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 of 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 CONTENTS
ARCHIVES OF NEUROLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, August 14, 2006)
MEDICATION MAY PROMOTE OPENING OF ARTERIES FOLLOWING STROKE
HIGH-FAT, COPPER-RICH DIETS ASSOCIATED WITH INCREASED RATES OF COGNITIVE DECLINE IN OLDER ADULTS
ARCHIVES OF INTERNAL MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, August 14, 2006)
PHYSICIANS MORE LIKELY TO DISCLOSE MEDICAL ERRORS THAT WOULD BE APPARENT TO THE PATIENT
LOW TESTOSTERONE LEVELS ASSOCIATED WITH INCREASED RISK OF DEATH IN MEN
NEW MEDICATION APPEARS EFFECTIVE IN HELPING SMOKERS KICK THE HABIT
ARCHIVES OF OPHTHALMOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, August 14, 2006)
PIGMENTS IN CORN, SQUASH AND OTHER VEGETABLES MAY HELP PROTECT AGAINST AGE-RELATED VISION LOSS
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
Please Note: Because Archives of Internal Medicine publishes only one issue in August, there will be no Archives news releases for August 28.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 14, 2006
Media Advisory: To contact corresponding author James C. Grotta, M.D., call Deborah Mann Lake at 713-500-3030.
MEDICATION MAY PROMOTE OPENING OF ARTERIES FOLLOWING STROKE
CHICAGO—A medication known as argatroban, when combined with another drug already used in the treatment of stroke patients, may help restore the flow of blood through blocked arteries, according to a preliminary study in the August issue of the Archives of Neurology, one of the JAMA/Archives journals.
Ischemic stroke, the most common type of stroke, generally occurs when a blood clot lodges in an artery, blocking blood flow to the brain. Some patients with ischemic stroke are treated quickly with intravenous recombinant tissue plasminogen activator (rtPA), which works to help dissolve the clot and reopen the artery. However, some patients do not respond to rtPA alone, according to background information in the article. In animals, argatroban-which blocks the action of chemicals that clot the blood-has been shown to work with rtPA, increasing blood flow, speeding the opening of blood vessels and preventing recurring blockages. Argatroban is approved for use in patients with heart attacks to help prevent clots but has not been tested in human stroke victims.
Rebecca M. Sugg, M.D., University of Texas-Houston Medical School, and colleagues evaluated the safety and efficacy of the drug combination in 15 stroke patients (10 men and five women, average age 61 years) who had blockages in the cerebral arteries, major blood vessels leading to the brain. Patients received the standard dose of rtPA intravenously an average of 118 minutes after their symptoms began, with the initial dose of the drug administered in one minute and the rest infused over the period of an hour. Within one hour of rtPA treatment (an average of 172 minutes after symptoms began), the patients received a large dose of argatroban followed by a continuous 48-hour infusion. Patients were watched closely for signs of excessive bleeding (hemorrhage), the most common risk associated with drugs that prevent clotting; all but one participant, who showed initial signs of hemorrhage, received the intended dose of argatroban. Blood vessel blockages were monitored using a technique known as transcranial Doppler imaging.
Two patients experienced hemorrhage with symptoms, one had asymptomatic bleeding and one died. Within two hours, the arteries completely opened (a process known as recanalization) in six patients and partially opened in four patients. Reocclusion, or the recurrence of the blockage, occurred in three of those individuals. The average scores of all the patients on scales used to measure the severity of strokes improved after treatment.
Argatroban and other similar agents have not been shown to be effective on their own, but these promising early results with combination therapy warrant further study, the authors write. "Low-dose agratroban combined with intravenous rtPA may be safe and may produce faster and more complete recanalization than does rtPA alone," they conclude. A second phase of the trial, in which 50 more patients will be enrolled, is now under way. "The equilibrium point in the assessment of the risk-benefit balance of this combined therapy can ultimately be established only in an adequately powered, blinded clinical trial with an appropriate interim monitoring for early benefit and harm," they write.
(Arch Neurol. 2006;63:1057-1062. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: Dr. Grotta received grant support from Texas Biotechnology Corporation. This study was supported by a training grant from the National Institutes of Health to the University of Texas-Houston Medical School Stroke Program; a grant from the National Institute of Neurological Disorders and Stroke to the Argatroban tPA Stroke Study; and a grant from the National Institute of Neurological Disorders and Stroke to the CLOTBUST trial. Texas Biotechnology Corporation provided the argatroban. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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, August 14, 2006
Media Advisory: To contact Martha Clare Morris, Sc.D., call Mary Ann Schultz at 312-942-7816.
HIGH-FAT, COPPER-RICH DIETS ASSOCIATED WITH INCREASED RATES OF COGNITIVE DECLINE IN OLDER ADULTS
CHICAGO—Among older adults whose diets are high in saturated and trans fats, a high intake of copper may be associated with an accelerated rate of decline in thinking, learning and memory abilities, according to a report in the August issue of the Archives of Neurology, one of the JAMA/Archives journals.
Although copper, zinc and iron are essential for brain development and function, an imbalance of these metals may play a role in the development of brain plaques associated with Alzheimer's disease. Previous studies have also linked fat intake, especially that of saturated and trans fats, to Alzheimer's disease and other forms of cognitive difficulties, according to background information in the article. One recent animal study found that the consumption of copper in drinking water could amplify the degenerative effects of a high-fat diet on rabbit brains.
Martha Clare Morris, Sc.D., Rush University Medical Center, Chicago, and colleagues assessed the connection between dietary fat and dietary copper intake in 3,718 Chicago residents age 65 years and older. Participants underwent cognitive testing at the beginning of the study, after three years and after six years. An average of one year after the study began, they filled out a questionnaire about their diets. The dietary recommended allowance of copper for adults is .9 milligrams per day. Organ meats, such as liver, and shellfish are the foods with the highest copper levels, followed by nuts, seeds, legumes, whole grains, potatoes, chocolate and some fruits. Copper pipes may also add trace amounts of the metal to drinking water.
Cognitive abilities declined in all participants as they aged. Overall, copper intake was not associated with the rate of this decline. However, among the 604 individuals (16.2 percent of the study group) who consumed the most saturated and trans fats, cognitive function deteriorated more rapidly with the more copper they had in their diets. "The increase in rate for the high-fat consumers whose total copper intake was in the top 20 percent (greater than or equal to 1.6 milligrams per day) was equivalent to 19 more years of age," the authors write.
Other metals assessed in this study, iron and zinc, did not show any effects on cognitive decline in interaction with a high-fat diet. Previous studies have found higher levels of copper in the blood of patients with Alzheimer's disease, and medications that bind with copper to block its effects have shown promise treating patients with the condition.
"This finding of accelerated cognitive decline among persons whose diets were high in copper and saturated and trans fats must be viewed with caution," the authors conclude. "The supporting evidence on this topic is limited. The strength of the association and the potential impact on public health warrant further investigation."
(Arch Neurol. 2006;63:1085-1088. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by grants from the National Institute on Aging. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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, August 14, 2006
Media Advisory: To contact Thomas H. Gallagher, M.D., call Clare Hagerty at 206-685-1323.
PHYSICIANS MORE LIKELY TO DISCLOSE MEDICAL ERRORS THAT WOULD BE APPARENT TO THE PATIENT
Specialty also affects disclosure attitudes, but malpractice environment does not
CHICAGO—While physicians in the United States and Canada generally support disclosing medical errors to patients, they vary widely in when and how they would tell patients an error had occurred, according to two articles in the August 14/28 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
Research has revealed that most patients want detailed information following a medical error, including an explicit statement that an error has occurred, an apology, information about why the error happened and an explanation of what will be done to prevent future errors. However, less than half of harmful errors may be disclosed to patients, according to background information in the articles. This may diminish trust in physicians and may also increase the risk that patients will file malpractice lawsuits.
Thomas H. Gallagher, M.D., University of Washington School of Medicine, Seattle, and colleagues surveyed physicians in the United States and Canada to gauge their attitudes regarding the disclosure of medical errors. The 2,637 physicians had an average age of 49.2 and had been in practice for an average of 16.8 years; 1,233 were from the United States (from Washington and Missouri) and 1,404 were from Canada; about half (49.7 percent) were medical specialists, 40.3 percent were surgeons, 8.5 percent were in family practice, and 1.4 percent did not list their specialty; and 78.6 percent were male and 18.6 percent female.
In the first study, the researchers presented the physicians with one of four scenarios involving a medical error. Two of the scenarios were tailored to internal medicine specialists and two to surgeons; one of each type of error would be apparent to the patient, and the others would not be apparent to the patient if he or she was not informed. For instance, the more apparent surgical error involved a sponge left inside a patient's body and the less apparent surgical error involved an internal injury that a surgeon inflicted because of unfamiliarity with a new surgical tool. The physicians answered a series of questions about the scenario they received, including how likely they would be to disclose the error, what information they would convey if they did disclose the error, how serious the error was and how likely it was to result in a lawsuit.
Eighty-five percent of the physicians agreed that the error they received was serious and 81 percent believed the physician was very or extremely responsible for the error. Overall, 65 percent would definitely disclose the error, 29 percent would probably disclose, 4 percent would disclose only if the patient asked and 1 percent would definitely not disclose. The language the physicians would use also varied widely; 42 percent would use the word "error," 56 percent would mention the adverse event but not the error, 50 percent would give the patient specific information about what the error was and 13 percent would not reveal any details not requested by the patient. Physicians who had a positive attitude toward disclosure and past positive experiences with disclosure, who felt responsible for the error or who were Canadian tended to report that they would disclose more information.
Specialty and the nature of the error affected how likely the physicians were to disclose the error. Surgeons were more likely than other physicians to say they would definitely disclose the error (81 percent vs. 54 percent) but also reported that they would disclose less information-35 percent of surgeons and 61 percent of other physicians said they would disclose specific details about the error. Those who received the more apparent errors were more likely to say they would disclose them than those who received the less apparent errors (81 percent vs. 50 percent) and would also disclose more information about them (51 percent would use the word error, vs. 32 percent). "Some dimensions of errors might justify disclosing less information, such as if the error caused only trivial harm," the authors write. "However, physicians agreed that all the scenarios represented serious errors. Basing disclosure decisions on whether the patient was aware of the error is not ethically defensible or consistent with standards such as those from the Joint Commission on Accreditation of Health Care Organizations."
In a second study based on the same survey, the researchers report that U.S. and Canadian physicians have similar attitudes toward and experiences with error disclosure despite different malpractice environments, suggesting that the probability of lawsuits is not associated with their support for disclosure. Of the 2,637 physicians:
- 64 percent agreed that errors were a serious problem
- 98 percent supported disclosing serious errors to patients and 78 percent supported disclosing minor errors
- 58 percent had disclosed an error to a patient and 85 percent of those were satisfied with the disclosure
- 66 percent agreed that disclosing a serious error reduces malpractice risk
Physicians' estimates of how likely they were to be sued did not affect whether they supported disclosing errors to patients. "The medical profession should consider whether the culture of medicine itself represents a more important barrier than the malpractice environment to the disclosure of harmful medical errors to patients," the authors conclude. "Patients justifiably expect that harmful medical errors will be disclosed to them. Increasing physician engagement in efforts to communicate openly with patients following errors and to enhance patient safety could provide a much-needed boost to patients' confidence in the quality and integrity of the health care system."
(Arch Intern Med. 2006;166:1585-1593 and 1605-1611. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by grants from the Agency for Healthcare Research and Quality and by the Greenwall Foundation Faculty Scholars Program. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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, August 14, 2006
Media Advisory: To contact Molly M. Shores, M.D., call Clare Hagerty at 206-685-1323.
LOW TESTOSTERONE LEVELS ASSOCIATED WITH INCREASED RISK OF DEATH IN MEN
CHICAGO—Men who have a low testosterone level after age 40 may have a higher risk of death over a four-year period than those with normal levels of the hormone, according to a report in the August 14/28 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
Unlike women undergoing menopause, middle-aged men generally do not experience a dramatic decrease in the production of sex hormones, according to background information in the article. Testosterone levels gradually decline as a man ages, decreasing approximately 1.5 percent per year after age 30. The effects of low testosterone levels include decreased muscle mass and bone density, insulin resistance, decreased sex drive, less energy, irritability and feelings of depression.
Molly M. Shores, M.D., and colleagues at the VA Puget Sound Health Care System and University of Washington, Seattle, studied the relationship between hormone levels and death in a total of 858 male veterans older than age 40 years. All participants received care in the VA Puget Sound Health Care System and had their testosterone levels checked at least twice between 1994 and 1999, with at least one week and no more than two years elapsing between tests. The men were followed for an average of 4.3 years and a maximum of eight years, through 2002.
About 19 percent (166) of the men had a low testosterone level; 28 percent (240) had an equivocal testosterone level, meaning that their tests revealed an equal number of low and normal levels; and 53 percent (452) had normal testosterone levels. One-fifth (20.1 percent) of the men with normal testosterone levels died during the course of the study, compared with 24.6 percent of men with equivocal levels and 34.9 percent of those with low levels. Men with low testosterone levels had an 88 percent increase in risk of death compared with those who had normal levels. When the researchers considered other variables that may influence risk of death, such as age, other illnesses and body mass index, the association between low testosterone levels and death persisted.
Previous studies have found that testosterone levels may dramatically decrease one to two days after surgery, trauma or critical illness-all factors that can increase the risk of death. To eliminate these effects, the authors reanalyzed the data excluding men who had died within the first year of follow-up. Men with low testosterone levels were still 68 percent more likely to have died. "The persistence of elevated mortality risk after excluding early deaths suggests that the association between low testosterone and mortality is not simply due to acute illness," they write. "Large prospective studies are needed to clarify the association between low testosterone levels and mortality."
(Arch Intern Med. 2006;166:1660-1665. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by the Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System; the Royalty Research Fund of the University of Washington (Dr. Shores); and a VA merit review grant (Dr. Matsumoto). Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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, August 14, 2006
Media Advisory: To contact Mitchell Nides, Ph.D., call 310-231-7533. To contact Cheryl Oncken, M.D., call Jane Shaskan at 860-679-4777. To contact editorialist Bankole A. Johnson, D.Sc., M.D., Ph.D., call Peter Jump at 434-924-1501. To contact Jean-Francois Etter, Ph.D., M.P.H., e-mail: jean-francois.etter{at}imsp.unige.ch.
NEW MEDICATION APPEARS EFFECTIVE IN HELPING SMOKERS KICK THE HABIT
CHICAGO—A drug recently approved by the U.S. Food and Drug Administration as an aid to smoking cessation appears effective both short- and long-term for smokers trying to quit, according to two reports in the August 14/28 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
Smoking is the leading cause of preventable death in the United States and worldwide. Currently available pharmacotherapies for smoking cessation include nicotine replacement therapy (NRT)-such as gum, skin patches, tablets, nasal spray and inhalers-and the antidepressant drugs bupropion hydrochloride and nortriptyline hydrochloride. These have shown limited success rates, with success at one year averaging approximately seven percent to 30 percent, according to background information in the articles.
The new drug varenicline tartrate mimics the effects of nicotine to help offset cravings, and in the presence of nicotine it helps suppress some of the reinforcing effects of smoking.
Mitchell Nides, Ph.D., of Los Angeles Clinical Trials, and colleagues with the Varenicline Study Group conducted a randomized, double-blind, placebo-controlled study to evaluate the efficacy, tolerability and safety of varenicline for smoking cessation. Healthy smokers aged 18 to 65 years were randomly assigned to receive varenicline in a dosage of .3 milligrams once daily, 1 milligram once daily, or 1 milligram twice daily for six weeks, plus placebo for one week; to 150 milligrams of sustained-release bupropion hydrochloride twice daily for seven weeks; or to placebo for seven weeks.
The authors report that varenicline, in combination with brief behavioral counseling, was more effective for short- and long-term smoking cessation than placebo.
"Efficacy improved as the dose increased, with varenicline tartrate, 1 milligram twice daily, providing the highest rates of continuous abstinence across all treatment groups, including bupropion," they write. Four-week continuous quit rates were 48 percent for varenicline, 1 milligram twice daily; 37.3 percent for varenicline, 1 milligram daily; 33.3 percent for bupropion hydrochloride; and 17.1 percent for placebo. Long-term quit rates from four weeks to one year were 14.4 percent for the group that received varenicline, 1 milligram twice daily, vs. 4.9 percent for placebo.
"In this study, varenicline tartrate, 1 milligram twice daily, effectively helped subjects quit smoking, with response rates three times higher than those for placebo while demonstrating a good tolerability profile in this population of smokers who on average had smoked approximately 20 cigarettes per day for approximately 24 years," the authors write. "Efficacy was maintained in the non-drug treatment phase through week 52. The significant reductions in craving and in some of the rewarding effects of smoking seen with varenicline tartrate, 1 milligram twice daily, may assist in promoting abstinence and preventing relapse," they conclude.
(Arch Intern Med. 2006;166:1561-1568. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: Pfizer Inc. provided funding for this study and was involved in all elements of the study, including, but not limited to, the study design and monitoring. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
In an accompanying article, the same research team reports that varenicline taken over 12 weeks was effective in helping smokers quit, and was generally well tolerated.
Cheryl Oncken, M.D., of the University of Connecticut Health Center, Farmington, and colleagues studied 647 patients to evaluate the efficacy, safety and tolerability of four varenicline dose regimens-two with titrated, or progressive, dosing over the first week, and two with a non-titrated, or fixed, dosing schedule, for promoting smoking cessation. Healthy smokers aged 18 to 65 years randomly received varenicline, .5 milligrams twice daily non-titrated, .5 milligrams twice daily titrated, 1 milligram twice daily non-titrated, 1 milligram twice daily titrated or placebo for 12 weeks, then with a 40-week follow-up period to assess long-term efficacy.
"In this study, treatment with varenicline tartrate at doses of .5 milligrams and 1 milligram twice daily, was associated with significantly higher smoking cessation rates compared with placebo," the authors report. At weeks nine to 52, the abstinence rates were 22.4 percent in the 1-milligram group, 18.5 percent in the .5-milligram group and 3.9 percent in the placebo group.
Among those who were treated with varenicline, 16 percent to 42 percent experienced nausea. Reports of nausea were lower among those who received progressive dosing.
"In summary, varenicline tartrate (.5-milligram and 1-milligram doses taken twice daily for 12 weeks) significantly improved short- and long-term abstinence rates compared with placebo," the authors conclude. "Future studies are warranted to compare the efficacy of varenicline to other smoking cessation pharmacotherapies and to determine whether a longer duration of medication treatment improves smoking cessation rates."
(Arch Intern Med. 2006;166:1571-1577. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: Pfizer Inc. provided funding for this study and was involved in all elements of the study, including, but not limited to, the study design and monitoring. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: "NO MORE EXCUSES TO DELAY TREATMENT"
The results of the studies by the Varenicline Study Group demonstrate that varenicline is a novel medication to aid in smoking cessation, writes Bankole A. Johnson, D.Sc., M.D., Ph.D., of the University of Virginia, Charlottesville, in an accompanying editorial.
Dr. Johnson also summarizes other approaches to treating nicotine addiction now in development, including medications and a vaccine.
"In sum, pharmacological and immunological studies are opening up new vistas for safe, efficacious and potent treatments for nicotine dependence," he writes. "Molecular genetic studies also are investigating how to identify those individuals vulnerable to becoming nicotine dependent and, once they are dependent, the treatments that might work best for them. All these advances will deliver real aid to curbing smoking. Now, a smoker who wants help to quit no longer has a legitimate excuse to delay seeking treatment."
(Arch Intern Med. 2006;166:1547-1550. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: Dr. Johnson has consulting agreements with Ortho-McNeil Pharmaceutical Inc., Alkermes Inc., Sanofi-Aventis, and TransOral Pharmaceuticals Inc. This study was supported by grants from the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
LARGELY UNNOTICED AGENT MAY BE EFFECTIVE SMOKING DETERRENT
A plant-derived medication that has been used to treat tobacco dependence in Eastern Europe for 40 years may be effective for smoking cessation, but it remains largely unnoticed in English-language literature, according to a review article in the same issue.
Cytisine is an alkaloid found in a plant known as the golden rain tree, or Cytisus laburnum. It has been used for decades as a smoking cessation drug in Eastern European countries, according to background information in the article.
Jean-Francois Etter, Ph.D., M.P.H., of the University of Geneva, Switzerland, reviewed the literature on the effect of cytisine on smoking cessation. Ten studies were found, and all were conducted in Bulgaria, Germany, Poland and Russia between 1967 and 2005.
"Research conducted during the past 40 years suggests that cytisine is effective for smoking cessation," Dr. Etter reports. "Thus, an apparently effective smoking cessation drug that has been used for decades in Germany and Eastern European countries remained unnoticed in other countries."
Most of the articles reviewed by Dr. Etter were never cited in English-language literature. Recent reviews of the efficacy of smoking cessation drugs omitted cytisine, and little research on the drug has been conducted in recent years.
Dr. Etter suggests the omission may be explained because studies on the efficacy of cytisine were not published in English and because the available research is based on studies that do not conform to current standards in conducting and reporting drug trials.
"An apparently effective treatment for the first avoidable cause of death in developed countries remained largely unnoticed, despite research published during the past 40 years," he concludes. "How many other effective drugs are there for which efficacy remained unnoticed because existing trials were not published in English in Western countries?"
(Arch Intern Med. 2006;166:1553-1559. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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, August 14, 2006
Media Advisory: To contact corresponding author Julie A. Mares, Ph.D., call Sayward Proctor at 608-265-7344.
PIGMENTS IN CORN, SQUASH AND OTHER VEGETABLES MAY HELP PROTECT AGAINST AGE-RELATED VISION LOSS
CHICAGO—Women younger than age 75 years who eat diets rich in the yellow plant pigments lutein and zeaxanthin may have a reduced risk of developing the eye disease age-related macular degeneration, according to a report in the August issue of the Archives of Ophthalmology, one of the JAMA/Archives journals.
Age-related macular degeneration (AMD) occurs when the macula, the area at the back of the retina that produces the sharpest vision, deteriorates over time. The condition is the leading cause of blindness in aging Americans, according to background information in the article. There is no cure for AMD and limited treatment options are available to slow its progression, so research on preventive measures is essential. Previous studies have suggested a potential link between AMD and lutein and zeaxanthin, plant pigments known as carotenoids and found in leafy green vegetables, corn, egg yolks, squash, broccoli and peas. These compounds may reduce the risk of AMD by absorbing blue light that could damage the macula, by preventing free radicals from damaging eye cells and by strengthening eye cell membranes.
Suzen M. Moeller, Ph.D., University of Wisconsin, Madison, and colleagues with the Carotenoids in Age-Related Eye Disease Study (CAREDS) Research Study Group, assessed the effects of dietary lutein plus zeaxanthin in 1,787 women ages 50 to 79 years in Iowa, Wisconsin and Oregon. The women with the highest and lowest dietary intakes of lutein and zeaxanthin in the Women's Health Initiative, a large study of postmenopausal women that began between 1994 and 1998, were recruited to participate in CAREDS. At the beginning of the study, participants filled out a questionnaire to evaluate what their diets were like 15 years before the beginning of the study. Blood samples were taken to assess levels of carotenoids and color photographs of the retina were used to determine the presence and progression of AMD.
A higher intake of lutein plus zeaxanthin was associated with a lower risk of intermediate-stage AMD in women younger than age 75 years who had a stable intake of the carotenoids over the 15-year period and did not have previous AMD or a chronic disease, such as cardiovascular disease, diabetes or hypertension, that might alter their dietary habits. However, no significant difference was observed in the overall group of women or when comparing lutein and zeaxanthin levels in the blood to AMD occurrence. There was a weak association between dietary lutein plus zeaxanthin and advanced-stage AMD in all the women and in women younger than age 75 years.
The lack of a link between intake of carotenoids and AMD in the overall study group could be due to several factors, including the fact that the older women who participated in the study may have been more likely to have consumed higher levels of fruits and vegetables during their lifetimes than other older adults who have already died. Many nutrients may work together to provide protection against AMD, and the study may not have measured other dietary deficits that influence risk, the authors write.
"This exploratory observation is consistent with a broad body of evidence from observational and experimental studies that suggests that these carotenoids may protect against AMD," they conclude. "Still, given the numerous analyses performed in this study, our results could be due to chance. More conclusive evidence from long-term prospective studies and clinical trials is needed to determine whether the intake of macular carotenoids themselves, or as markers of broader dietary patterns, can protect against intermediate AMD or delay progression in individuals who have early stages of the disease."
(Arch Ophthalmol. 2006;124:1151-1162. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This research was supported by National Institutes of Health grants and by Research to Prevent Blindness. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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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