CHICAGO—Persons with certain genetic variations who take statins to lower their cholesterol will not realize the same benefit as other individuals, according to a study in the June 16 issue of the Journal of the American Medical Association (JAMA).

Therapy with 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) lowers total and low-density lipoprotein (LDL) cholesterol and has proven to be highly effective for cardiovascular risk reduction, according to background information in the article. However, there is wide variation in interindividual response to statin therapy, and it has been hypothesized that genetic differences may contribute to this variation.

Daniel I. Chasman, Ph.D., of Brigham and Women's Hospital and Harvard Medical School, Boston, and colleagues conducted a study to determine whether common genetic variants influence the degree of lipid level reduction during pravastatin therapy. The study included 1,536 individuals treated with pravastatin, 40 mg/per day. Their DNA in blood samples was analyzed for 148 single-nucleotide polymorphisms (SNPs) within 10 candidate genes related to lipid metabolism. Variation within these genes was then examined for associations with changes in lipid levels observed with pravastatin therapy during a 24-week period.

"In this analysis of 148 SNPs across 10 genes known to be involved in cholesterol synthesis and statin metabolism, we found 2 common and closely linked polymorphisms in the HMG-CoA reductase gene that were significantly associated with a 22 percent smaller reduction in total cholesterol and a 19 percent smaller reduction in LDL cholesterol following 24 weeks of pravastatin therapy," the authors write. "For total cholesterol, these effects remained significant after adjustment for all SNPs evaluated and were consistent in magnitude and direction among men and women and among whites as well as the total cohort."

CHICAGO—Adolescents are more likely to overeat when served fast food, but lean adolescents tend to compensate for the over-consumption by eating less at other meals, which is not something their overweight counterparts are likely to do, according to a study in the June 16 issue of the Journal of the American Medical Association (JAMA).

"Consumption of fast food has increased rapidly since the 1970s among adolescents from all socioeconomic and racial/ethnic groups across the United States," the authors provide as background information in the article. "An estimated 75 percent of adolescents eat fast food one or more times per week. The increase in fast food consumption parallels the escalating obesity epidemic, raising the possibility that these 2 trends are causally related," the authors suggest. "Characteristics of fast food previously linked to excess energy intake [overeating] or adiposity [fat] include enormous portion size, high energy density, palatability, excessive amounts of refined starch and added sugars, high fat content, and low levels of dietary fiber."

In this study, Cara B. Ebbeling, Ph.D., from Children's Hospital, Boston, and colleagues conducted two studies to evaluate the effects of fast food on energy intake in overweight versus lean adolescents. Fifty-four adolescents were enrolled in the studies (26 overweight, 28 lean) aged 13 to 17 years who reported eating fast food at least one time per week. Fifty-one (24 overweight, 27 lean) of the 54 participants enrolled in study 1 also completed study 2. In this investigation, the researchers grouped adolescents who were overweight and at risk of overweight into one group and adolescents with a BMI [body mass index = weight in kilograms divided by the square of height in meters] not exceeding the 85th percentiles for their ages were considered lean.

In study one, participants were fed extra large fast food meals in a food court and instructed to eat as much or as little as desired during the one-hour meal. In study two, the researchers assessed how much food was eaten under free-living conditions for two days when fast food was consumed and two days when it was not consumed. The participants recalled dietary and physical activity on telephone interviews. Data were collected between July 2002 and March 2003.

"In study 1, mean [average] energy intake from the fast food meal among all participants was extremely large (1,652 kcal =calories), accounting for 61.6 percent of estimated daily energy requirements," the researchers found. "Overweight participants ate more than lean participants whether energy was expressed in absolute terms (1,860 vs. 1,458 kcal) or relative to estimated daily energy requirements (66.5 percent vs. 57 percent). In study 2, overweight participants consumed significantly more total energy on fast food days than non-fast food days (2,703 vs. 2,295 kcal/d; plus 409 kcal/d), an effect that was not observed among lean participants (2,575 vs. 2,622 kcal/d; less 47 kcal/d)." The researchers also found that overweight participants tended to under-report total energy intake compared with lean participants.

"...the overweight participants consumed more total energy on days with than without fast food, in contrast to the lean participants, who consumed virtually the same amount on both days. This observation suggests that overweight individuals do not compensate completely for the massive portion sizes characteristic of fast food today," the author note. "… these findings suggest that, at least, fast food consumption serves to maintain or exacerbate obesity in susceptible individuals."

CHICAGO—The high levels of overweight among children and obesity among adults remain a major public health concern, according to a report in the June 16 issue of the Journal of the American Medical Association (JAMA).

According to background information in the article, "The prevalence of overweight and obesity is considered an important public health issue in the United States. Healthy People 2010 identified overweight and obesity as one of the 10 leading health indicators."

Allison A. Hedley, Ph.D., from the Centers for Disease Control and Prevention, Atlanta, and colleagues updated the U.S. prevalence estimates of overweight in children and obesity in adults using the most recent national data of height and weight measurements. The researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES), a probability sample of the U.S. non-institutionalized civilian population. Both height and weight measurements were obtained from 4,115 adults and 4,018 children in 1999 - 2000 and from 4,390 adults and 4,258 children in 2001-2002.

"For adults, overweight, obesity, and extreme obesity, were defined as body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) of 25.0 to 29.9, 30.0 or more, and 40.0 or more, respectively." For children, "at risk for overweight was defined as at or above the 85th percentile but less than the 95th percentile of the sex-specific BMI for age", as defined by the CDC growth charts. "Overweight was defined as at or above the 95th percentile of the sex-specific BMI-for-age growth chart."

"Between 1999 - 2000 and 2001 - 2002, there were no significant changes among adults in the prevalence of overweight or obesity (64.5 percent vs. 65.7 percent), obesity (30.5 percent vs. 30.6 percent), or extreme obesity (4.7 percent vs. 5.1 percent), or among children aged 6 through 19 years in the prevalence of at risk for overweight or overweight (29.9 percent vs. 31.5 percent) or overweight (15.0 percent vs. 16.5 percent)," the authors found. "Overall, among adults aged at least 20 years in 1999 - 2002, 65.1 percent were overweight or obese, 30.4 percent were obese, and 4.9 percent were extremely obese. Among children aged 6 through 19 years in 1999 - 2002, 31 percent were at risk for overweight or overweight and 16 percent were overweight."

"The prevalence of obesity by age, sex, and racial/ethnic group ranged from 22.9 percent of non-Hispanic white men aged 20 through 39 years to 50.6 percent of non-Hispanic black women aged 40 through 59 years. Among women, non-Hispanic black women had the highest level of extreme obesity (13.5 percent) compared with 5.5 percent and 5.7 percent of non-Hispanic white and Mexican American women, respectively. There was no significant difference in the prevalence of obesity among men across racial/ethnic categories for all age groups. Among women aged at least 20 years, the prevalence of obesity differed significantly between racial/ethnic groups, with non-Hispanic white women having the lowest prevalence (30.7 percent), non-Hispanic black women having the highest (49.0 percent), and the prevalence among Mexican American women falling in between (38.4 percent). The prevalence of obesity was significantly higher among women than men."

CHICAGO—Additional research is needed before laser therapy can be recommended as a treatment for acne, according to a study in the June 16 issue of the Journal of the American Medical Association (JAMA).

Acne is a common disorder that has the potential to negatively affect the lives of millions of individuals, according to information in the article. In addition to the sometimes more short-term consequences of physical and emotional discomfort associated with this condition, acne also carries the risk of scarring that may serve as a permanent reminder of the disorder and thus prolong its psychological impact. Therefore, the development of safer, more convenient, and more effective treatments for acne is highly desirable. Treatment with various lasers has been reported to improve acne.

Jeffrey S. Orringer, M.D., and colleagues with the University of Michigan Medical School, Ann Arbor, Mich., evaluated the clinical efficacy of a type of laser treatment, pulsed dye laser therapy, for the treatment of acne.

The study was a randomized, controlled, clinical trial that included 40 patients aged 13 years or older with facial acne, conducted at an academic referral center from August 2002 to September 2003. Patients received one or two pulsed dye laser treatments to half of the face. The degree of acne was measured through blinded clinical assessments (lesion counts) and the use of standardized bilateral serial photographs comparing the treated and untreated sides of the face.

The researchers found no significant improvement in facial acne from the laser treatment. Changes in lesion counts for both sides of the face showed no statistically significant differences from baseline to week 12. Grading of serial photographs confirmed the clinical assessments.

CHICAGO—States with in-person license renewal policies had a 17 percent lower fatality rate among drivers 85 years and older than states without, according to a study in the June 16 issue of the Journal of the American Medical Association (JAMA).

According to background information in the article, motor vehicle death rates among older drivers have been increasing over the past two decades and are expected to account for up to 25 percent of total driver deaths in the year 2030, compared to 14 percent currently. In addition, elderly drivers have more deadly crashes per mile driven than any other group except teenage males.

David C. Grabowski, Ph.D., and colleagues from the University of Alabama at Birmingham, conducted a study examining states' license-renewal laws and fatal motor vehicle accidents involving older drivers in the United States. The researchers used data from the Fatality Analysis Reporting System (FARS), collected from January 1990 to December 2000 by the National Highway Traffic Safety Administration, which includes in-depth information on cars, drivers, and passengers involved in fatal motor vehicle accidents. In addition to in-person renewal laws, the researchers also studied the effect of vision tests, roads tests, and frequency of license renewal on elderly driver deaths.

There were 4,605 driver fatalities throughout the 11-year study period for drivers 85 years of age or older. The researchers found that states with mandated in-person license renewal laws had a 17 percent lower death rate among this age group than those states without such laws. However, the researchers also found that "vision tests, road tests, and more frequent renewals [were] not independently associated with additional safety benefits." In 2000, 45 states had in-person renewal laws, 40 states required vision tests and 2 states required road tests at the time of license renewal for older drivers.

LEAN TEENS COMPENSATE FOR EATING FAST FOOD BY EATING LESS CALORIES THROUGHOUT THE DAY - OVERWEIGHT TEENS DON'T COMPENSATE