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, January 22, 2008)
JAMA NEWS RELEASES
COMBINATION THERAPY IMPROVES SURVIVAL FOR CERTAIN PROSTATE CANCER PATIENTS
OVERWEIGHT PATIENTS WITH DIABETES APPEAR MORE LIKELY TO ACHIEVE REMISSION WITH WEIGHT-LOSS SURGERY
FINDINGS SUGGEST LINK BETWEEN VITAMIN E AND SUBSEQUENT DECLINE IN PHYSICAL FUNCTION FOR OLDER ADULTS
GENE VARIATIONS ASSOCIATED WITH EFFECTIVENESS OF BLOOD PRESSURE MEDICATIONS
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
VITAMIN E IMPORTANT TO PHYSICAL HEALTH AS YOU AGE
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
TV Note: This week's JAMA Report video is on the effect of poor nutrition on physical function among older persons. The report will be fed Tuesday, January 22, 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, January 22, 2008
Media Advisory: To contact Anthony V. D’Amico, M.D., Ph.D., call Lori Shanks at 617-534-1604.
COMBINATION THERAPY IMPROVES SURVIVAL FOR CERTAIN PROSTATE CANCER PATIENTS
CHICAGO—Men with localized prostate cancer who were treated with male hormone suppression therapy and radiation treatment had longer survival, but those with moderate to high levels of other illnesses did not experience this effect, according to a study in the January 23 issue of JAMA.
Several studies have documented increased survival when androgen (male sex hormone) suppression therapy (AST) is combined with external beam radiation therapy (RT) compared with RT alone in the treatment of unfavorable localized and locally advanced prostate cancer. However, comorbid (co-existing) illnesses may increase the negative effects of specific anti-cancer treatments such as AST, altering the survival benefit observed when AST is added to RT.
Anthony V. D’Amico, M.D., Ph.D., of Brigham and Women’s Hospital and Dana Farber Cancer Institute, Boston, and colleagues performed an analysis of overall survival of 206 men with localized but unfavorable–risk prostate cancer in subgroups defined by their level of comorbidity at the time of their randomization to AST and RT vs. RT alone. During a median follow-up of 7.6 years, 74 deaths occurred.
Estimates of overall survival were significantly higher for men who were randomized to RT and AST compared with RT. The cumulative incidence estimates of prostate cancer–specific mortality significantly favored the RT and AST group, with an increased risk of prostate cancer–specific mortality (14 vs. 4 deaths) that translated into an increased risk of all-cause mortality (44 vs. 30 deaths) in men randomized to RT compared with RT and AST.
A significant interaction was noted between comorbidity score and treatment. For the 157 men with no or minimal comorbidity scores, treatment with RT and AST compared with RT was associated with a significantly higher survival (31 vs. 11 deaths). Among the 49 men with moderate or severe comorbidity, those randomized to RT alone vs. RT and AST did not have an increased risk of all-cause mortality (13 vs. 19 deaths).
“The clinical significance of this finding is that pre-existing comorbid illness may increase the negative effects of specific anti-cancer treatments such as AST,” the authors write.
“In conclusion, the addition of 6 months of AST to RT resulted in increased overall survival in men with localized but unfavorable–risk prostate cancer. This result may pertain only to men without moderate or severe comorbidity, but this requires further assessment in a clinical trial specifically designed to assess this interaction.”
(JAMA. 2008;299[3]:289-295. 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, January 22, 2008
Media Advisory: To contact John B. Dixon, M.B.B.S., Ph.D., email: john.dixon{at}med.monash.edu.au. To contact editorial co-author David E. Cummings, M.D., call Clare Hagerty at 206-685-1323.
OVERWEIGHT PATIENTS WITH DIABETES APPEAR MORE LIKELY TO ACHIEVE REMISSION WITH WEIGHT-LOSS SURGERY
CHICAGO—Preliminary research indicates that obese patients with type 2 diabetes who had gastric banding surgery lost more weight and had a higher likelihood of diabetes remission compared to patients who used conventional methods for weight loss and diabetes control, according to a study in the January 23 issue of JAMA.
“Obesity and type 2 diabetes are likely to be the 2 greatest public health problems of the coming decades. The conditions are strongly linked, with the increased prevalence of diabetes correlating with the increased prevalence of obesity,” the authors write. Weight control is perhaps the most important aspect of type 2 diabetes management. Recent evidence indicates that improvement in blood glucose control is related to the degree of weight loss.
Currently available lifestyle and pharmacological strategies provide only small to modest levels of weight loss, a problem compounded by patients with diabetes experiencing greater difficulty in losing weight than those without diabetes. Significant sustained weight loss as a result of bariatric surgery has never been formally studied as a treatment for type 2 diabetes in obese participants, according to background information in the article.
John B. Dixon, M.B.B.S., Ph.D., of Monash University, Melbourne, Australia, and colleagues conducted a 2-year trial involving 60 obese participants (body mass index [BMI] greater than 30, less than 40) to compare surgically induced weight loss with conventional therapy for the management of type 2 diabetes. Patients were randomized to receive either conventional diabetes therapy with a focus on weight loss by lifestyle change or laparoscopic adjustable gastric banding with conventional diabetes care. Of the 60 patients enrolled, 55 (92 percent) completed the 2-year follow-up.
The researchers found that remission of type 2 diabetes was achieved by 26 study participants (43 percent) at two years, with 22/30 (73 percent) from the surgical program and 4/30 (13 percent) from the conventional-therapy program. This represented 76 percent and 15 percent remission rates for those in the surgery and conventional-therapy groups, respectively. Greater percentage of weight loss at two years and lower baseline HbA1c values (hemoglobin used primarily to identify the average plasma glucose concentration) were independently associated with remission, but percentage of weight loss alone explained most of the variance.
“After 2 years, the surgical group displayed a 5 times higher remission rate and 4 times greater reduction in HbA1C values than the conventional-therapy group,” the authors write.
The surgical group achieved an average 20.7 percent body weight loss at two years, compared with 1.7 percent among the conventional-therapy group, representing a loss of 62.5 percent of excess weight (using BMI of 25 as ideal weight) in the surgical group compared with 4.3 percent in the conventional-therapy group. There were no serious complications in either group.
“An important finding of this study is that degree of weight loss, not the method, appears to be the major driver of glycemic improvement and diabetes remission in obese participants. This has important implications, as it suggests that intensive weight-loss therapy may be a more effective first step in the management of diabetes than simple lifestyle change. This study shows that few participants achieved remission with a body weight loss of less than 10 percent, a level expected to produce important health benefits,” the researchers add.
“While caution is required in interpreting the longer-term benefits of surgery and weight loss, this study presents strong evidence to support the early consideration of surgically induced loss of weight in the treatment of obese patients with type 2 diabetes,” they conclude.
(JAMA. 2008;299[3]:316-323. 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: GASTROINTESTINAL SURGERY AS A TREATMENT FOR DIABETES
In an accompanying editorial, David E. Cummings, M.D., and David R. Flum, M.D., M.P.H., of the University of Washington, Seattle, comment on the findings of Dixon and colleagues.
“...there is much to learn about surgical treatments for diabetes. Researchers are striving to elucidate surgical mechanisms of diabetes improvement, hoping ultimately to harness the effects of ‘surgery in a pill’—i.e., a formulation providing the desired effects without operative risks. Policy and health care leaders are grappling with the costs and risks of surgical interventions, which must be balanced against the costs and risks of not taking advantage of surgically induced diabetes remission, in the face of an expanding pandemic. Addressing these issues requires time and resources, but in this era of advanced diabetes research, the insights already beginning to be gained by studying surgical interventions for diabetes may be the most profound since the discovery of insulin. As a result, the future looks brighter for patients.”
(JAMA. 2008;299[3]:341-343. Available pre-embargo to the media 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 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, January 22, 2008
Media Advisory: To contact Benedetta Bartali, R.D., Ph.D., call Karen Peart at 203-432-1326.
FINDINGS SUGGEST LINK BETWEEN VITAMIN E AND SUBSEQUENT DECLINE IN PHYSICAL FUNCTION FOR OLDER ADULTS
CHICAGO—Low serum concentration of vitamin E, an indication of poor nutrition, is associated with physical decline for older persons, according to a study in the January 23 issue of JAMA.
“The decline in physical function that occurs with aging often represents the early stage of a continuum leading to disability and other important adverse outcomes such as institutionalization,” the authors write. Understanding the mechanisms associated with this process has been identified as a priority. The potential harmful effect of poor nutrition on physical function in older persons is not well understood.
Benedetta Bartali, R.D., Ph.D., of Yale University School of Medicine, New Haven, Conn., and colleagues conducted a study to determine whether a low concentration of specific micronutrients is associated with subsequent decline in physical function. The study included 698 community-living persons 65 years or older who were randomly selected from a population registry in Tuscany, Italy. To measure nutritional status and physical function, participants completed a baseline examination, conducted from November 1998 through May 2000, and 3-year follow-up assessments from November 2001 through March 2003. Measurements were obtained for several micronutrients, including serum folate and vitamins B6, B12, D and E. Decline in physical function was defined as a loss of at least 1 point in the Short Physical Performance Battery during the follow-up, which included three objective tests of physical function.
The average decline in physical function score was 1.1 point. In analyses adjusted for other factors, only a low concentration of vitamin E was significantly associated with subsequent decline in physical function. Additional analyses indicated that age older than 81 years and vitamin E (in participants 70-80 years) were the strongest determinants of decline in physical function.
“The hypothesis that antioxidants [such as vitamin E] play a role in the etiology of decline in physical function and disability is supported by our previous findings and other studies suggesting that oxidative stress is involved in muscle fatigue and that antioxidants play a preventive role in muscle damage by reducing oxidative injury,” the authors write.
“Thus, at least 3 different mechanisms may explain the effect of low concentration of vitamin E on subsequent decline in physical function: (1) increased oxidative stress leading to muscle or DNA damage, (2) exacerbation of atherosclerosis or other pathologic conditions, and (3) development of neurodegenerative disorders.”
Participants in the study did not take vitamin supplements and the authors do not recommend vitamin E supplements to increase levels. They state, “Approximately 15 to 30 mg/d of dietary alpha-tocopherol [a component of vitamin E] is needed … this amount can be easily reached through diet, from sources such as almonds, tomato sauce, and sunflower seeds among others.”
“In conclusion, the current study provides empirical evidence that a low concentration of vitamin E is associated with subsequent decline in physical function in a population-based sample of older persons living in the community. Although the findings from this epidemiological study cannot establish causality, they provide a solid base that low concentration of vitamin E contributes to decline in physical function. Clinical trials may be warranted to determine whether optimal concentration of vitamin E reduces functional decline and the onset of disability in older persons with a low concentration of vitamin E,” the researchers write.
(JAMA. 2008;299[3]:308-315. 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, January 22, 2008
Media Advisory: To contact corresponding author Donna K. Arnett, Ph.D., call Kristen Vaughn at 205-934-8935.
GENE VARIATIONS ASSOCIATED WITH EFFECTIVENESS OF BLOOD PRESSURE MEDICATIONS
CHICAGO—Patients with hypertension and certain gene variations experienced varying results with some blood pressure medications, suggesting matching a patient’s genotype with certain hypertension medications could result in more favorable outcomes, according to a study in the January 23 issue of JAMA.
Approximately 71 million individuals in the United States have one or more types of cardiovascular disease (CVD), of whom at least 65 million have hypertension. Although control of hypertension has been improving in recent years, among those treated, only about two-thirds have their hypertension controlled, according to background information in the article. Seeking ways to reduce CVD illness and death by tailoring treatment to a patient’s particular genotype has been an area of research, but results have yet to yield therapeutic choices for the clinical setting.
Amy I. Lynch, Ph.D., of the University of Minnesota, Minneapolis, and colleagues conducted a study to examine whether patients with hypertension with minor NPPA (atrial natriuretic precursor A) genotypes (NPPA G664A and NPPA T2238C) randomized to the diuretic chlorthalidone had different outcomes for CVD measures than patients who were randomized to other classes of antihypertensive medication. Previous research has suggested that the NPPA gene may influence the effectiveness of some antihypertensive drugs.
The study included 38,462 participants with hypertension from ALLHAT (Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial), a multicenter randomized clinical trial conducted in the United States and Canada. Genotyping was performed from February 2004 to January 2005. Participants were randomly assigned to receive a diuretic (chlorthalidone; n = 13,860), a calcium channel blocker (amlodipine; n = 8,174), an angiotensin-converting enzyme (ACE) inhibitor (lisinopril; n = 8,233), or an alpha-blocker (doxazosin; n = 8,195). Follow-up averaged 4.9 years.
The researchers found evidence of a pharmacogenetic association of the NPPA T2238C variant with coronary heart disease (CHD), stroke, all-cause death, combined CHD, and combined CVD when comparing the chlorthalidone (diuretic) group with the amlodipine (calcium channel blocker) group, and for stroke when comparing the chlorthalidone group with those receiving amlodipine or lisinopril (ACE inhibitor). The association was consistent for all outcomes: those with at least one copy of the minor C allele (alternative form of a gene) had lower risk of disease and/or death when assigned to chlorthalidone compared with those assigned to amlodipine (and the amlodipine group plus the lisinopril group for stroke), while those in the chlorthalidone group with the TT genotype had higher risk of disease and/or death than those assigned to amlodipine.
“We also observed a pharmacogenetic association of NPPA T2238 on change in systolic and diastolic blood pressure 6 months after treatment randomization in a similar direction: generally, minor C allele carriers had greater reductions in blood pressure when randomized to chlorthalidone vs. either lisinopril or doxazosin relative to those with the common TT genotype,” the authors write.
“This study demonstrates the importance (and sometimes paradoxical findings) of pharmacogenetic research; for example, while minor NPPA T2238C allele carriers (as well as the entire study population viewed as a whole) may have had more favorable outcomes when randomized to a diuretic (chlorthalidone), participants with the most common genotype (TT) responded better when assigned to a calcium channel blocker (amlodipine) for some clinical outcomes.”
“Further research is needed to determine the optimal approach for personalizing antihypertensive medication treatment regiments according to genotype information and for achieving the best possible clinical outcomes,” the researchers conclude.
(JAMA. 2008;299[3]:296-307. 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
VITAMIN E IMPORTANT TO PHYSICAL HEALTH AS YOU AGE
INTRO:
According to the U.S. Census Bureau, by the year 2030, there will be an estimated 71 million people age 65 and older. For many, independence and mobility are important factors as they age. Now new research suggests vitamin E could be an essential part of your diet if you want to maintain physical function. Jennifer Mitchell explains in this week's JAMA Report.
VIDEO:
B-ROLL
Lois reading
Lois walking
AUDIO:
LOIS ACAMPORA (AH-cam-pora) IS 81 YEARS OLD. WHILE SHE TAKES SPECIAL CARE TO EAT RIGHT AND WALKS AT LEAST AN HOUR A DAY, SHE NOTICES ROUTINE TASKS ARE BECOMING MORE DIFFICULT
VIDEO:
SOT/FULL
@ :11
Super: Lois Acampora
Cares about health
Runs :12
AUDIO:
“I do notice that within the past year to year and a half I’ve noticed how I’ve slowed down physically and mentally and I don’t like it.”
VIDEO:
B-ROLL
Lois eating
Tight shots of food
GFX/JAMA COVER
Vitamin E
AUDIO:
GOOD NUTRITION MAY BE EVEN MORE IMPORTANT THAN SHE FIRST THOUGHT. IN FACT, ACCORDING TO A NEW STUDY IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, LOW LEVELS OF VITAMIN E IN PARTICULAR APPEAR TO CONTRIBUTE TO A DECLINE IN PHYSICAL FUNCTION.
VIDEO:
SOT/FULL
@ :39
Super: Benedetta Bartali, R.D., Ph.D.
Yale University School of Medicine
Runs :10
AUDIO:
“Our results show that only vitamin E is associated with subsequent decline in physical function.”
VIDEO:
B-ROLL
Hold bite up through her name
Bartali and colleague talking – looking at study
Full screen graphic
FULL SCREEN GRAPHIC:
Physical Function In Older Adults
Nutrient levels compared to physical activity
Walking, standing from chair, balancing
FULL SCREEN GRAPHIC:
Vitamin E and Physical Function
- 698 Participants
- 50.4% Showed decline in physical function within 3 years
- Low vitamin E associated with decline
AUDIO:
DR. BENEDETTA BARTALI (bar-tal-E) IS A NUTRITIONIST AND RESEARCHER AT YALE UNIVERISITY SCHOOL OF MEDICINE. SHE AND HER COLLEAGUES COLLECTED DATA IN A RANDOMLY SELECTED GROUP OF ITALIAN MEN AND WOMEN AGE 65 AND OLDER. THEY COMPARED NUTRIENT LEVELS IN BLOOD WITH THE ABILITY TO PERFORM BASIC SKILLS SUCH AS WALKING, STANDING UP FROM A CHAIR, AND BALANCING. OUT OF NEARLY SEVEN HUNDRED PEOPLE STUDIED, ABOUT HALF EXPERIENCED A DECLINE IN PHYSICAL FUNCTION WITHIN THREE YEARS. THE STUDY FOUND LOW LEVELS OF VITAMIN E WERE ASSOCIATED WITH THIS DECLINE.
VIDEO:
SOT/FULL
Benedetta Bartali, R.D., Ph.D.
Yale University School of Medicine
Runs :07
AUDIO:
“Having an adequate level of vitamin E may reduce the decline in physical function.”
VIDEO:
B-ROLL
Bartali doing work at desk
older people doing activity
Almonds into hand
Bag of sunflower seeds
Lois eating
AUDIO:
RESEARCHERS SUGGEST YOU NEED AT LEAST FIFTEEN TO THIRTY MILLIGRAMS OF VITAMIN “E” A DAY. ALMONDS, SUNFLOWER SEEDS AND OLIVE OIL ARE ALL GOOD SOURCES. LOIS SAYS WHILE SHE FEELS HEALTHY, SHE WILL BE MORE AWARE.
VIDEO:
SOT/FULL
Lois Acampora
Cares about health
Runs :09
AUDIO:
“I’m certainly going to pay more attention to my intake of vitamin E because it’s very important to me.”
VIDEO:
B-ROLL
Lois tight shot and reading
AUDIO:
IMPORTANT FOR HER TO HAVE THE BEST QUALITY OF LIFE POSSIBLE. JENNIFER MITCHELL , THE JAMA REPORT.
TAG:
Only one participant in the study reported taking a vitamin E supplement. Researchers say getting vitamin E from food may be best to avoid having too much synthetic vitamin E in your body. The study used data collected in Tuscany, Italy from 1998 to 2003. Further studies are needed to determine whether appropriate intake of vitamin E can help prevent physical decline and disabilities as we
age. For more information, visit www.jama.com.
