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.
THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3:00 p.m. CT, Tuesday, December 13, 2005)
JAMA NEWS RELEASES
POOLED ANALYSIS SUGGESTS THAT HIGH INTAKE OF DIETARY FIBER NOT ASSOCIATED WITH REDUCED RISK OF COLORECTAL CANCER
PROGRESS SLOW IN IMPROVING HOSPITALS' PATIENT SAFETY SYSTEMS
INSULIN LEVELS AND RESISTANCE LINKED TO RISK OF PANCREATIC CANCER
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
VIDEO: Windows Media | Quicktime
EATING FIBER DOES NOT REDUCE RISK OF COLON CANCER
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Embargoed for Release: 3:00 p.m. CT, Tuesday, December 13, 2005
Media Advisory: To contact corresponding author Stephanie A. Smith-Warner, Ph.D., call Kevin Myron at 617-432-3952. To contact editorial author John A. Baron, M.D., call Deborah Kimbell at 603-653-1913.
POOLED ANALYSIS SUGGESTS THAT HIGH INTAKE OF DIETARY FIBER NOT ASSOCIATED WITH REDUCED RISK OF COLORECTAL CANCER
CHICAGO—In an analysis combining data from 13 studies, high intake of dietary fiber was not associated with reduced risk of colorectal cancer, according to a study in the December 14 issue of JAMA.
Dietary fiber has been hypothesized to reduce the risk of colorectal cancer, according to background information in the article. However, the results of numerous epidemiological studies have been inconsistent. Ecological correlation studies and many case-control studies have found an inverse association between dietary fiber intake and risk of colorectal cancer. But most prospective cohort studies have found no association between dietary fiber intake and risk of colorectal cancer or adenomas (precursors of colorectal cancer), and randomized clinical trials of dietary fiber supplementation have failed to show reductions in the recurrence of colorectal adenomas.
Yikyung Park, Sc.D., of the Harvard School of Public Health, Boston, and colleagues evaluated the association between dietary fiber intake and risk of colorectal cancer by reanalyzing the primary data from 13 prospective cohort studies (Pooling Project of Prospective Studies of Diet and Cancer). The pooled analysis included 725,628 men and women who were followed-up for 6 to 20 years across studies.
During the follow-up, 8,081 colorectal cancer cases were identified. Among the studies, median (midpoint) energy-adjusted dietary fiber intake ranged from 14 to 28 g/d in men and from 13 to 24 g/d in women. The major source of dietary fiber varied across studies with cereals as a major contributor to dietary fiber intake in the European studies, and fruits and vegetables as the main sources in the North American studies.
In the age-adjusted model, dietary fiber intake was significantly associated with a 16 percent lower risk of colorectal cancer in the highest quintile compared with the lowest. This association was attenuated slightly but still remained statistically significant after adjusting for nondietary risk factors, multivitamin use, and total energy intake. Additional adjustment for dietary folate intake further weakened the association. In the final model, which further adjusted for other dietary factors, such as red meat, total milk, and alcohol intake, only a nonsignificant weak inverse association was found. Fiber intake from cereals, fruits, and vegetables was not associated with risk of colorectal cancer.
"The association between dietary fiber intake and risk of colorectal cancer has been inconsistent among observational studies and several factors may explain the disparity: potential biases in each study, the failure to adjust for covariates in the multivariate models, and the range of dietary fiber intake," the authors write.
"In conclusion, we did not find support for a linear inverse association between dietary fiber intake and risk of colorectal cancer in a pooled analysis of 13 prospective cohort studies. Although high dietary fiber intake may not have a major effect on the risk of colorectal cancer, a diet high in dietary fiber from whole plant foods can be advised because this has been related to lower risks of other chronic conditions such as heart disease and diabetes," the researchers write.
(JAMA. 2005;294:2849-2857. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: The study was funded by research grants from the National Institutes of Health and by the National Colorectal Cancer Research Alliance.
EDITORIAL: DIETARY FIBER AND COLORECTAL CANCER — AN ONGOING SAGA
In an accompanying editorial, John A. Baron, M.D., of Dartmouth Medical School, Lebanon, N.H., examines the results of the pooled analysis.
"The findings by Park et al … provide at least some indications that dietary fiber of some sort is related in some way to colon or rectal cancer risk. … Over the short term, wheat fiber or psyllium [soluble fiber] interventions do not seem to affect colorectal carcinogenesis, but understanding longer-term relationships with any type of fiber will require more work. Studies like that of Park et al provide valuable help, but unfortunately there is more to do," Dr. Baron writes.
(JAMA. 2005;294:2904-2906. Available pre-embargo to the media at www.jamamedia.org)
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: 3:00 p.m. CT, Tuesday, December 13, 2005
Media Advisory: To contact Daniel R. Longo, Obl.S.B., Sc.D., call Christian Basi at 573-882-4430.
To contact editorial co-author Stephen G. Pauker, M.D., call Melissa Sweeney at 617-636-3265.
PROGRESS SLOW IN IMPROVING HOSPITALS' PATIENT SAFETY SYSTEMS
CHICAGO—While there has been some improvement in patient safety systems at hospitals, progress has been slow and the current systems are not close to meeting certain recommendations, according to a study in the December 14 issue of JAMA.
The 1998 Institute of Medicine (IOM) National Roundtable on Health Care Quality and subsequent reports ushered in a period of extensive research about the quality of the U.S. health care system, according to background information in the article. The IOM report, To Err Is Human, provided in-depth analyses of a wide range of patient safety problems and underscored the need for improvement. Subsequently, the IOM has called for "fundamental change … to close the quality gap and save lives," and proposed a national initiative to "provide a strategic direction for redesigning the health care system of the 21st century." These documents indicate that successful implementation of change in the nation's overall health care system requires change in specific patient safety systems at the hospital level.
Daniel R. Longo, Obl.S.B., Sc.D., and colleagues from the University of Missouri-Columbia, conducted a study to assess the status of patient safety systems and examine changes from 2002 to 2004. The study included a survey of all acute care hospitals in Missouri and Utah at 2 points in time, in 2002 and 2004, using a 91-item comprehensive questionnaire (n = 126 for survey 1 and n = 128 for survey 2). The researchers analyzed the responses of the 107 hospitals that responded to both surveys to assess the changes over time.
Seven variables were constructed to represent the most important patient safety constructs studied: computerized physician order entry systems, computerized test results, and assessments of adverse events; specific patient safety policies; use of data in patient safety programs; drug storage, administration, and safety procedures; manner of handling adverse event/error reporting; prevention policies; and root cause analysis. For each hospital, the 7 variables were summed to give an overall measure of the patient safety status of the hospital.
The researchers found that development and implementation of patient safety systems is at best modest. "Self-reported regression in patient safety systems was also found. While 74 percent of hospitals reported full implementation of a written patient safety plan, nearly 9 percent reported no plan. The area of surgery appears to have the greatest level of patient safety systems. Other areas, such as medications, with a long history of efforts in patient safety and error prevention, showed improvements, but the percentage of hospitals with various safety systems was already high at baseline for many systems. Some findings are surprising, given the overall trends; for example, while a substantial percentage of hospitals have medication safety systems, only 34.1 percent reported full implementation at survey 2 of computerized physician order entry systems for medications, despite the growth of computer technology in general and in hospital billing systems in particular."
"Response from within the health care system clearly has been slow. In part, this is because of the complexities involved in implementing systems and changing cultures; however, complexity can also be an excuse," the authors write.
"Based on our findings, we recommend that individual hospitals, including their boards of directors, medical staffs, administration, and staff, review the list of patient safety systems our expert focus groups identified as needed in all hospitals. They can conduct their own survey of where they stand with regard to development and implementation of each of these and report where they stand to the community. While the list may seem long, it is very manageable when viewed by individual hospital departments to which given system characteristics apply. We concur with the larger recommendations of others that nationally there must be a far more aggressive agenda," the researchers write.
(JAMA. 2005;294:2858-2865. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Funding for this study was provided by a grant from the Agency for Healthcare Research and Quality and through subcontracts with the Utah Department of Health and the Missouri Department of Health and Senior Services.
EDITORIAL: CREATING A SAFER HEALTH CARE SYSTEM — FINDING THE CONSTRAINT
In an accompanying editorial, Stephen G. Pauker, M.D., Ellen M. Zane, B.A., M.A., and Deeb N. Salem, M.D., of the Tufts-New England Medical Center, Boston, comment on the study by Longo et al.
"To produce sustained change, it is essential to understand root causes of current problems, establish policies to induce and maintain change, create measurements at all levels that shape safer behaviors, and properly measure progress toward the goal of having a safer health care system. Longo et al provide data about the introduction of safety systems, but better measurement systems and better data are also needed about the incidence of adverse events."
"Rewarding safety will surely help. Some clinicians might consider being paid to perform as being unprofessional, but few could object to creating a safer and higher-quality health care system. Rather than labeling such initiatives as pay-for-performance programs, it may be preferable to think of them as paying for quality and paying for safety. The time has come to take bold action and to embrace change, but first it is time to understand the constraints to accomplishing that change," they write.
(JAMA. 2005;294:2906-2908. Available pre-embargo to the media at www.jamamedia.org)
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: 3:00 p.m. CT, Tuesday, December 13, 2005
Media Advisory: To contact Rachael Z. Stolzenberg-Solomon, Ph.D., call the NCI Media Relations Office at 301-496-6641.
INSULIN LEVELS AND RESISTANCE LINKED TO RISK OF PANCREATIC CANCER
CHICAGO—Higher insulin concentrations and insulin resistance are associated with an increased risk of pancreatic cancer in men, according to a study in the December 14 issue of JAMA.
Based on the findings from several retrospective and prospective observational studies, type 2 diabetes mellitus and glucose intolerance are fairly consistent, albeit somewhat controversial, risk factors for pancreatic cancer, according to background information in the article. This is because it has been unresolved whether diabetes mellitus is involved in pancreatic carcinogenesis or the result of subclinical malignancy. One biologically plausible mechanism whereby type 2 diabetes mellitus may be related to pancreatic carcinogenesis is through the growth-regulatory effects of insulin. Experimental studies show that insulin has growth promoting effects on pancreatic cancer cells and patients with type 2 diabetes mellitus are known to exhibit hyperinsulinemia, during the early stages of their disease.
The Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study (1985-1988) of male smokers previously reported a significant 2-fold increased risk between self-reported diabetes mellitus and pancreatic cancer. Rachael Z. Stolzenberg-Solomon, Ph.D., of the National Cancer Institute, Department of Health and Human Services, Rockville, Md., and colleagues examined a cohort from the ATBC study to determine whether fasting serum insulin and glucose concentrations were associated with risk for incident pancreatic cancer. The study consisted of 29,133 male Finnish smokers ages 50 to 69 years. The study included 400 randomly sampled subcohort control participants and 169 incident pancreatic cancer cases that occurred after the 5th year of follow-up. All participants were followed up through December 2001 (up to 16.7 years of follow-up).
The researchers found that after adjustment for age, years smoked, and body mass index, higher concentrations of glucose, insulin, and insulin resistance tended to show positive dose-response associations with pancreatic cancer. Biochemically defined diabetes mellitus and insulin concentration in the highest quartile demonstrated significant 2-fold increased risks. There were significant interactions between quartile-categorized glucose, insulin, and insulin resistance and pancreatic cancer by follow-up time, such that risks were greater among the cases that occurred with longer follow-up time.
"In conclusion, our results support the hypothesis that higher insulin concentrations and insulin resistance may be a mechanism that explains the associations between diabetes mellitus, higher glucose concentration, and pancreatic cancer observed in previous studies. Although based solely on male smokers, our findings for glucose and biochemical-defined diabetes mellitus are consistent with previous studies conducted in diverse populations that have included women and nonsmokers," the authors write.
"The associations for insulin and insulin resistance reported herein require confirmation and along with observations of other studies could potentially have important implications for nutrition and treatment-related cancer preventive strategies that modify or interfere with the insulin resistance pathway to help decrease the burden from this devastating disease. Lifestyle changes to decrease glucose and insulin concentrations through weight reduction, increasing physical activity, and diet such as decreasing saturated fat intake, and identification of other modifiable factors that may contribute to higher glucose and insulin concentrations could possibly impact pancreatic cancer development, as well as other cancer and chronic disease," the researchers write.
(JAMA. 2005;294:2872-2878. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by the Intramural Research Program of the National Institutes of Public Health, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services.
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
VIDEO: Windows Media | Quicktime
EATING FIBER DOES NOT REDUCE RISK OF COLON CANCER
VIDEO:
SOT/FULL
@ :01
Super: Jane Stevens
Eats fiber
Runs :10
AUDIO:
"Well I think I should be eating a fair amount of fiber. From what I understand it’s good for you. It’s supposed to keep cancer at bay."
VIDEO:
B-ROLL
Oranges
Lettuce/Broccoli
Cereals
Whole grains (bread)
GFX/JAMA COVER
AUDIO:
LOTS OF PEOPLE THOUGHT THAT EATING FRUITS, VEGETABLES, CEREALS AND WHOLE GRAINS COULD REDUCE THE RISK OF COLORECTAL CANCER, ALSO KNOWN AS COLON CANCER. BUT A NEW STUDY IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, SAYS IT’S JUST NOT SO.
VIDEO:
SOT/FULL
@ :24
Super: Stephanie Smith-Warner, Ph.D.
Harvard School of Public Health
Runs :06
AUDIO:
"We found that eating a high-fiber diet was not associated with a lower risk of colorectal cancer."
VIDEO:
B-ROLL
Let bite run long
Exterior/sign of Harvard School of Public Health –pan
Dr. Smith-Warner at computer
Computer images of normal colon and colon cancer
Colon cancer image
AUDIO:
DR. STEPHANIE SMITH-WARNER AND HER COLLEAGUES AT THE HARVARD SCHOOL OF PUBLIC HEALTH WERE PART OF A HUGE, INTERNATIONAL STUDY THAT INCLUDED THIRTEEN DIFFERENT STUDIES WITHIN IT, TRACKING THE HEALTH AND FIBER-EATING HABITS OF MORE THAN 725-THOUSAND PEOPLE FOR UP TO TWENTY YEARS. ABOUT 8-THOUSAND OF THOSE PEOPLE DEVELOPED COLORECTAL CANCER.
VIDEO:
SOT/FULL
Stephanie Smith-Warner, Ph.D.
Harvard School of Public Health
Runs :09
AUDIO:
"We found that people who ate higher amounts of fiber had the same risk of developing colorectal cancer as individuals who ate lower amounts of fiber."
VIDEO:
Broccoli
Tomatoes
Grapefruit
Bread
Red peppers
Lettuce/carrots
AUDIO:
AND IT DIDN’T MATTER WHAT KIND OF FIBER, NONE OF IT AFFECTED COLORECTAL CANCER. BUT, EATING LOTS OF FIBER DID LOWER THE RISK OF RECTAL CANCER A BIT, AND FIBER HAS BEEN SHOWN TO HELP REDUCE HEART DISEASE AND DIABETES RISK.
VIDEO:
SOT/FULL
Stephanie Smith-Warner, Ph.D.
Harvard School of Public Health
Runs :03
AUDIO:
"So it’s still important to eat a high-fiber diet."
VIDEO:
B-ROLL
Woman eating carrot
AUDIO:
EVEN IF IT DOESN’T PREVENT COLORECTAL CANCER.
VIDEO:
SOT/FULL
Jane Stevens
Eats fiber
Runs :11
AUDIO:
"I think I’ll just keep on eating fiber anyway because it just seems like, you know, fruits and vegetables and cereals and grains, just seems like those are gonna be good for you whether or not they prevent cancer."
VIDEO:
B-ROLL
Pan of salad bar contents
AUDIO:
SHE’S RIGHT, THEY ARE. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
