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, November 6, 2007)
RISK OF DISABILITY INCREASING AMONG OLDER OBESE INDIVIDUALS
CHRONIC KIDNEY DISEASE IN THE U.S. APPEARS TO BE INCREASING
STUDY EXAMINES ASSOCIATION BETWEEN WEIGHT AMOUNT AND CAUSE OF DEATH
MEDICATION DOES NOT APPEAR TO IMPROVE SYMPTOMS OR OUTCOMES FOR PATIENTS WITH ACUTE HEART FAILURE
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
OBESITY, BUT NOT OVERWEIGHT, LINKED TO CANCER AND CARDIOVASCULAR DEATHS
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TV Note: This week's JAMA Report video is on the association between weight amounts and causes of death. The report will be fed Tuesday, November 6, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Galaxy 26 (formerly Intelsat America 6) C-Band, Transponder 14, downlink frequency: 3880 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, November 6, 2007
Media Advisory: To contact Dawn Alley, Ph.D., call Kate Olderman Tavella at 215-349-8369. To contact editorial co-author Edward W. Gregg, Ph.D., call Chris Cox at 770-488-5131.
RISK OF DISABILITY INCREASING AMONG OLDER OBESE INDIVIDUALS
CHICAGO—The older obese population in the U.S. appear to be experiencing more impairments in functional abilities related to movement, although there have been improvements in the cardiovascular health of this population, according to a study in the November 7 issue of JAMA.
Recent studies have suggested that the obese population may have grown healthier since the 1960s, with the prevalence of high cholesterol and high blood pressure declining among obese individuals. It is unclear, however, whether improvements in cardiovascular risk factors have been accompanied by improvements in other health outcomes, according to background information in the article.
Dawn Alley, Ph.D., and Virginia W. Chang, M.D., Ph.D., of the University of Pennsylvania, Philadelphia, conducted a study to determine whether the association between obesity and disability has changed among individuals age 60 years and older. A previous analysis of trends in obesity and disability showed a constant effect of obesity on disability over time, with disability increasing in both obese and nonobese populations. “Disability in this age group is of particular importance, given the current context of population aging and an increasing prevalence of obesity among older-aged individuals. Furthermore, obesity-associated disability is associated with significant burden in terms of both quality of life and health care costs in this age group,” the authors write.
The researchers analyzed data from the nationally representative National Health and Nutrition Examination Surveys (NHANES III [1988-1994] and NHANES 1999-2004). The population set for this study included 9,928 adults age 60 years and older with measured body mass index (BMI). The participants were surveyed regarding difficulty or inability to perform tasks in two disability domains: functional limitations (walking one-fourth mile, walking up 10 steps, stooping, lifting 10 pounds, walking between rooms, and standing from an armless chair) and activities of daily living (ADL) limitations (getting in and out of bed, eating, and dressing).
The researchers found that the prevalence of obesity (a BMI of 30 or greater) increased by 8.2 percentage points over time from 23.5 percent of the population age 60 years and older in 1988-1994 (time 1) to 31.7 percent in 1999-2004 (time 2). During both time ranges, obese individuals were more likely than normal-weight individuals to have a functional impairment. During time 2, obese individuals were also more likely to have an ADL impairment. Examining trends over time showed that the prevalence of functional impairment did not change significantly among normal-weight individuals, but increased among obese individuals by 5.4 percent, from 36.8 percent to 42.2 percent.
The odds of being functionally impaired did not change for nonobese individuals from time 1 to time 2, but increased 43 percent among obese individuals. There was an increasing association between obesity and disability over time. At time 1, obese individuals had a 78 percent increased odds of functional impairment relative to those with normal weight. At time 2, the odds of functional limitation for obese individuals were 2.75 times greater than for those with normal weight.
In terms of ADL limitations, the risk of ADL impairment in obese older individuals was not significantly different from normal weight during time 1. Between 1988-1994 and 1999-2004, the odds of ADL impairment decreased by 34 percent within the nonobese population, but did not change in the obese population. At time 2, the odds of ADL impairment for obese individuals was about twice as great than for those with normal weight.
“Obese participants in NHANES 1999-2004 were more likely to report functional impairments than obese participants in NHANES III (1988-1994), which suggests an increasing risk of disability in the obese population. Furthermore, reductions in ADL disability observed among nonobese older individuals did not occur among obese individuals. Taken together, these findings suggest that recent improvements in cardiovascular health have not been accompanied by a reduction in disability burden among obese individuals; instead, the risk of some types of disability is actually increasing,” the authors conclude.
(JAMA. 2007;298(17):2020-2027. Available pre-embargo to the media 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.
EDITORIAL: IS DISABILITY OBESITY’S PRICE OF LONGEVITY?
In an accompanying editorial, Edward W. Gregg, Ph.D., of the Centers for Disease Control and Prevention, Atlanta, and Jack M. Guralnik, M.D., Ph.D., of the National Institutes of Health, Bethesda, Md., comment on the findings in this issue of JAMA regarding obesity and disability.
“Disability represents in part the collective effects of multiple obesity-related conditions, which bodes poorly for any simple clinical or public health solutions to modify the obesity-associated disability trends. This challenge is compounded by the lack of commonly practiced interventions directly aimed at reducing disability in at-risk populations. Structured exercise and weight loss programs may be among the most promising unifying interventions because they appear to help prevent type 2 diabetes, reduce arthritis symptoms, and improve physical functioning—i.e., they can reduce each of the outcomes of obesity that have persisted over time. Thus, these findings make a compelling case to overcome the barriers of integrating effective lifestyle and exercise programs into health systems and communities. In the end, however, reducing the effect of obesity on morbidity by simply altering its course or accommodating its presence may never have an impact equal to a successful public health strategy to prevent obesity.”
(JAMA. 2007;298(17):2066-2067. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
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, November 6, 2007
Media Advisory: To contact Josef Coresh, M.D., Ph.D., call Tim Parsons at 410-955-7619.
CHRONIC KIDNEY DISEASE IN THE U.S. APPEARS TO BE INCREASING
CHICAGO—The estimated prevalence of chronic kidney disease among adults in the U.S. has increased to 13 percent, in part because of the increase in diabetes and hypertension, according to a study in the November 7 issue of JAMA.
Chronic kidney disease (CKD) is now recognized as a common condition that elevates the risk of cardiovascular disease as well as kidney failure and other complications. The number of patients with kidney failure treated by dialysis and transplantation (the end-stage of CKD) has increased dramatically in the United States, as has the incidence of end-stage renal disease, according to background information in the article. “Estimation of the prevalence of earlier stages of CKD in the U.S. population and ascertainment of trends over time is central to disease management and prevention planning, particularly given the increase in the prevalence of obesity, diabetes, and hypertension, the leading risk factors for CKD,” the authors write. Whether there have been changes in the prevalence of earlier stages of CKD is uncertain.
Josef Coresh, M.D., Ph.D., of Johns Hopkins University, Baltimore, and colleagues compared the prevalence, stages and severity of CKD in National Health and Nutrition Examination Surveys (NHANES 1988-1994 [n = 15,488] and NHANES 1999-2004 [n = 13,233]), a nationally representative sample of adults age 20 years or older. Chronic kidney disease prevalence was determined based on persistent albuminuria (the presence of excessive protein in the urine) and decreased estimated glomerular filtration rate (GFR; a measurement of fluid filtered by the kidney).
The researchers found that the prevalence of both albuminuria and decreased GFR increased from 1988-1994 to 1999-2004. The prevalence of CKD stages 1 to 4 increased from 10.0 percent in 1988-1994 to 13.1 percent in 1999-2004. A higher prevalence of diagnosed diabetes and hypertension and higher body mass index explained the entire increase in prevalence of albuminuria but only part of the increase in the prevalence of decreased GFR. Change in average serum creatinine (a product of protein metabolism) accounted for some of the increased prevalence of CKD.
“In conclusion, survey data suggest that the prevalence of CKD in the United States is high and has increased between 1988-1994 and 1999-2004, from 10 percent to 13 percent, while awareness of kidney disease among the general public remains very low. The increasing prevalence of diagnosed diabetes and hypertension has contributed to this increase, which may propagate to higher rates of complications and kidney failure requiring dialysis or transplantation. Earlier stages accounted for most of the individuals with CKD. Because individuals with early stages of CKD have a higher risk of cardiovascular disease morbidity and mortality than their risk of progression to kidney failure, cardiovascular risk factor management in this group is critical. The high prevalence of CKD overall, and particularly among older individuals and persons with hypertension and diabetes, suggests that CKD needs to be a central part of future public health planning,” the authors write.
(JAMA. 2007;298(17):2038-2047. Available pre-embargo to the media 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 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, November 6, 2007
Media Advisory: To contact Katherine M. Flegal, Ph.D., call Jeff Lancashire at 301-458-4800.
STUDY EXAMINES ASSOCIATION BETWEEN WEIGHT AMOUNT AND CAUSE OF DEATH
CHICAGO—The association between weight and causes of death can vary considerably, with obesity associated with a significantly increased mortality from cardiovascular disease (CVD), underweight associated with increased mortality from primarily non-cancer, non-CVD causes, and overweight associated with increased mortality from diabetes and kidney disease combined, but with reduced mortality from other non-cancer non-CVD causes of death, according to a study in the November 7 issue of JAMA.
“In a previous study, we estimated excess all-cause mortality associated with underweight, overweight, and obesity in the United States in 2000 using data from national surveys,” the authors write. “We found significantly increased all-cause mortality in the underweight and obese categories and significantly decreased all-cause mortality in the overweight category compared with normal weight. To gain further insight into these findings, we now extend that work, using additional mortality data with longer follow-up, to examine the association of cause-specific mortality with different weight categories among U.S. adults in 2004.”
Katherine M. Flegal, Ph.D., of the Centers for Disease Control and Prevention, Hyattsville, Md., and colleagues estimated the cause-specific excess deaths associated with underweight (body mass index [BMI] less than 18.5), overweight (BMI 25 to less than 30), and obesity (BMI 30 or greater). BMI is calculated as weight in kilograms divided by height in meters squared. The researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES) I, 1971-1975; II, 1976-1980; and III, 1988-1994, which was combined with data on BMI and other covariates from NHANES 1999-2002 with underlying cause of death information for 2.3 million adults 25 years and older from 2004 vital statistics data for the United States.
Based on total follow-up, underweight was associated with a significantly increased mortality from noncancer, non-CVD causes (23,455 excess deaths) but not associated with cancer or CVD mortality. Overweight was associated with a significantly decreased mortality from noncancer, non-CVD causes but was not associated with cancer or CVD mortality.
Obesity was associated with a significantly increased mortality from CVD (112,159 excess deaths) but not associated with cancer mortality or with noncancer, non-CVD mortality. In further analyses, overweight and obesity combined were associated with increased mortality from diabetes and kidney disease (61,248 excess deaths) and decreased mortality from other noncancer, non-CVD causes. Obesity was associated with an increased mortality from cancers considered obesity-related (13,839 excess deaths) but not associated with mortality from other cancers. Comparisons across surveys suggested a possible decrease in the association of obesity with CVD mortality over time.
“Some evidence suggests that modestly higher weights may improve survival in a number of circumstances, which may partly explain our findings regarding overweight. Overweight is not strongly associated with increased cancer or CVD risk, but may be associated with improved survival during recovery from adverse conditions, such as infections or medical procedures, and with improved prognosis for some diseases. Such findings may be due to greater nutritional reserves or higher lean body mass associated with overweight,” the authors write.
“...our data indicate that the association of BMI with mortality varies considerably by cause of death. These results help to clarify our earlier findings of excess overall mortality associated with underweight and obesity but not with overweight.”
(JAMA. 2007;298(17):2028-2037. Available pre-embargo to the media 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 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, November 6, 2007
Media Advisory: To contact John J. V. McMurray, M.D., email: j.mcmurray{at}bio.gla.ac.uk. To contact co-author John R. Teerlink, M.D., call Steve Tokar at 415-221-4810, ext. 5202.
MEDICATION DOES NOT APPEAR TO IMPROVE SYMPTOMS OR OUTCOMES FOR PATIENTS WITH ACUTE HEART FAILURE
CHICAGO—The medication tezosentan, which was thought could be beneficial for the treatment of acute heart failure, did not improve breathlessness or reduce the risk of fatal or nonfatal cardiovascular events, according to a study in the November 7 issue of JAMA.
Patients with heart failure have higher plasma concentrations of the vasoconstrictor peptide endothelin-1 (a peptide that can cause narrowing of a blood vessel opening), which has been associated with worse clinical or health outcomes, according to background information in the article. Tezosentan is an intravenous short-acting endothelin receptor antagonist (a drug that neutralizes or counteracts the effects of another drug) and a vasodilator (a drug that causes dilation of blood vessels).
John J. V. McMurray, M.D., of Western Infirmary, Glasgow, United Kingdom, and colleagues conducted the Value of Endothelin Receptor Inhibition With Tezosentan in Acute Heart Failure Studies (VERITAS) to test the hypothesis that tezosentan would have a favorable effect on symptoms and clinical outcomes in patients with acute heart failure. The two randomized trials were conducted from April 2003 through January 2005 at sites in Australia, Europe, Israel, and North America and included 1,435 patients admitted with certain heart failure symptoms. The patients were randomized to tezosentan (5 mg/hour for 30 minutes, followed by 1 mg/hour for 24 to 72 hours [n = 730]) or placebo (n = 718).
The researchers found that tezosentan did not improve dyspnea (difficulty breathing) more than placebo in either trial. The incidence of death or worsening heart failure at seven days in the combined trials was 26 percent in each treatment group, and up to 30 days was 32 percent in the tezosentan group and 33 percent in the placebo group. The number of deaths at six months was 104 (14.3 percent) in the tezosentan group and 101 (14.3 percent) in the placebo group.
“In summary, tezosentan, a treatment with ‘favorable’ hemodynamic actions, failed to improve breathlessness or reduce fatal and nonfatal cardiovascular events in patients following an emergency admission to hospital with acute heart failure. So far, it has proved impossible to identify a therapeutic role for endothelin antagonists in patients with acute or chronic heart failure,” the authors write.
(JAMA. 2007;298(17):2009-2019. Available pre-embargo to the media 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 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
OBESITY, BUT NOT OVERWEIGHT, LINKED TO CANCER AND CARDIOVASCULAR DEATHS
INTRO:
We know maintaining a healthy weight is important, but a new study looked at the association between death from various diseases and being overweight, or being obese. Obesity is associated with death from some cancers, and death from heart disease, but being overweight is not. Mavis Prall explains in this week’s JAMA Report.
VIDEO:
B-ROLL
People of various weights walking on city sidewalk
AUDIO:
LET’S START WITH HOW THE CENTERS FOR DISEASE CONTROL AND PREVENTION DEFINES DIFFERENT WEIGHT CATEGORIES. THE CDC USES BODY MASS INDEX, OR BMI, WHICH IS ESSENTIALLY WEIGHT DIVIDED BY HEIGHT SQUARED.
VIDEO:
SOT/FULL
@:12
Super: Katherine Flegal, Ph.D.
Centers for Disease Control and Prevention
Runs :13
AUDIO:
“We define obesity as a body mass index of 30 and above. We define normal weight as a body mass index of 18.5 to 25 and overweight is the intermediate category from 25 up to 30.”
VIDEO:
B-ROLL
Wide shot of Brent walking outside
AUDIO:
IT MAY SURPRISE YOU TO LEARN THAT 26-YEAR OLD BRENT HAGEN FITS THE CDC DESCRIPTION OF OVERWEIGHT.
VIDEO:
SOT/FULL
@ :31
Super: Brent Hagen “Overweight”
Runs :05
AUDIO:
“I don’t think of myself as overweight and I don’t think anyone that I know has ever thought of me as overweight either.”
VIDEO:
B-ROLL
Dr. Flegal and colleague discussing data
AUDIO:
BUT THE CDC’S DR. KATHERINE FLEGAL (FLEE-gle) SAYS BEING HER DEFINITION OF OVERWEIGHT MAY HAVE SOME HEALTH BENEFITS.
VIDEO:
SOT/FULL
Katherine Flegal, Ph.D.
Centers for Disease Control and Prevention
Runs :13
AUDIO:
“We found very different relationships between weight and different causes of death in the U.S. population.”
VIDEO:
B-ROLL
GFX/JAMA COVER
Obese people walking on city sidewalks
More obese people
“Overweight” people
AUDIO:
IN A STUDY IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, DR. FLEGAL AND COLLEAGUES FOUND THAT OBESITY WAS LINKED TO ABOUT ELEVEN PERCENT OF DEATHS FROM CANCERS SUCH AS BREAST, KIDNEY, COLON OR PANCREATIC CANCER. AND OBESITY WAS ASSOCIATED WITH ABOUT NINE PERCENT OF CARDIOVASCULAR DEATHS. BUT OVERWEIGHT HAD NO ASSOCIATION WITH DEATHS FROM CANCER OR CARDIOVASCULAR DISEASE. AND THERE’S MORE...
VIDEO:
SOT/FULL
Katherine Flegal, Ph.D.
Centers for Disease Control and Prevention
Runs :12
AUDIO:
“About 40 % of deaths in the U.S. population are due to causes that are neither cancer nor cardiovascular disease, and there we found that overweight was associated with a significantly reduced number of deaths from those causes.”
VIDEO:
B-ROLL
Brent walking away
AUDIO:
SO OVERWEIGHT MAY HAVE SOME PROTECTIVE EFFECT.
VIDEO:
SOT/FULL
Brent Hagen
“Overweight”
Runs :11
AUDIO:
“When you think of someone who is overweight, you think of someone who is visibly large. You think of someone who is unhealthy, basically.”
VIDEO:
B-ROLL
More Brent walking
AUDIO:
BUT USING THE STUDY’S DEFINITION OF OVERWEIGHT MAY CHANGE THAT THINKING. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
The researchers conducted their study by analyzing data on about thirty-six-thousand people and twelve-thousand deaths in 2004. You can calculate your BMI at http://www.cdc.gov/nccdphp/dnpa/bmi/. For more information, visit www.jama.com.
