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 INTERNAL MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, April 23, 2007)
NEITHER ABORTION NOR MISCARRIAGE ASSOCIATED WITH BREAST CANCER RISK
OBESITY MAY BE ASSOCIATED WITH DISABILITY IN WORKERS, ELDERLY
SYMPTOMS OF DEPRESSION ASSOCIATED WITH DEVELOPMENT OF DIABETES IN OLDER ADULTS
MIGRAINES ASSOCIATED WITH INCREASED RISK OF CARDIOVASCULAR DISEASE IN MEN
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 23, 2007
Media Advisory: To contact Karin B. Michels, Sc.D., Ph.D., call Leah Gourley at 617-432-0442.
NEITHER ABORTION NOR MISCARRIAGE ASSOCIATED WITH BREAST CANCER RISK
CHICAGO—Neither induced abortion nor spontaneous abortion (miscarriage) appears to be associated with breast cancer risk in premenopausal women, according to a report in the April 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Women younger than age 35 who carry a pregnancy to term appear to have a reduced lifetime risk of breast cancer, according to background information in the article. Pregnancy may accelerate breast cell differentiation, the process by which cells take on specialized roles. “An incomplete pregnancy may not result in sufficient differentiation to counter the high levels of pregnancy hormones that may foster proliferation,” the rapid growth and division typical of cancer cells, the authors write. “However, these biological mechanisms are uncertain, and a prematurely terminated pregnancy may not affect breast cancer risk at all.”
Karin B. Michels, Sc.D., Ph.D., and colleagues at Brigham and Women’s Hospital, Harvard Medical School and Harvard School of Public Health, Boston, examined the association between abortion and breast cancer in 105,716 women who were part of the Nurses’ Health Study II (NHSII). The women were between age 29 and 46 at the beginning of the study in 1993. At that time, and again every two years through 2003, they answered questions about whether and at what age they had had miscarriages or induced abortions and provided information about breast cancer risk factors and diagnoses.
A total of 16,118 participants (15 percent) reported having a history of induced abortion and 21,753 (21 percent) had a history of spontaneous abortion. Between 1993 and 2003, 1,458 new cases of breast cancer occurred among the women. “In this cohort study of young women, we found no association between induced abortion and breast cancer incidence and a suggestion of an inverse association between spontaneous abortion and breast cancer incidence during 10 years of follow-up,” the authors write.
“We observed associations in two subgroups, an association between induced abortion and progesterone receptor–negative breast cancer [cancer that does not respond to the hormone progesterone] and an inverse association between spontaneous abortion before the age of 20 years and breast cancer incidence,” they continue. However, they caution that these secondary analyses are based on small numbers of women. “No obvious mechanisms can be provided for these subgroup findings; thus, chance has to be considered as a possible explanation.”
A 2003 international expert panel convened by the National Cancer Institute reviewed and assessed research regarding reproductive events and the risk of breast cancer, and concluded that based on existing evidence, induced abortion is not associated with an increased risk of breast cancer. “The data from the NHSII provide further evidence of a lack of an important overall association between induced or spontaneous abortions and risk of breast cancer,” the authors conclude. “Among this predominantly pre-menopausal population, neither induced nor spontaneous abortion was associated with the incidence of breast cancer.”
(Arch Intern Med. 2007;167:814-820. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: The NHSII is supported by a Public Health Service grant from the National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services. 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, April 23, 2007
Media Advisory: To contact Truls Østbye, M.D., Ph.D., call Richard Merritt at 919-660-1309. To contact Soham Al Snih, M.D., Ph.D., call Tom Curtis at 409-772-2455. To contact corresponding editorialist Luigi Ferrucci, M.D., Ph.D., call Linda Joy at 301-496-1752.
OBESITY MAY BE ASSOCIATED WITH DISABILITY IN WORKERS, ELDERLY
CHICAGO—Obese individuals appear more likely to file workers’ compensation claims for injuries on the job, according to a report in the April 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. A second report in the same issue suggests that older Americans with a body mass index (BMI) of between 25 and 30—considered to be overweight—may have a higher risk of disability but a lower risk of death than those with BMI in the recommended range of 18.5 to 25.
Obesity is an increasing public health problem and a risk factor for many chronic diseases and death, according to background information in the articles. Increased BMI, calculated as weight in kilograms divided by height in meters squared, has been shown to be associated with increased costs to employee health plans. Obese workers have up to 21 percent higher health care costs than those whose weight is in the recommended range. “Less is known about more direct costs of obesity to employers, such as work-related illness and injury,” the authors write.
Truls Østbye, M.D., Ph.D., and colleagues at Duke University Medical Center, Durham, N.C., studied 11,728 health care and university employees who completed at least one health risk assessment questionnaire—available yearly to all employees eligible for health benefits—between 1997 and 2004. The assessment included a measure of height and weight. Workers with a BMI of less than 18.5 were categorized as underweight; between 18.5 and 24.9, recommended weight; 25 to 29.9, overweight; 30 to 34.9, obesity class I; 35 to 39.9, obesity class II; and 40 or higher, obesity class III.
Over an average of three years of follow-up, workers with higher BMIs tended to have more workers’ compensation claims—those in the group with the highest BMI (40 or greater) had twice the rate of claims as those at the recommended weight. “Because the number of lost workdays and the costs per claim also increase rapidly with BMI, the effects of BMI on lost workdays and costs were even stronger,” the authors write. “The number of lost workdays was almost 13 times higher, medical claims costs were seven times higher and indemnity claims costs were 11 times higher among the heaviest employees compared with those of recommended weight.”
This association between BMI and claims was apparent for injuries or illnesses involving most parts of the body, but was most pronounced in claims related to the back, wrist or arm, neck or shoulder, and knee, foot or hip. The types of injuries most strongly related to BMI were sprain or strain, contusion or bruise, and pain or inflammation.
“Maintaining healthy weight not only is important to workers but should also be a high priority for their employers given the strong effect of BMI on workers’ injuries,” the authors conclude. “Complementing general interventions to make all workplaces safer, work-based programs targeting healthy eating and physical activity should be developed and evaluated.”
In the second study, Soham Al Snih, M.D., Ph.D., and colleagues at the University of Texas Medical Branch, Galveston, and colleagues studied 12,725 adults 65 years or older who were not disabled at the beginning of the study. At initial interviews, which occurred between 1982 and 1993, researchers gathered information about health conditions, demographic information and psychosocial characteristics. Blood pressure, height and weight, and physical function were also measured. Follow-up interviews, in person or by phone, were conducted annually for seven years.
Over the follow-up period, 3,570 participants became disabled, 2,019 died, and 5,681 were known to be alive and non-disabled. The average BMI was 26.4 for non-disabled individuals, 26.4 for disabled individuals and 25.7 for those who died. “Subjects with BMIs of lower than 18.5 [underweight] or 30 or higher [obese] at baseline were significantly more likely to experience disability during the follow-up period,” the authors write. In contrast, those who had BMIs of 25 to 34.9—considered to be overweight—had a lower risk of death during the study compared with those whose BMIs were less than 25 or 35 or higher. “Disability-free life expectancy is greatest among subjects with a BMI of 25 to less than 30,” they continue.
There are several possible explanations for the link between obesity and disability in the elderly, the authors note. “Obesity is associated with several conditions that, in turn, are risk factors for subsequent disability, including osteoarthritis of the weight-bearing joints, diabetes mellitus and cardiovascular disease,” they write. There are also several potential reasons for the weak link between obesity and death. For instance, BMI may not be an accurate measure of obesity in older adults. In addition, because obesity and death are clearly linked in younger adults, it is possible that individuals at risk of early death because of high BMI die before they reach age 65.
In addition, “obesity might have a protective effect at older ages that is less important at younger ages. This protective effect might counterbalance the known adverse consequences of obesity on survival.” For instance, obesity might reduce the risk of hip fractures, or allow individuals who get sick to survive with a low calorie intake for a longer period of time.
“Assessments of the effect of obesity on the health of older Americans should account for mortality and incidence of disability,” the authors conclude.
(Arch Intern Med. 2007;167:766-773, 774-780. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Please see the articles for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: FURTHER RESEARCH NEEDED TO ILLUMINATE LINK BETWEEN OBESITY, DISABILITY
As evidence accumulates for an association between obesity and frailty, a dialogue must begin regarding the consequences of rising obesity rates for the aging population, write Luigi Ferrucci, M.D., Ph.D., National Institute on Aging, Baltimore, and Dawn Alley, Ph.D., University of Pennsylvania, Philadelphia, in an accompanying editorial.
“Several important questions about the relationship between obesity and disability remain unanswered,” Drs. Ferrucci and Alley write. “How does obesity result in disability independent of disease? Are there ways to intervene in this process by making obesity less disabling, and are there ways to intervene without weight loss, which may be risky in older persons? Why is obesity closely related to disability in old age but less related to mortality? Does obesity exert a protective effect in elderly patients?”
“Given the costs, the difficulties, and the burden associated with treating obesity, there is an overwhelming need for research that addresses these questions,” they conclude.
(Arch Intern Med. 2007;167:750-751. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Please see the article for additional information, including 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, April 23, 2007
Media Advisory: To contact Mercedes R. Carnethon, Ph.D., call Marla Paul at 312-503-8928.
SYMPTOMS OF DEPRESSION ASSOCIATED WITH DEVELOPMENT OF DIABETES IN OLDER ADULTS
CHICAGO—Older adults who have had symptoms of depression—whether those symptoms occurred once, increased or remained steady over a 10-year period—may be more likely to develop diabetes than those without depressive symptoms, according to a report in the April 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Previous research suggests that high levels of symptoms of depression, including irritability and trouble sleeping, are associated with increased risk of development of type 2 diabetes, according to background information in the article. However, with few exceptions, most of the studies have defined symptoms of depression based on a single survey filled out by participants. “Given the episodic nature of depression and depressive symptoms, a single self-report of symptoms may not fully characterize the association between depressive symptoms and diabetes,” the authors write.
Mercedes R. Carnethon, Ph.D., of Feinberg School of Medicine, Northwestern University, Chicago, and colleagues followed a group of 4,681 participants age 65 and older (average age 72.7) who did not have diabetes at the beginning of the study in 1989. Each year for 10 years, the participants were evaluated for the presence of 10 symptoms of depression, including those related to mood, irritability, calorie intake, concentration and sleep. Symptoms were scored on a scale of zero to 30, with scores of eight or higher indicating high levels of symptoms. Sociodemographic characteristics, clinical measures including height and weight, and information about medication use that would indicate the development of diabetes were also updated annually.
At the beginning of the study, the average depressive symptom score was 4.5, and one-fifth of participants had a score of eight or higher. During the follow-up period, scores increased by at least five points in nearly half the participants, and 234 individuals developed diabetes. Rates of diabetes were higher among those with a score of eight or higher, compared with those who had scores below eight.
“In this sample of older adults, a single report of high depressive symptoms, an increase in symptoms with time and persistently high symptoms over time are each associated with an excess incidence of diabetes,” the authors write. “Furthermore, increasing symptoms with time are associated with incident diabetes beyond initial high depressive symptoms and the association between increasing scores and incident diabetes was strongest among those with initially low baseline scores.”
These associations were not explained by considering other risk factors for diabetes, including physical activity, smoking and body mass index. “The pathophysiologic mechanism for this association remains unclear,” the authors write.
“Our findings in this population of older adults are of particular public health importance because there are 35 million U.S. adults older than 65 years,” they conclude. Because an estimated 2 million older adults experience depression or a related illness and 15.3 percent of those over 65 have diabetes, “findings from this study of a novel and highly prevalent risk factor for diabetes have important implications for a substantial subset of our population.”
(Arch Intern Med. 2007;167:802-807. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by contracts from the National Heart, Lung, and Blood Institute, National Institutes of Health, with additional contribution from the National Institute of Neurological Disorders and Stroke; in part by a career development award from the National Heart, Lung, and Blood Institute; and by an unrestricted grant from Amgen Inc. 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, April 23, 2007
Media Advisory: To contact Tobias Kurth, M.D., Sc.D., call Kevin Myron at 617-534-1605.
MIGRAINES ASSOCIATED WITH INCREASED RISK OF CARDIOVASCULAR DISEASE IN MEN
CHICAGO—Men with migraine headaches may be at an increased risk for major cardiovascular disease and especially heart attacks, according to a report in the April 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Migraines are recurring moderate to severe headaches that may be accompanied by visual disturbances, dizziness, nausea, vomiting or sensitivity to light and sound. More than 28 million people in the United States have this condition, which peaks in midlife, according to background information in the article. Approximately 18 percent of women and 6 percent of men have migraines.
Tobias Kurth, M.D., Sc.D., Harvard Medical School, Harvard School of Public Health and Brigham and Women’s Hospital, Boston, and colleagues studied 20,084 men age 40 to 84 without a previous history of heart disease. From the time they enrolled in the study (between 1981 and 1984) through 2005, the men were sent yearly questionnaires asking about cardiovascular disease events. These included non-fatal ischemic stroke (stroke caused by reduced blood flow to the brain), non-fatal myocardial infarction (heart attack) or death from ischemic cardiovascular disease (an insufficient supply of blood to the heart). Coronary revascularization (coronary artery angioplasty or bypass surgery) and angina (chest pain) were also evaluated.
Participants were classified as having migraine if they indicated experiencing migraine during the first five years. A total of 1,449 (7.2 percent) of the men reported migraines, including 434 with frequent migraines (four or more times during the five-year period). During an average of 15.7 years of follow-up, 2,236 major ischemic cardiovascular disease events occurred, including 750 ischemic strokes, 1,046 myocardial infarctions and 866 ischemic cardiovascular disease deaths, plus 2,257 coronary revascularizations and 2,625 cases of angina.
“Compared with men who did not report migraine, those who reported migraine were at significantly increased risk of major cardiovascular disease and myocardial infarction.” The incidence of major cardiovascular disease per 10,000 men per year was 8.5 for those without migraine and 10.4 for those with migraine.
“Several mechanisms have been proposed supporting a biological link between migraine and vascular events,” the authors write. For instance, those with an increased body mass index (BMI) tend to have more frequent and severe migraines as well as an increased risk of heart disease, and it is possible that migraines are a marker for atherosclerosis, or a buildup of plaque in the arteries. “However, the increased risk of vascular events remained after controlling for major cardiovascular risk factors in the present data and other studies.”
“In conclusion, in this large prospective cohort of apparently healthy middle-aged men, migraine was associated with increased risk of subsequent major cardiovascular disease, which was driven by increased risk of myocardial infarction,” the authors write.
(Arch Intern Med. 2007;167:795-801. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: The Physicians’ Health Study was funded by grants from the National Institutes of Health. 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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