(Embargoed Until: 3 P.M. (CT), Monday, January 10, 2005)
(Embargoed Until: 3 P.M. (CT), Monday, January 10, 2005)
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 10, 2005
To contact Robert D. Vorona, M.D., call Doug Gardner or Madeleine Hill at 757-446-6070. To contact corresponding author Coen D.A. Stehouwer, M.D., Ph.D., email: cda.stehouwer{at}vumc.nl. To contact editorialist Joseph Bass, M.D., Ph.D., call Elizabeth Crown at 312-503-8928.
INSUFFICIENT SLEEP ASSOCIATED WITH OVERWEIGHT AND OBESITY
CHICAGO—Obese and overweight patients in a study group reported sleeping less than their peers with normal body mass indexes (BMIs), according to an article in the January 10 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
Insufficient sleep causes neurocognitive changes such as excessive daytime sleepiness, altered mood, and increased risk for work-related injury and automotive accidents, according to background information in the article. It has been reported that the average American is currently getting less sleep than they did a century ago. With these declining sleep times there has also been an increase in the number of both obese and severely obese people in the U.S.
Robert D. Vorona, M.D., from Eastern Virginia Medical School, Norfolk, and colleagues examined patients' total sleep time per 24 hours in relation to their body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters). One thousand-one patients completed a questionnaire involving demographics, medical problems, sleep habits, and sleep disorders. The patients were classified as being of normal weight (BMI less than 25), overweight (BMI 25 - 29.9), obese (BMI 30 - 39.9), or severely obese (BMI 40 or greater). The average participant had a BMI of 30, and was 48 years old.
The researchers found that total sleep time decreased as BMI increased, except in the severely obese group. Men slept an average of 27 minutes less than women, and overweight and obese patients slept less than patients with normal BMIs. The difference in total sleep time between patients with a normal BMI and the other patients was 16 minutes per day, reaching 112 minutes, or 1.86 hours, over a week. In addition, night-shift work was associated with 42 minutes less total sleep time.
"Americans experience insufficient sleep and corpulent bodies. Clinicians are aware of the burden of obesity on patients," the authors write. "Our findings suggest that major extensions of sleep time may not be necessary, as an extra 20 minutes of sleep per night seems to be associated with a lower BMI. We caution that this study does not establish a cause-and-effect relationship between restricted sleep and obesity. Investigations demonstrating success in weight loss via extensions of sleep would help greatly to establish such a relationship."
(Arch Intern Med. 2005;165:25-30. Available post-embargo at archinternmed.com)
Editor's Note: This study was supported by the Division of Sleep Medicine of the Department of Internal Medicine and the Department of Family Practice of Eastern Virginia Medical School and by the office of Dr. Feldman (co-author).
WEIGHT, FITNESS AND LIFESTYLE IDENTIFIED AS IMPORTANT FACTORS CONTRIBUTING TO METABOLIC SYNDROME
The metabolic syndrome, a group of several abnormalities, including obesity and high blood pressure, in one individual was identified in 10.4 percent of 36-year-old study participants, according to an article in the January 10 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
According to background information in the article, the prevalence of metabolic syndrome, an important cause of cardiovascular disease, is increasing, especially in young individuals. Metabolic syndrome is identified when three or more of five risk factors are present: high blood pressure, high cholesterol, high triglyceride levels, high blood sugar levels, and a waist circumference of more than 94 cm [about 37 inches] in men and more than 80 cm [about 31.5 inches] in women. Although metabolic syndrome is believed to be caused principally by obesity, its determinants aren't completely understood.
Isabel Ferreira, Ph.D., from the Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, the Netherlands, and colleagues analyzed to what extent specific variables determined the occurrence of the metabolic syndrome in patients from age 13 to 36 years. The researchers measured body fatness and fat distribution, cardiopulmonary fitness, and lifestyle factors in 364 participants from the Amsterdam Growth and Longitudinal Study, which began in 1977.
The prevalence of the metabolic syndrome at the age of 36 years was 10.4 percent. Participants with the metabolic syndrome, compared to those without, had a more significant increase in total body fatness and trunk fat beneath the skin; a decrease in cardiopulmonary fitness; an increase in physical activities of light-to-moderate intensity, but a decrease in more intense physical activities; a higher energy intake throughout the study; and a decreased likelihood of alcoholic beverage consumption. The metabolic syndrome was identified in 3.2 percent of the women and 18.3 percent of the men participating in the study.
"Fatness, fitness, and lifestyle are important determinants of the metabolic syndrome in young adults," the authors write. "More important, these associations were independent of each other and, therefore, represent separate potential targets for the prevention of metabolic syndrome. Our study further suggests that intervening early in life (e.g., in the period of transition from adolescence to adulthood) may be a fruitful area for prevention of the metabolic syndrome," they concluded.
(Arch Intern Med. 2005;165:42-45. Available post-embargo at archinternmed.com)
Editor's Note: Dr. Ferreira was supported by a joint research grant from the Foundation for Science and Technology (State Secretary of Science and Technology of Portugal) and the European Social Fund (Third European Community Framework Program).
EDITORIAL: SLEEPLESS IN AMERICA
In an accompanying editorial, Joseph Bass, M.D., Ph.D., from Northwestern University Feinberg School of Medicine, and Fred W. Turek, M.D., Northwestern University, Evanston, Ill., commented on two obesity studies in this week's Archives of Internal Medicine.
"Obesity is a disease that, in just the past few decades, has been rising dramatically in developed countries and reached epidemic levels in the United States," the authors write. "Besides the social stigma attached to obesity, these trends are cause for concern because of the risks of secondary complications, including insulin resistance and type 2 diabetes mellitus, hyperlipidemia [high cholersterol], cardiovascular disease, hypertension [high blood pressure], stroke, cancer, and arthritis."
"In recent years, a new and unexpected 'obesity villain' has emerged, first from laboratory studies and now, as reported by Vorona et al in this issue of the ARCHIVES, in population-based studies: insufficient sleep....However, while there is a growing awareness among some sleep, metabolic, cardiovascular, and diabetes researchers that insufficient sleep could be leading to a cascade of disorders, few in the general medicine profession or in the lay public have yet made the connection."
"It is now critical to determine the importance of lack of sufficient sleep during the early formative years in putting our youth on a trajectory toward obesity and the metabolic syndrome-a trajectory that could be altered if sleep loss is indeed playing a role in this epidemic," the authors write.
(Arch Intern Med. 2005;165:15-16. Available post-embargo at archinternmed.com)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 10, 2005
To contact Farr A. Curlin, M.D., call John Easton at 773-702-6241.
PHYSICIANS' RESPONSE TO RELIGION-RELATED CONFLICTS IN MEDICINE
CHICAGO—Physicians may encounter situations in which their medical recommendations conflict with a patient's religious beliefs, according to an article in the January 10 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
According to background information in the article, many patients use their religious beliefs and values to understand, cope with, and navigate their experience of illness, and at times, these beliefs will conflict with physicians' recommendations. How physicians should act in response to such discrepancies has been a topic of discussion; however, little is know about how these disagreements should actually be negotiated.
Farr A. Curlin, M.D., from the University of Chicago, and colleagues conducted one-to-one, in-depth interviews with 21 physicians in order to explore conflicts between medical recommendations and patients' religious commitments. Of the physicians interviewed, seven identified themselves as non-religious (either no affiliation with or no practice of any religion), six as Protestant, four as Jewish, two as Catholic, one as Hindu, and one as Buddhist.
Nearly all of the physicians interviewed related circumstances in which patients used religious terms to describe their disagreement with medical recommendations. In general, the researchers found that patients most often refuse medical recommendations for religious reasons in scenarios of relative medical uncertainty in which treatment offers moderate possibilities of benefit, or in situations in which treatment is intended to decrease risks of adverse events in the future. The researchers also found that if physicians believed a religious patient would suffer harm by not following their recommendations, "the physician's commitment to preserving the patient's health may lead the physician to attempt to persuade the patient to reconsider his or her decision."
The authors write: "Our findings suggest that physicians always navigate a balance between respect for patient autonomy (remaining open-minded and flexible) and concern for the patient's good (persuading the patient to adhere to recommendations)...Rather than striving for illusory neutrality, physicians should practice an ethic of candid, respectful dialogue in which they negotiate accommodations that allow them to respectfully work together with patients, despite their different ways of understanding the world."
(Arch Intern Med. 2005;165:88-91. Available post-embargo at archinternmed.com)
Editor's Note: This study was funded by grant support for "The Integration of Religion and Spirituality in Patient Care Among U.S. Physicians: A Three-Part Study" from the Greenwall Foundation, New York, N.Y., and from The Robert Wood Johnson Clinical Scholars Program, Princeton, N.J. [Drs. Curlin, and Lantos and Chin (co-authors)].
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 10, 2005
To contact corresponding author Lenore J. Launer, Ph.D., call Doug Dollemore at 301-496-1752. To contact editorialist Michael Grundman, M.D., M.P.H., call Anita Kawatra at 800-252-3526.
WEIGHT LOSS MAY BE AN EARLY SIGN OF DEMENTIA IN THE ELDERLY
CHICAGO—Dementia-associated weight loss begins before the onset of the definite dementia symptoms and accelerates by the time of the diagnosis, according to a study in the January issue of the Archives of Neurology, one of the JAMA/Archives journals.
Weight loss in old age is common and may be related to various diseases, according to background information in the article. "It has long been observed that weight loss is common in Alzheimer disease (AD), but this has been documented in people who already have dementia."
Robert Stewart, M.D., From the Institute of Psychiatry, London, and colleagues analyzed data from 1,890 men (aged 77-98 years) who were participants in The Honolulu-Asia Aging Study. This population-based study of Japanese American men included 112 men with incident [new onset] dementia and 1,778 without dementia. The study participants were examined on six occasions over a period of up to 34 years. Weight was measured at each examination and dementia was ascertained at the three most recent examinations.
"Incident dementia was associated with significant previous weight loss, which was independent of a large number of potential confounding factors," the researchers found. "A high proportion of men with dementia at examination 6 had lost at least 5 kg [about 11 pounds], which approaches 10 percent of average body weight for this cohort. This weight loss occurred in many cases over the two to four years prior to reaching the clinical threshold of dementia. The association was similar in AD and vascular dementia."
In conclusion the authors write: "An important consideration arising from research in this area is the extent to which weight loss may be prevented or minimized in dementia. Poor nutrition and frailty frequently complicate later stages of dementia, causing falls, poor wound healing, and increased physical dependence. ...The results presented here suggest that weight change and nutritional state in people with dementia should be taken seriously at least from the time of diagnosis if not at earlier stages of more mild cognitive impairment."
(Arch Neurol. 2005;62:55-60. Available post-embargo at archneurol.com)
Editor's Note: Dr. Stewart was supported by a Research Training Fellowship in Clinical Epidemiology from the Wellcome Trust, London, United Kingdom. The Honolulu-Asia Aging Study is supported by the National Institutes of Health, Bethesda, Md.: National Institute on Aging and National Heart, Lung, and Blood Institute.
EDITORIAL: WEIGHT LOSS IN THE ELDERLY MAY BE A SIGN OF IMPENDING DEMENTIA
In an accompanying editorial, Michael Grundman, M.D., M.P.H., from Elan Pharmaceuticals, San Diego, Calif., writes: "The article by Stewart et al in this issue of Archives of Neurology provide evidence that men who develop dementia (both AD and vascular dementia) tend to start losing weight at least several years prior to their clinical diagnoses."
"Since it is already known that specific risk factors and genes are implicated in some patients who develop AD and other susceptibility genes are likely to be discovered, it may be too optimistic to suppose that nutritional approaches will necessarily have a huge impact on preventing AD or slowing cognitive decline. Nevertheless, even modest effects could have large public health implications. The degree to which treatment interventions directed toward maintaining optimal nutrition and preventing excess weight loss could slow the disease course requires more rigorous study."
(Arch Neurol. 2005;62:20-22. Available post-embargo at archneurol.com)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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