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, August 26, 2008)
JAMA NEWS RELEASES
CONSUMPTION OF NUTS, CORN OR POPCORN NOT ASSOCIATED WITH INCREASED RISK OF DIVERTICULOSIS IN MEN
AYURVEDIC MEDICINES SOLD VIA INTERNET MAY CONTAIN LEAD, MERCURY OR ARSENIC
FINDINGS CHALLENGE COMMON PRACTICE REGARDING GLUCOSE CONTROL FOR CRITICALLY ILL PATIENTS
PRELIMINARY REPORT SUGGESTS ALLOPURINOL APPEARS TO LOWER BLOOD PRESSURE IN ADOLESCENTS WITH HYPERTENSION
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
STUDY FINDS POPCORN, NUTS AND CORN DO NOT INCREASE THE INCIDENCE OF DIVERTICULAR COMPLICATIONS
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
TV Note: This week's JAMA Report video is on whether consuming nuts, corn or popcorn has an effect on the risk of diverticulosis. The report will be fed Tuesday, August 26, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Galaxy 28 (C-Band), Transponder 19, downlink frequency: 4080 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, August 26, 2008
Media Advisory: To contact Lisa L. Strate, M.D., M.P.H., call Clare Hagerty at 206-685-1323.
CONSUMPTION OF NUTS, CORN OR POPCORN NOT ASSOCIATED WITH INCREASED RISK OF DIVERTICULOSIS IN MEN
CHICAGO—Contrary to a common recommendation to avoid eating popcorn, nuts and corn to prevent diverticular complications, a large prospective study of men indicates that the consumption of these foods does not increase the risk of diverticulosis or diverticular complications, according to a study in the August 27 issue of JAMA.
Diverticular disease is a common and costly digestive disorder in Western countries. One-third of the U.S. population will develop diverticulosis by the age of 60 years and two-thirds will do so by the age of 85 years, according to background information in the article. Historically, physicians have advised individuals with diverticular disease to avoid eating nuts, corn, seeds and popcorn, even though there is little evidence to support this recommendation. The authors write that the potential health benefits of nut consumption paired with the large number of individuals with diverticulosis makes it timely and important to study this long-held belief.
Lisa L. Strate, M.D., M.P.H., of the University of Washington School of Medicine, Seattle, and colleagues examined the association between nut, corn, and popcorn consumption and diverticular disease in a large study group (The Health Professionals Follow-up Study), a group of men followed up from 1986 to 2004 via self-administered questionnaires about medical (once every two years) and dietary (every 4 years) information. Twenty-seven percent of participants reported eating nuts at least twice per week, and corn and popcorn each were consumed at least twice a week by 15 percent of the participants.
The study included 47,228 men age 40 to 75 years who at baseline were free of diverticulosis or its complications, cancer, and inflammatory bowel disease. During 18 years of follow-up, there were 801 new cases of diverticulitis and 383 new cases of diverticular bleeding.
The researchers found that nut, corn, and popcorn consumption was not associated with an increased risk of new diverticulitis or diverticular complications, but instead inverse relationships were observed between nut and popcorn consumption and the risk of diverticulitis. After adjustment for other known and potential risk factors for diverticular complications, men with the highest intake of nuts (at least twice per week) had a 20 percent lower risk of diverticulitis compared with men with the lowest intake (less than once per month); men with the highest intake of popcorn had a 28 percent lower risk of diverticulitis compared with men with the lowest intake. No association was seen between corn consumption and diverticulitis, and for diverticular bleeding, there were no significant associations observed for nut, corn, or popcorn consumption.
"In conclusion, our results suggest that nut, corn, and popcorn consumption is not associated with an increased risk of incident diverticulitis or diverticular bleeding and may be protective for the former. These findings refute the pervasive but unproven belief that these foods are associated with diverticular complications and suggest that the recommendation to avoid these foods in diverticular disease should be reconsidered," the authors write.
(JAMA. 2008;300[8]:907-914. 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, August 26, 2008
Media Advisory: To contact Robert B. Saper, M.D., M.P.H., call Michelle Roberts at 617-638-8491.
AYURVEDIC MEDICINES SOLD VIA INTERNET MAY CONTAIN LEAD, MERCURY OR ARSENIC
CHICAGO—An analysis of Ayurvedic medicines (based on a traditional medical system commonly used in India) purchased via the Internet found that one-fifth of these products contain levels of lead, mercury or arsenic that exceed acceptable standards, according to a study in the August 27 issue of JAMA.
Ayurvedic medicines are used by a majority of India's 1.1 billion population and worldwide by people from South Asia, as well as others, according to background information in the article. "However, since 1978 more than 80 cases of lead poisoning associated with Ayurvedic medicine use have been reported worldwide," the authors write. Ayurvedic medicines are divided into two major types: herbal-only and rasa shastra, which is an ancient practice of deliberately combining herbs with metals (e.g., mercury, lead, iron, zinc), minerals (e.g., mica) and gems (e.g., pearl). Rasa shastra experts claim that these medicines, if properly prepared and administered, are safe and therapeutic. The prevalence of metals in Ayurvedic medicines sold via the Internet and in those manufactured in the United States is unknown.
Robert B. Saper, M.D., M.P.H., of Boston University School of Medicine and Boston Medical Center, and colleagues conducted a study to determine the prevalence of Ayurvedic medicines available via the Internet containing detectable lead, mercury, or arsenic and compared the prevalence of toxic metals between U.S.- and Indian-manufactured products, and in rasa shastra vs. non–rasa shastra medicines. The researchers conducted an Internet search using the search terms Ayurveda and Ayurvedic medicine and identified 673 products, of which 230 Ayurvedic medicines were randomly selected for purchase in August - October 2005. Country of manufacturer/Web site supplier, rasa shastra status, and claims of Good Manufacturing Practices were recorded. Metal concentrations were measured using x-ray fluorescence spectroscopy. One hundred ninety-three of the 230 requested medicines were received and analyzed.
The researchers found that the prevalence of metal-containing products was 20.7 percent and that the prevalence of metals in U.S.-manufactured products was 21.7 percent, compared with 19.5 percent in Indian products. Rasa shastra medicines were more than twice as likely as non–rasa shastra products to contain detectable metals and had higher median (midpoint) concentrations of lead and mercury. Among the metal-containing products, 95 percent were sold by U.S. Web sites and 75 percent claimed Good Manufacturing Practices. All metal-containing products exceeded 1 or more standards for acceptable daily metal intake. "Several Indian-manufactured rasa shastra medicines could result in lead and/or mercury ingestions 100 to 10,000 times greater than acceptable limits," the authors write.
"A 2005 Institute of Medicine report concluded that 'the regulatory mechanisms for monitoring the safety of dietary supplements … [should] be revised. The constraints imposed on FDA [U.S. Food and Drug Administration] with regard to ensuring the absence of unreasonable risk associated with the use of dietary supplements make it difficult for the health of the American public to be adequately protected," the researchers write. "New FDA regulations and current Indian policies do not specify any maximum acceptable concentrations or daily dose limits for metals in dietary supplements for domestic use. We suggest strictly enforced, government-mandated daily dose limits for toxic metals in all dietary supplements and requirements that all manufacturers demonstrate compliance through independent third-party testing."
(JAMA. 2008;300[8]:915-923. 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, August 26, 2008
Media Advisory: To contact Renda Soylemez Wiener, M.D., M.P.H., call Jason Aldous at 603-653-1913. To contact editorial co-author Simon Finfer, M.B.B.S., F.J.F.I.C.M., email: sfinfer{at}george.org.au.
FINDINGS CHALLENGE COMMON PRACTICE REGARDING GLUCOSE CONTROL FOR CRITICALLY ILL PATIENTS
CHICAGO—An analysis of randomized trials indicates that for critically ill adults, tight glucose control is not associated with a significantly reduced risk of death in the hospital, but is associated with an increased risk of hypoglycemia, calling into question the recommendation by many professional societies for tight glucose control for these patients, according to an article in the August 27 issue of JAMA.
In 2001, a randomized controlled trial (van den Berghe et al) showed that tight glucose control for critically ill surgical patients reduced hospital mortality by one-third. "Because few interventions in critically ill adult patients reduce mortality to this extent, the results of this trial were enthusiastically received and rapidly incorporated into guidelines," the authors write. Numerous organizations, including the American Diabetes Association and the American Association of Clinical Endocrinologists now recommend tight glucose control in all critically ill adults. "These recommendations have led to worldwide adoption of tight glucose control in a variety of intensive care unit (ICU) settings." But some subsequent trials of tight glucose control in certain ICU settings have failed to show the mortality benefit, and have indicated an increased risk for hypoglycemia (abnormally low blood sugar level).
Renda Soylemez Wiener, M.D., M.P.H., of the Department of Veterans Affairs Medical Center, White River Junction, Vt., and Dartmouth Medical School, Hanover, N.H., and colleagues conducted a meta-analysis of 29 randomized controlled trials, examining the risks and benefits of tight glucose control (glucose goal less than 150 mg/dL) as compared with usual care in critically ill adults. The meta-analysis included data for 8,432 patients.
The researchers found that among these trials, there was no significant difference in hospital mortality between tight glucose control and usual care strategies (21.6 percent vs. 23.3 percent) and no significant difference in hospital mortality when stratified by surgical, medical, and medical-surgical ICU setting. Tight glucose control was not associated with a significantly decreased risk for new need for dialysis (11.2 percent vs. 12.1 percent), but was associated with a significantly decreased risk of septicemia (10.9 percent vs. 13.4 percent; generalized illness due to bacteria in the bloodstream). The risk of hypoglycemia was increased about 5-fold (13.7 percent vs. 2.5 percent).
"Given the overall findings of this meta-analysis, it seems appropriate that the guidelines recommending tight glucose control in all critically ill patients should be re-evaluated until the results of larger, more definitive clinical trials are available," the authors write.
(JAMA. 2008;300[8]:933-944. 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: TIGHT GLYCEMIC CONTROL IN CRITICALLY ILL ADULTS
In an accompanying editorial, Simon Finfer, M.B.B.S., F.J.F.I.C.M., of The George Institute for International Health, and Anthony Delaney, M.B.B.S., F.J.F.I.C.M., of the Royal North Shore Hospital, Sydney, Australia, comment on the results of the meta-analysis.
"Possible explanations for the discordant results of the study by van den Berghe et al and the meta-analysis by Wiener et al are that the meta-analysis is flawed, the studies that form the basis of the meta-analysis are flawed or inherently different, or the findings of the study by van den Berghe et al occurred due to random chance or as a result of another unique factor interacting with tight glycemic control."
"… those investigating tight glycemic control should take a step back and address the fundamental questions of defining quality standards for tight glycemic control, finding affordable methods of frequent and highly accurate measurement of blood glucose in the ICU, and conduct multicenter efficacy studies to determine if tighter glycemic control can reduce mortality under optimal conditions. If tighter glycemic control can be proven effective in optimal conditions, determining how to make that benefit available to millions of critically ill patients in both developed and resource-poor countries around the world would be a truly worthwhile challenge. There is no simple or clear answer to the complex problem of glycemic control in critically ill adults; at present, targeting tight glycemic control cannot be said to be either right or wrong."
(JAMA. 2008;300[8]:963-965.. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other 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, August 26, 2008
Media Advisory: To contact Daniel I. Feig, M.D., Ph.D., call Glenna Picton at 713-798-4710.
PRELIMINARY REPORT SUGGESTS ALLOPURINOL APPEARS TO LOWER BLOOD PRESSURE IN ADOLESCENTS WITH HYPERTENSION
The drug allopurinol, which lowers uric acid levels, appears to reduce blood pressure in adolescents with newly diagnosed hypertension, according to a preliminary report in the August 27 issue of JAMA.
Hypertension is commonly associated with hyperuricemia (elevated blood level of uric acid, a by-product of normal chemical processes in the body and found in the urine and blood). Early research suggested uric acid had a causal role in hypertension, but an elevation of uric acid in hypertension could be a consequence of several factors, and hyperuricemia is not considered a true risk factor for hypertension, according to background information in the article. Recent studies have challenged this belief, including evidence supporting a causal role of uric acid in hypertension, as indicated from experimental studies in laboratory animals.
Daniel I. Feig, M.D., Ph.D., of the Baylor College of Medicine, Houston, and colleagues conducted a randomized, placebo-controlled "crossover" trial to determine whether lowering uric acid levels with the drug allopurinol would reduce blood pressure (BP) in hyperuricemic adolescents (age 11-17 years) with newly diagnosed hypertension. Thirty patients were randomly assigned to receive either allopurinol or placebo, twice daily for four weeks. This was followed by a two week "washout" period during which the patients received neither allopurinol nor placebo, after which they received the other therapy (allopurinol or placebo) they had not received earlier, for four more weeks.
Allopurinol treatment was associated with a significant decrease in casual and ambulatory systolic and diastolic BP. The average decrease in casual BP during allopurinol treatment was -6.9 mm Hg for systolic and -5.1 mm Hg for diastolic BP; for placebo, the respective changes were -2.0 and -2.4. The average changes in 24-hour ambulatory BP during allopurinol were -6.3 mm Hg, systolic; -4.6, diastolic BP. Systolic BP increased slightly during the placebo phase by 0.8 mm Hg and diastolic BP slightly decreased by 0.3. The decrease in ambulatory BP directly correlated with allopurinol treatment. Twenty of the 30 participants achieved normal BP by casual and ambulatory criteria during the allopurinol phase, whereas only 1 of 30 achieved normal BP during the placebo phase.
"The results of this study represent a potentially new therapeutic approach, that of control of a biochemical cause of hypertension, rather than nonspecifically lowering elevated BP. Although not representing a fully developed therapeutic strategy, this study raises an alternative strategy that may prove to be more effective than currently available options," the authors write.
"Despite these findings, this clinical trial is a small one and allopurinol is not indicated for the treatment of hypertension in adolescents or other populations. The potential adverse effects of allopurinol, including gastrointestinal complaints and especially Stevens-Johnson syndrome [a severe, allergic reaction], make allopurinol an unattractive alternative to available antihypertensive medications. More clinical trials are needed to determine the reproducibility of the data and whether it can be generalized to the larger hypertensive population. Nevertheless, the observation that lowering uric acid can reduce BP in adolescents with newly diagnosed hypertension raises intriguing questions about its role in the pathogenesis of hypertension," the researchers conclude.
(JAMA. 2008;300[8]:924-932. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study, including design, data collection, statistical analysis and manuscript preparation, was supported by a research grant from C. R. Bard 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 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
STUDY FINDS POPCORN, NUTS AND CORN DO NOT INCREASE THE INCIDENCE OF DIVERTICULAR COMPLICATIONS
INTRO:
For years people with diverticulosis have been warned to stay away from foods including popcorn, nuts and corn. The concern is that these small foods may increase the risk of developing diverticulitis and diverticular bleeding. But a new study involving more than forty-seven thousand men finds certain foods may not be a problem and you may not need to avoid them after all. Jennifer Mitchell explains in this week's JAMA Report.
VIDEO:
B-ROLL
People on street
Image of diverticulosis
AUDIO:
ONE THIRD OF THE U.S. POPULATION WILL DEVELOP DIVERTICULOSIS BY AGE SIXTY. THESE ARE SMALL POCKETS THAT CAN FORM IN THE COLON. IF INFECTED, THEY CAN LEAD TO A MORE SERIOUS CONDITION CALLED DIVERTICULITIS.
VIDEO:
SOT/FULL
Super @ :15
Sapna Syngal, M.D., M.P.H.
Brigham and Women's Hospital
Runs: 09
AUDIO:
"Diverticulitis is a real medical condition. It can be serious. It can lead to operations, surgery, colon perforations, death even in rare instances."
VIDEO:
B-ROLL
Doctor walking
Working at desk
Men walking
Man standing
Foods on table
Tight popcorn
Nuts
Corn
AUDIO:
DOCTOR SAPNA (sup-na) SYNGAL (single) IS A GASTROENTEROLOGIST AT BRIGHAM AND WOMEN'S HOSPITAL IN BOSTON. SHE AND HER COLLEAGUES ANALYZED DATA FROM MORE THAN FORTY-SEVEN THOUSAND MEN. DATA WERE COMPILED FROM QUESTIONNAIRES THAT MONITORED WHAT THE MEN ATE AND THEIR MEDICAL CONDITION EVERY TWO YEARS. RESEARCHERS COMPARED INTAKE OF POPCORN, NUTS AND CORN WITH THE INCIDENCE OF DIVERTICULITIS.
VIDEO:
SOT/FULL
Sapna Syngal, M.D., M.P.H.
Brigham and Women's Hospital
Runs: 09
AUDIO:
"To our surprise there was no association with nut, popcorn or corn intake and the development of diverticulitis or diverticular bleeding."
VIDEO:
B-ROLL
Man eating popcorn
Tight popcorn
GXF/JAMA COVER
AUDIO:
RESEARCHERS FOLLOWED PARTICIPANTS FOR ABOUT EIGHTEEN YEARS. THEY SAY MEN WHO ATE POPCORN, NUTS AND CORN MORE THAN TWICE A WEEK WERE NO MORE LIKELY TO DEVELOP DIVERTICULITIS THAN THOSE WHO ONLY ATE THESE FOODS LESS THAN ONCE A MONTH. THE STUDY APPEARS THIS WEEK IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
Sapna Syngal, M.D., M.P.H.
Brigham and Women's Hospital
Runs: 09
AUDIO:
"The people who had higher intakes of nuts and popcorn had a lower rate of diverticulitis. So it actually went against what has been believed for a long period of time"
VIDEO:
B-ROLL
Popcorn, nuts and corn
AUDIO:
RESEARCHERS SAY BASED ON THEIR FINDINGS THEY BELIEVE IT IS UNNECESSARY TO AVOID EATING POPCORN, NUTS OR CORN.
VIDEO:
SOT/FULL
Sapna Syngal, M.D., M.P.H.
Brigham and Women's Hospital
Runs: 05
AUDIO:
"I think the question is what can you do to avoid complications and we don't have the exact answers to that right now."
VIDEO:
B-ROLL
Foods on table
Man eating
AUDIO:
RESEARCHERS SAY FURTHER STUDIES ARE NEEDED TO DETERMINE IF CERTAIN FOODS MAY ACTUALLY PROTECT YOU FROM DIVERTICULITIS.
JENNIFER MITCHELL, THE JAMA REPORT.
TAG:
This study only looked at men ages forty to seventy-five years old who did not have diverticulosis when the study began. Researchers say they believe the findings may also hold true for women, but they cannot say for sure until studies involving women are conducted. For more information about this study you can log on to www.jama.com.
