JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.

JAMA NEWS RELEASES
(Embargoed for Release: 3 p.m. CT, Tuesday, April 19, 2005)

JAMA NEWS RELEASES

   BEING OBESE, UNDERWEIGHT, ASSOCIATED WITH INCREASED RISK OF DEATH

   NO STRONG EVIDENCE LINKING BLOOD MERCURY LEVELS WITH WORSE NEUROBEHAVIORAL PERFORMANCE IN OLDER ADULTS

   A MATHEMATICAL MODEL SUGGESTS THAT A NATIONAL KIDNEY PAIRED DONATION PROGRAM WOULD PROVIDE MORE MATCHES FOR PREVIOUSLY INCOMPATIBLE RECIPIENTS AND DONORS

JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)

   NEW STUDY MEASURES HOW MANY LIVES LOST TO OBESITY, OVERWEIGHT AND UNDERWEIGHT IN U.S.

INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.

TV Note: This week's JAMA video news release is on the lives lost from obesity, overweight, and underweight in the U.S. The release will be fed Tuesday, April 12, from 9:00 - 9:30 a.m. ET on Intelsat America 6 (formerly Telstar 6), Transponder 11 (C-Band) and from 2:00 - 2:30 p.m. ET on Intelsat America 6, Transponder 11 (C-Band). For more information, call 312/464-JAMA (5262).

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Embargoed for Release: 3 p.m. CT, TUESDAY, April 19, 2005
To contact Katherine M. Flegal, Ph.D., or Edward W. Gregg, Ph.D.,call Karen Hunter at 404-639-3286. To contact editorialist David H. Mark, M.D., M.P.H., call Jann Ingmire at 312-464-2499.

CHICAGO—Compared with normal weight, a person who is overweight or underweight has an increased risk of death, although that risk appears to have decreased in recent years for obesity, according to a study in the April 20 issue of JAMA.

As the prevalence of obesity increases in the United States, concern about the association of body weight and a higher risk of death has also increased, according to background information in the article.

Katherine M. Flegal, Ph.D., of the Centers for Disease Control and Prevention, Hyattsville, Md., and colleagues conducted a study to estimate deaths associated with underweight, overweight, and obesity in the United States in 2000 by using all available mortality data from the National Health and Nutrition Examination Surveys (NHANES). The researchers estimated relative risks of mortality associated with different levels of BMI (calculated as weight in kilograms divided by the square of height in meters) from the nationally representative (NHANES) I (1971-1975) and NHANES II (1976-1980), with follow-up through 1992, and from NHANES III (1988-1994), with follow-up through 2000. The authors then applied those relative risks to the NHANES 1999-2002 data to estimate excess mortality in 2000.

The researchers found that relative to the normal weight category (BMI 18.5 to less than 25), obesity (BMI 30 or greater) was associated with 111,909 excess deaths and underweight (BMI less than 18.5) with 33,746 excess deaths. Overweight was not associated with excess mortality. The relative risks associated with obesity were lower in NHANES II and NHANES III than in NHANES I.

"The differences between NHANES I and the later surveys suggest that the association of obesity with total mortality may have decreased over time, perhaps because of improvements in public health or medical care for obesity-related conditions. However, such speculation should be tempered by the awareness that these differences between surveys may simply represent chance variation and that small differences in relative risk translate into large differences in the numbers of deaths," the authors conclude.
(JAMA. 2005;293:1861-1867. Available post-embargo at jama.com)

Editor's Note: Partial salary support for Dr. Flegal was provided by the U.S. Army Research Institute of Environmental Medicine.

CARDIOVASCULAR RISK FACTORS HAVE DECLINED SUBSTANTIALLY OVER PAST 40 YEARS

Prevalence of high cholesterol levels, hypertension and smoking, particularly among overweight and obese adults, have declined considerably over the past 40 years, according to a study in the April 20 issue of JAMA. This trend was not true for diabetes, which has had a stable prevalence.

The association between the increase in obesity in the U.S. population and cardiovascular disease (CVD) risk factors has been uncertain. according to background information in the article.

Edward W. Gregg, Ph.D., of the Centers for Disease Control and Prevention, Atlanta, and colleagues analyzed data from 5 NHANES conducted during the last 40 years and examined whether long-term changes in levels of key cardiovascular risk factors have been different in overweight or obese persons compared with lean persons. The risk factors included prevalence of high cholesterol levels (240 mg/dL or greater [6.2 mmol/L or greater] regardless of treatment), high blood pressure (140/90 mm Hg or greater regardless of treatment), current smoking, and total diabetes (diagnosed and undiagnosed combined) according to BMI group (lean, less than 25; overweight, 25-29; and obese, 30 or greater).

The researchers found: "In this unique series of nationally representative surveys of the U.S. adult population, we documented a substantial decline in the prevalence of key CVD risk factors over the last 3 to 4 decades, affecting obese, overweight, and lean segments of the population. Among obese persons today, prevalence of high cholesterol, high blood pressure, and smoking are now 21, 18, and 12 percentage points lower, respectively, than among obese persons 30 to 40 years ago. The corresponding reductions among lean persons have been somewhat less, with average declines of 12 to 14 percentage points. Although obesity remains associated with a higher prevalence of important CVD risk factors, differences in total cholesterol levels across BMI groups may be narrowing, and for blood pressure and smoking improvements have been similar across BMI groups. Thus, obese and overweight persons may be at lower risk of CVD now than in previous eras."

"Diabetes is a notable exception to the observed reduction in risk factors, as prevalence of total diabetes (i.e., diagnosed and undiagnosed combined) did not decrease within BMI groups. This was accompanied by a 55 percent increase in total diabetes among the overall population (i.e., all BMI groups combined), presumably due to an increasing proportion of the population moving into the obese categories," the authors write.

"Despite our encouraging findings, a considerable proportion of lean as well as obese persons still have elevated levels of modifiable risk factors, particularly when one considers that the current definitions of risk factor control are more aggressive than the definitions used in this trend analyses. Clinical and public health efforts should continue to emphasize maintenance of healthy lifestyle behaviors for both lean as well as overweight and obese persons," the authors conclude.
(JAMA. 2005;293:1868-1874. Available post-embargo at jama.com)

EDITORIAL: DEATHS ATTRIBUTABLE TO OBESITY

In an accompanying editorial, David H. Mark, M.D., M.P.H., Contributing Editor of JAMA, Chicago, discusses the two studies in this week's JAMA that examine weight and health.

"These studies...highlight the importance of continuing to develop more rigorous approaches for estimating obesity-attributable deaths. Ultimately, though, it may be possible to gain a better and more realistic understanding of the preventable disease burden caused by obesity by evaluating public health and individual programs designed to both prevent and treat obesity, such as diet and exercise programs."

"Such programs should also be evaluated for their ability to reduce disease and morbidity in addition to effects on body weight, for there may be additional benefits (or possible risks). With sufficient knowledge of the effectiveness and required resources of these programs, it will be possible to make rational decisions regarding the best way to maintain and improve the health of the public," Dr. Mark concludes.
(JAMA. 2005;293:1918-1919. Available post-embargo at jama.com)

For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.

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Embargoed for Release: 3 p.m. CT, TUESDAY, April 19, 2005
Media Advisory: To contact Megan Weil, M.H.S., call Kenna Lowe at 410-614-6029.

NO STRONG EVIDENCE LINKING BLOOD MERCURY LEVELS WITH WORSE NEUROBEHAVIORAL PERFORMANCE IN OLDER ADULTS

CHICAGO—In a study of older adults, researchers did not find a definitive association between blood mercury levels, which can become elevated with fish consumption, and adverse neurobehavioral effects, according to a study in the April 20 issue of JAMA.

Mercury can be found throughout the environment, and enters the air during fossil-fuel combustion, mining, smelting, and solid-waste incineration, according to background information in the article. It is converted to methylmercury by microorganisms, enters the food chain, and accumulates in predatory fish. Consumption of certain fish is the primary source of methylmercury exposure in the general population. Methylmercury distributes rapidly throughout the body and easily crosses the blood-brain barrier into the brain, where it may become trapped.

Recent regulations for mercury emissions, the increasing trend in fish-consumption advisories, clinical studies, and heightened media attention have led to the emergence of mercury as a leading public health concern. Fish consumption is frequently recommended for older adults due to its high omega-3 fatty acid content, well-documented cardiovascular benefits, and, more recently, its possible protective association with Alzheimer disease. Since the aging nervous system is more sensitive to neurotoxicants, there is reason for concern about mercury contamination in fish.

Megan Weil, M.H.S., of the Johns Hopkins Bloomberg School of Public Health, Baltimore and colleagues conducted a study to examine associations between mercury exposure and neurobehavioral outcomes in a representative sample of older adults in the United States. The research included 474 randomly selected participants in the Baltimore Memory Study, a longitudinal study of cognitive decline involving 1,140 Baltimore residents aged 50 to 70 years. Total mercury in whole blood samples was measured and the researchers used multiple linear regression to examine its associations with scores from 12 neurobehavioral tests. First-visit data were obtained in 2001-2002. Participants also completed a food frequency questionnaire to determine fish consumption levels

"In summary, the study provided no compelling evidence that blood mercury levels were adversely associated with neurobehavioral test scores. There were some consistent associations across models but because of the large number of comparisons and the observation that statistically significant associations were in different directions (i.e., worse performance on a test of visual memory and better performance on tests of manual dexterity), we cannot exclude the possibility that associations were due to chance," the authors write.

"Since the aging population may be particularly vulnerable to neurotoxicants, this study was an attempt to examine whether this rapidly growing group is sensitive to even lower levels of exposure. Since the blood mercury levels in our study did not appear to be associated with adverse neurobehavioral effects, our results suggest that these levels of exposure may not present a concern for older adults. Studies with more detailed dose assessment are necessary to confirm this conclusion since a single blood-mercury level may not be an optimal estimate of cumulative dose," the researchers conclude.
(JAMA. 2005;293:1875-1882. Available post-embargo at jama.com)

Editor's Note: This work was supported by training grants from the National Institute of Environmental Health Sciences and from the National Institute of Occupational Safety and Health and a research grant from the National Institutes of Health.

For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.

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Embargoed for Release: 3 p.m. CT, TUESDAY, April 19, 2005
Media Advisory: To contact Dorry L. Segev, M.D., call Trent Stockton at 410-955-8665.

A MATHEMATICAL MODEL SUGGESTS THAT A NATIONAL KIDNEY PAIRED DONATION PROGRAM WOULD PROVIDE MORE MATCHES FOR PREVIOUSLY INCOMPATIBLE RECIPIENTS AND DONORS

CHICAGO—A mathematical simulation model suggests that implementation of a national kidney paired donation program would provide a greater number and quality of matches for recipients and donors that were incompatible, according to a study in the April 20 issue of JAMA.

Kidney transplantation has emerged as the treatment of choice for medically suitable patients with end-stage kidney disease, according to background information in the article. More than 60,000 patients await kidney transplantation and are listed on the United Network for Organ Sharing (UNOS) recipient registry. Live donor kidney transplantation represents the most promising solution for closing the gap between organ supply and demand. Unfortunately, about one-third of patients with willing live donors will be excluded from kidney transplantation because of blood type or tissue incompatibility.

Kidney paired donation (KPD) offers an incompatible donor/recipient pair the opportunity to match with another donor and recipient in a similar situation. In the United States, these exchanges are currently performed at few institutions, with matches identified through local or regional patient databases. UNOS has recently proposed a national live donor KPD program through the Organ Procurement and Transplantation Network, but regulatory obstacles to a national program still exist; therefore, no data exist regarding the impact of national vs. regional programs.

Dorry L. Segev, M.D., of the Johns Hopkins University School of Medicine, Baltimore, and colleagues developed a novel kidney donor matching algorithm using optimization, a mathematical technology used in various applications. They then created a mathematical model that uses simulated pools of incompatible donor/recipient pairs to determine if their new matching algorithm might improve matches that can be found in a small (regional) or large (national) pool. The researchers compared the optimized algorithm with the scheme currently used in some centers and regions. The model included simulated patients from the general community with characteristics drawn from distributions describing end-stage kidney disease patients eligible for kidney transplantation and their willing and eligible live donors.

The researchers found that a national optimized matching algorithm would result in more transplants (47.7 percent vs. 42.0 percent), better matches, and more grafts surviving at 5 years when compared with an extension of the currently used first-accept scheme to a national level. Highly sensitized patients, who are extremely difficult to match and typically wait almost 7 years for a deceased donor kidney, would benefit 6-fold from a national optimized algorithm (14.1 percent vs. 2.3 percent). Furthermore, to alleviate concerns that a national KPD program would require extensive travel to accommodate matches, the study shows how optimization would dramatically reduce the number of pairs required to travel (2.9 percent vs. 18.4 percent).

"Even if only 7 percent of patients awaiting kidney transplantation participated in an optimized national KPD program, the health care system could save as much as $750 million," the authors write. "Our simulations suggest that approximately 47 percent of incompatible pairs could be matched through an optimized national KPD program."

"Determining optimal allocation priorities and algorithms is absolutely crucial to the smart proliferation of KPD in the United States and the prevention of a haphazard system that diminishes the impact of this promising approach to the organ shortage," the researchers write. "We believe that KPD should be the preferred treatment for patients who have incompatibilities with their intended donors who wish to participate, as KPD is less expensive than desensitization and requires less immunosuppression."
(JAMA. 2005;293:1883-1890. Available post-embargo at jama.com)

Editor's Note: Dr. Segev is funded by an American Society of Transplant Surgeons Fellowship in transplantation. Co-author Ms. Gentry is funded by a U.S. Department of Energy Computational Science Graduate Fellowship.

For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.

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JAMA REPORTS

NEW STUDY MEASURES HOW MANY LIVES LOST TO OBESITY, OVERWEIGHT AND UNDERWEIGHT IN U.S.

VIDEO:
B-ROLL
Crowd shots with corresponding body types
Dr. Flegal going over computer data with colleague
Underweight older woman
Different underweight older woman

AUDIO:
WE KNOW THAT THE ISSUE OF WEIGHT PLAYS A MAJOR ROLE IN OUR HEALTH. BUT HOW DOES BODY WEIGHT AFFECT OUR RISK OF DYING? TO FIND OUT, DR. KATHERINE FLEGAL OF THE CENTERS FOR DISEASE CONTROL AND PREVENTION AND HER COLLEAGUES ANALYZED NATIONAL SURVEY DATA OF MORE THAN 30-THOUSAND AMERICANS, COMPARING BODY WEIGHTS AND DEATH RATES.

AUDIO:
"We compared the death rate in underweight, overweight and obese people to the death rate in people of normal weight, as we looked at the number of excess deaths among the underweight, overweight and obese categories relative to the normal weight category."

VIDEO:
GFX/JAMA COVER
B-roll
Video of overweight person – then hold still under full screen graphic
FULL SCREEN GRAPHIC
Title - Weight and Excess Deaths in 2000
Obesity - 112,000 deaths
Underweight - 34,000 deaths
Overweight - 0 deaths

AUDIO:
THE FINDINGS APPEAR IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. THE RESEARCHERS FOUND THAT IN THE YEAR 2000, COMPARED TO PEOPLE OF NORMAL WEIGHT, OBESITY WAS ASSOCIATED WITH ABOUT 112-THOUSAND EXCESS DEATHS. UNDERWEIGHT WAS ASSOCIATED WITH ABOUT 34-THOUSAND EXCESS DEATHS. THERE WERE NO EXCESS DEATHS ASSOCIATED WITH OVERWEIGHT.

VIDEO:
SOT/FULL
Katherine Flegal, Ph.D.
Centers for Disease Control and Prevention
Runs :14

AUDIO:
"There were a number of things that surprised us. One was that the underweight was associated with a fairly large number of deaths, especially in the elderly. Most of the deaths associated with underweight occurred in the elderly. And we were also surprised that overweight did not have any excess deaths associated with it."

VIDEO:
B-ROLL
Overweight people, not obese

AUDIO:
IN FACT, OVERWEIGHT WAS ASSOCIATED WITH A REDUCTION IN DEATHS COMPARED TO NORMAL WEIGHT. SO DOES THIS MEAN IT’S OKAY TO BE OVERWEIGHT?

VIDEO:
SOT/FULL
Katherine Flegal, Ph.D.
Centers for Disease Control and Prevention
Runs :06

AUDIO:
"We have to be cautious in saying that overweight is protective in any sense. I think that is something beyond the limits of our study."

VIDEO:
B-ROLL
Overweight person
People of varying weights

AUDIO:
SHE SAYS MORE RESEARCH MUST BE DONE BEFORE WE UNDERSTAND OVERWEIGHT’S IMPACT ON DEATH. MEANWHILE, IT’S A GOOD IDEA TO FIND OUT WHICH BODY WEIGHT CATEGORY APPLIES TO YOU. THE RESEARCHERS USED BODY MASS INDEX, WEIGHT IN KILOGRAMS DIVIDED BY THE SQUARE OF HEIGHT IN METERS, TO DETERMINE WEIGHT CATEGORIES.

VIDEO:
SOT/FULL
Katherine Flegal, Ph.D.
Centers for Disease Control and Prevention
Runs :08

AUDIO:
"We defined underweight as a body mass index of less than 18.5, overweight as a BMI of 25 to less than 30 and obesity as a BMI of 30 and above."

VIDEO:
B-ROLL
People of varying weights

AUDIO:
YOUR PHYSICIAN CAN HELP YOU MEASURE YOUR B-M-I. THIS IS MAVIS PRALL, WITH THE JAMA REPORT.