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 p.m. CT Tuesday, December 16, 2008)
JAMA NEWS RELEASES
IN PATIENTS WITH DIABETES, LOW-GLYCEMIC DIET SHOWS GREATER IMPROVEMENT IN GLYCEMIC CONTROL THAN HIGH-FIBER DIET
MULTI-FACETED STRATEGY IMPROVES NUTRITIONAL SUPPORT FOR ICU PATIENTS, BUT NOT OUTCOMES
PRE-EXISTING DIABETES FOR PERSONS DIAGNOSED WITH CANCER ASSOCIATED WITH INCREASED RISK OF DEATH
SMOKING ASSOCIATED WITH INCREASED RISK FOR COLORECTAL CANCER AND DEATH
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
STUDY FINDS LOW-GLYCEMIC INDEX DIET LOWERS BLOOD GLUCOSE LEVELS,RAISES HEALTHY CHOLESTEROL LEVELS IN PEOPLE WITH TYPE 2 DIABETES
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Please Note: This week's JAMA Report video is a comparison of the effect of a low glycemic vs. high-fiber diet for persons with diabetes. The report will be fed Tuesday, December 16, 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, December 16, 2008
Media Advisory: To contact David J. A. Jenkins, M.D., call Jennifer Humphries at 416-864-6094.
IN PATIENTS WITH DIABETES, LOW-GLYCEMIC DIET SHOWS GREATER IMPROVEMENT IN GLYCEMIC CONTROL THAN HIGH-FIBER DIET
CHICAGO—Persons with type 2 diabetes who had a diet high in low-glycemic foods such as nuts, beans and lentils had greater improvement in glycemic control and risk factors for coronary heart disease than persons on a diet with an emphasis on high-cereal fiber, according to a study in the December 17 issue of JAMA.
One dietary strategy aimed at improving both diabetes control and cardiovascular risk factors is the use of low-glycemic index diets, but there is disagreement over their effectiveness, according to background information in the article.
David J. A. Jenkins, M.D., of St. Michael's Hospital and the University of Toronto, and colleagues assessed the effects of a low-glycemic index diet vs. a high-cereal fiber diet on glycemic control and cardiovascular risk factors for 210 patients with type 2 diabetes. The participants, who were treated with antihyperglycemic medications, were randomly assigned to receive 1 of the 2 diet treatments for 6 months.
In the low-glycemic index diet, the following foods were emphasized: beans, peas, lentils, nuts, pasta, rice boiled briefly and low-glycemic index breads (including pumpernickel, rye pita, and quinoa and flaxseed) and breakfast cereals (including large flake oatmeal and oat bran). In the high-cereal fiber diet, participants were advised to take the "brown" option (whole grain breads; whole grain breakfast cereals; brown rice; potatoes with skins; and whole wheat bread, crackers, and breakfast cereals). Three servings of fruit and five servings of vegetables were encouraged on both treatments.
The researchers found that hemoglobin A1c (HbA1c; a substance of red blood cells tested to measure the blood glucose level) decreased by -0.50 percent absolute HbA1c units in the low-glycemic index diet compared with -0.18 percent absolute HbA1c units in the high-cereal fiber diet. Significant treatment effects were observed for high-density lipoprotein cholesterol (HDL-C) and the low-density lipoprotein cholesterol (LDL-C):HDL-C ratio. HDL-C increased in the low-glycemic index diet group by 1.7 mg/dL and decreased by -0.2 mg/dL in the high-cereal fiber diet group. The LDL-C:HDL-C ratio showed a greater reduction in the low-glycemic index diet group compared with the high-cereal fiber diet group.
"Lowering the glycemic index of the diet improved glycemic control and risk factors for coronary heart disease (CHD). These data have important implications for the treatment of diabetes where the goal has been tight glycemic control to avoid complications. The reduction in HbA1c was modest, but we think it has clinical relevance," the authors write. "Low-glycemic index diets may be useful as part of the strategy to improve glycemic control in patients with type 2 diabetes taking antihyperglycemic medications."
"Pharmacological interventions to improve glycemic control in type 2 diabetes have often failed to show a significant reduction in cardiovascular events. In view of the 2- to 4-fold increase in CHD risk in participants with type 2 diabetes, the ability of a low-glycemic index diet to address both glycemic control and CHD risk factors increases the clinical relevance of this approach for patients with type 2 diabetes, such as those in this study, who are overweight and also taking statins for CHD risk reduction."
(JAMA. 2008;300[23]:2742-2753. 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.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, December 16, 2008
Media Advisory: To contact Gordon S. Doig, Ph.D., email: gdoig{at}med.usyd.edu.au. To contact
editorial co-author Daren K. Heyland, M.D., F.R.C.P.C., call Karen Smith at 613-549-6666, ext. 6345.
MULTI-FACETED STRATEGY IMPROVES NUTRITIONAL SUPPORT FOR ICU PATIENTS, BUT NOT OUTCOMES
CHICAGO—A strategy to change practice in intensive care units was effective in implementing earlier nutritional support for critically ill patients, but the change did not result in a reduced risk of death or reduced length of stay in the ICU, according to a study in the December 17 issue of JAMA.
Previous studies have found that early nutritional support, provided within 24 hours of injury or intensive care unit (ICU) admission, is a key component in the treatment of critically ill patients and may reduce the risk of death. But early nutritional support varies widely between ICUs, and up to 40 percent of eligible patients may remain unfed after 48 hours in the ICU, according to background information in the article.
"Evidence-practice gaps are common in clinical practice, with 30 percent of hospitalized patients receiving care inconsistent with current best evidence. Evidence-based guidelines (EBGs) help reduce evidence-practice gaps by promoting awareness of interventions of proven benefit and discouraging ineffective care. However, the ICU is a complex multidisciplinary environment, and reducing evidence-practice gaps through the successful implementation of an EBG in such an environment is difficult," the authors write. They add that evidence supporting whether guidelines can improve ICU feeding practices and patient outcomes is contradictory.
Gordon S. Doig, Ph.D., of the University of Sydney, Australia, and colleagues conducted a study to examine the effect on death and measures of practice change of implementing EBGs for nutritional support in ICUs. The trial included 27 hospitals in Australia and New Zealand and 1,118 critically ill adult ICU patients. Intensive care units were randomly assigned as either guideline or control groups. An evidence-based guideline was developed and a practice-change strategy, consisting of 18 specific interventions, supported by educational outreach visits, was implemented in guideline ICUs. Guideline and control ICUs enrolled 561 and 557 patients, respectively.
The researchers found that no guideline hospitals failed to implement the evidence-based guideline. Significantly more patients in guideline ICUs received nutritional support during their ICU stay (94.3 percent vs. 72.7 percent) and were fed within 24 hours of ICU admission (60.8 percent vs. 37.3 percent). Patients in guideline ICUs were fed significantly earlier (0.75 vs. 1.37 average days to start of enteral nutrition [food provided through a feeding tube placed through the nose and into the stomach or small intestine]; and 1.04 vs. 1.40 average days to start of parenteral nutrition [intravenous feeding]), achieved caloric goals more often, and were fed on a greater proportion of ICU days (8.08 vs. 6.90 fed days per 10 patient-days) than patients in control ICUs.
There were no significant differences between guideline and control ICUs with regard to the rate of death in the hospital or ICU, or average length of stay in the ICU or hospital. The incidence of clinically significant kidney dysfunction was significantly lower in the guideline ICUs compared with controls; however, there was no difference in the use of renal replacement therapy (such as dialysis).
"We achieved significant practice change in the complex environment of the ICU through the use of a multifaceted, multilevel practice-change strategy, leveraged by educational outreach visits. Although the successful implementation of the guideline resulted in significant practice change, it did not result in reduced hospital mortality in critically ill patients," the authors conclude.
(JAMA. 2008;300[23]:2731-2741. 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: IMPLEMENTING NUTRITION GUIDELINES IN THE CRITICAL CARE SETTING—A WORTHWHILE AND ACHIEVABLE GOAL?
In an accompanying editorial, Naomi E. Jones, R.D., M.Sc., and Daren K. Heyland, M.D., F.R.C.P.C., of Queen's University and Kingston General Hospital, Kingston, Ontario, Canada, comment on the findings of Doig and colleagues.
"These results are somewhat disappointing and prompt reflection on possible explanations. Existing guidelines recommend starting enteral nutrition within 24 to 48 hours, so shifting the average time to initiation of enteral nutrition from 1.37 days (32.9 hours) to 0.75 days (18 hours) may not be a large enough effect to influence clinical outcomes. Moreover, practices in both treatment groups were within recommended limits, with 95 percent of patients in both groups fed by 1.6 days after admission."
"While Doig et al have made significant efforts to improve nutrition practice in the critical care setting, it is only through tailoring interventions to address identified barriers that change ultimately will occur and optimal nutrition will have positive effects on the morbidity and mortality of critically ill patients. The design of future studies will be strengthened by including barrier assessment and aligning the intervention with the complexity of the critical care environment."
(JAMA. 2008;300[23]:2798-2799. 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.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, December 16, 2008
Media Advisory: To contact corresponding author Frederick L. Brancati, M.D., M.H.S., call Christy Brownlee at 410-955-7832.
PRE-EXISTING DIABETES FOR PERSONS DIAGNOSED WITH CANCER ASSOCIATED WITH INCREASED RISK OF DEATH
CHICAGO—Patients with diabetes at the time of a cancer diagnosis have an increased risk of death compared to patients without diabetes, according to a meta-analysis of studies reported in the December 17 issue of JAMA.
Approximately 20 million Americans have diabetes mellitus, which is about 7 percent of the U.S. adult population. Diabetes mellitus appears to be a risk factor for some cancers, but the effect of pre-existing diabetes on all-cause death in newly diagnosed cancer patients is less clear, according to background information in the article.
Bethany B. Barone, Sc.M., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues conducted a meta-analysis to examine the association of pre-existing diabetes with long-term, all-cause death in cancer patients. The researchers identified 48 articles that met criteria for the study, including 23 articles for which data could be included in the meta-analysis.
The meta-analysis (of these 23 studies) indicated that pre-existing diabetes was associated with an increase in all-cause death following cancer diagnosis, compared with individuals with normal glucose levels, across all cancer types. Additional analyses by type of cancer showed that pre-existing diabetes was significantly associated with increased long-term, all-cause death for cancers of the endometrium, breast, and colorectum. Diabetes was associated with a nonsignificant increase in risk in prostate, gastric, hepatocellular, lung and pancreatic cancer.
"Future research should determine the relative importance of different pathways to diabetes-related mortality risk. If a clinical or biological interaction between diabetes and cancer care is confirmed, subsequent trials should test whether improvements in diabetes care for patients with newly diagnosed cancer might reduce long-term mortality," the authors conclude.
(JAMA. 2008;300[23]:2754-2764. 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.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, December 16, 2008
Media Advisory: To contact Edoardo Botteri, M.Sc., email: edoardo.botteri{at}ieo.it.
SMOKING ASSOCIATED WITH INCREASED RISK FOR COLORECTAL CANCER AND DEATH
CHICAGO—An analysis of previous studies indicates that smoking is significantly associated with an increased risk for colorectal cancer and death, according to an article in the December 17 issue of JAMA.
Although tobacco was responsible for approximately 5.4 million deaths in 2005, there are still an estimated 1.3 billion smokers in the world. While a number of cancers are attributable to smoking, the link between cigarette smoking and colorectal cancer (CRC) has been inconsistent among studies. "Because smoking can potentially be controlled by individual and population-related measures, detecting a link between CRC and smoking could help reduce the burden of the world's third most common tumor, which currently causes more than 500,000 annual deaths worldwide. In the United States alone, an estimate of approximately 50,000 deaths from CRC would have occurred in 2008," the authors write.
Edoardo Botteri, M.Sc., of the European Institute of Oncology, Milan, Italy, and colleagues conducted a meta-analysis to review and summarize published data examining the link between smoking and CRC incidence and death.
The researchers identified 106 observational studies, and the meta-analysis was based on a total of nearly 40,000 new cases of CRC. For the analysis on incidence, smoking was associated with an 18 percent increased risk of CRC. The researchers also found a statistically significant dose-relationship with an increasing number of pack-years (number of packs of cigarettes smoked/day, multiplied by years of consumption) and cigarettes per day. However, the association was statistically significant only after 30 years of smoking.
Seventeen studies were included in the analysis of mortality, which indicated that smokers have a 25 percent increased risk of dying from CRC than people who have never smoked. There also was an increase in risk of CRC death with increasing number of cigarettes per day smoked and for longer duration of smoking. For both incidence and death, the association was stronger for cancer of the rectum than of the colon.
"Smoking has not been considered so far in the stratification of individuals for CRC screening. However, several studies reported that CRC occurs earlier in smokers, particularly in those with heavy tobacco consumption, and our previous and present findings provide strong evidence of the detrimental effect of cigarette smoking on the development of adenomatous [benign tumor] polyps and CRC. We believe that smoking represents an important factor to consider when deciding on the age at which CRC screening should begin, either by lowering the age in smokers or increasing the age in non-smokers," the authors write.
(JAMA. 2008;300[23]:2765-2778. 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.
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JAMA REPORTS
VIDEO:
Windows Media |
Quicktime
STUDY FINDS LOW-GLYCEMIC INDEX DIET LOWERS BLOOD GLUCOSE LEVELS,RAISES HEALTHY CHOLESTEROL LEVELS IN PEOPLE WITH TYPE 2 DIABETES
INTRO:
People with Type 2 Diabetes not only need to keep their blood sugar levels in check, but they face an increased risk of developing cardiovascular disease. Now, a new study finds that a certain kind of diet may help on both fronts. Alissa Krinsky explains in this week's JAMA Report.
VIDEO:
B-ROLL
Beans, Fruit and other foods
AUDIO:
THEY'RE EVERYDAY FOODS THAT MAY HELP PEOPLE WITH TYPE 2 DIABETES LOWER THEIR BLOOD GLUCOSE LEVELS.
VIDEO:
SOT/FULL
Super @ :09
Sandy Mitchell, R.D.
University of Toronto-St. Michael's Hospital
Runs :05
AUDIO:
"Blood glucose is the level of sugar in our bloodstream."
VIDEO:
B-ROLL
Sandy walking into office
Dr. Jenkins at desk
High Fiber Foods and Low-Glycemic Foods
AUDIO:
BUT PEOPLE WITH TYPE 2 DIABETES ARE TO AVOID QUICK, SIZEABLE SPIKES IN BLOOD SUGAR. THAT'S WHY DIETICIAN SANDY MITCHELL OF THE UNIVERSITY OF TORONTO-ST. MICHAEL'S HOSPITAL ALONG WITH LEAD RESEARCHER DOCTOR DAVID JENKINS AND THEIR COLLEAGUES COMPARED HOW TWO DIETS AFFECT BLOOD GLUCOSE LEVELS.
VIDEO:
SOT/FULL
Super @ :32
David Jenkins, M.D., Ph.D.
University of Toronto-St. Michael's Hospital
Runs :12
AUDIO:
"Our study explores the effect of slowing the rate of digestion on blood glucose levels in diabetics and whether this can be used as part of their treatment."
VIDEO:
B-ROLL
GXF/JAMA COVER
GXF/Diet Comparison
- 210 Participants With Type 2 Diabetes
- Randomly Assigned Diet
- 6 Months
B-ROLL
High-Cereal Fiber Foods
Low-Glycemic Index Foods
AUDIO:
THE STUDY APPEARS THIS WEEK IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. IT INVOLVED 210 PARTICIPANTS WITH TYPE-TWO DIABETES RANDOMLY ASSIGNED TO ONE OF TWO DIETS FOR SIX MONTHS: THE FIRST, A HIGH-CEREAL FIBER DIET, WITH FOODS LIKE WHOLE WHEAT BREADS AND CEREALS, BROWN RICE, AND BAKED POTATOES THE OTHER, A LOW-GLYCEMIC INDEX DIET OF FOODS SUCH AS BEANS, OATS, BERRIES AND PUMPERNICKEL BREAD.
VIDEO:
SOT/FULL
Sandy Mitchell, R.D.
University of Toronto-St. Michael's Hospital
Runs :14
AUDIO:
"In our low-glycemic diet, we have foods that are digested more slowly, or the sugar that is digested is released into the bloodstream more slowly."
VIDEO:
B-ROLL
Food (Bread, beans, fruit)
AUDIO:
AND SO IT HAD GREATER EFFECT ON LOWERING BLOOD GLUCOSE LEVELS. IT ALSO HELPED LOWER CARDIOVASCULAR DISEASE RISK.
VIDEO:
SOT/FULL
David Jenkins, M.D., Ph.D.
University of Toronto-St. Michael's Hospital
Runs :14
AUDIO:
"It raised the healthy cholesterol —the HDL cholesterol— ...for heart disease."
VIDEO:
B-ROLL
Low GI Foods sign
Low-Glycemic Index Foods
AUDIO:
A LOW-GLYCEMIC INDEX DIET, THEREFORE, IS RECOMMENDED FOR PEOPLE WITH TYPE-2 DIABETES.
VIDEO:
SOT/FULL
David Jenkins, M.D., Ph.D.
University of Toronto-St. Michael's Hospital
Runs :08
AUDIO:
"Diet may play a role in controlling both blood glucose and cardiovascular risk factors at the same time."
VIDEO:
B-ROLL
Different types of beans
AUDIO:
A HEALTHY DIET CAN MEAN A HEALTHIER LIFE. ALISSA KRINSKY, THE JAMA REPORT.
TAG:
All study participants were already taking at least one diabetes medication to lower their blood sugar levels - but they were not on insulin injections. For more information about this study you can log on to www.jama.com.
