-1534. To contact editorialist Lee M. Jampol, M.D., call Elizabeth Crown at 312/503-8928.

VITAMIN USE HAS POTENTIAL TO PREVENT VISION LOSS FOR CERTAIN OLDER PEOPLE AT RISK FOR AGE-RELATED MACULAR DEGENERATION

CHICAGO—Vision loss could be prevented in a large population of people at risk for age-related macular degeneration (AMD) if they took a combination of certain antioxidants and zinc supplements, according to an article in the November issue of The Archives of Ophthalmology, one of the JAMA/Archives journals.

AMD is the leading cause of blindness for people aged 65 and older, and is caused by the deterioration of the retina. According to the article, in 2001, the Age-Related Eye Disease Study (AREDS) Research Group reported a reduced risk of advanced AMD and its associated vision loss for study participants with some vision loss who were assigned to high-dose supplementation with antioxidants (vitamin C, vitamin E, and beta carotene) plus zinc as zinc oxide, or zinc alone. On the basis of these findings, the AREDS Research Group recommended that people with the kinds of vision loss associated with the early stages of macular degeneration consider taking the vitamin supplements used in the study.

Neil M. Bressler, M.D., of The Johns Hopkins Medical Institutions, Baltimore, Md., and an Investigator on the AREDS Research Group, and colleagues estimated the potential public health impact of the findings of AREDS on reducing the number of people developing AMD during the next five years in the United States.

The researchers used estimates from AREDS on progression rates of AMD and the reduction of risk for developing AMD when using the antioxidant and zinc supplements. They applied these results to estimates of the U.S. population at risk for AMD in order to calculate the number of people who would potentially avoid developing advanced AMD over 5 years if those at risk took the supplements used in AREDS.

The researchers found that an estimated eight million people at least 55 years old in the United States are considered to be at high risk for advanced AMD and should consider taking the AREDS supplements. According to the researchers estimates, of these people, 1.3 million would develop advanced AMD if no treatment were given to reduce their risk. If all the people at risk took the supplements used in AREDS, more than 300,000 of them would avoid advanced AMD and any associated vision loss during the next five years.