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April 6, 2009JAMA 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 PEDIATRICS & ADOLESCENT MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, April 6, 2009)
ARCHIVES OF GENERAL PSYCHIATRY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, April 6, 2009)
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED. JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ON-LINE. Go to www.jamamedia.org for more information and to apply for access. Please Note: The FOR THE MEDIA website now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 6, 2009
Children With Low Self-Control More Likely to Become Overweight Pre-Teens
CHICAGO—Young children who do not display an ability to regulate their behavior or to delay gratification in exchange for a larger reward appear predisposed to gain extra weight by their pre-teen years, according to two reports published in the April issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. "Obesity in childhood and adolescence appears to track into adulthood, increasing the risk of developing cardiovascular disease, diabetes mellitus and certain cancers in adulthood," the authors write as background information in one of the articles. "To mount effective preventive efforts, we need better information regarding the factors involved in the etiology of childhood overweight and obesity." In one study, Lori A. Francis, Ph.D., and Elizabeth J. Susman, Ph.D., of Pennsylvania State University, State College, assessed self-regulation behavior in 1,061 children. Data were collected when children were ages 3, 5, 7, 9, 11 and 12 years old. At age 3, the children participated in a self-control assessment that involved sitting alone in a room with a toy for 150 seconds. Those who waited at least 75 seconds to play with the toy were classified as high in self-regulation. At age 5, the children participated in an exercise in delayed gratification that involved choosing a smaller portion of a favorite food immediately or a larger portion several minutes later. High self-regulation was defined as waiting at least 210 seconds to eat the food. Compared with children who showed high self-control on both tests, those who were unable to regulate their behavior at both ages had the highest body mass index (BMI) scores for their age at 12 years and the most rapid increases in BMI over the nine-year follow-up. "The findings reported herein have potential for early prevention of obesity," the authors write. "The implication is that interventions to enhance energy-balance regulation in young children will benefit from efforts to encourage self-regulation in other domains, such as encouraging self-control and delay of gratification, both of which are important factors in regulating energy intake." In another study, Desiree M. Seeyave, M.B.B.S., of the University of Michigan, Ann Arbor, and colleagues used a similar self-imposed waiting task to gauge 4-year-olds' ability to delay gratification. The children were asked to choose candy, animal crackers or pretzels as their preferred food and then left alone with two plates of different quantities of the food. "The child was told that he would be allowed to eat the large quantity of the chosen food if he waited until the examiner returned," the authors write. "If he could not wait until the examiner returned, he could ring a bell to summon the examiner back into the room, at which time he could eat the small quantity." Of the 805 children who participated, 47 percent failed the test, either by ringing the bell before the seven-minute waiting period elapsed, spontaneously beginning to eat the food, becoming distressed, going to the door or calling for a parent or the examiner. Those who displayed a limited ability to delay gratification were 29 percent more likely to be overweight at age 11. The association was partially explained by mothers' weight status. "The influence of maternal weight status on child weight reflects genetic as well as environmental factors, such as feeding patterns and availability of food," the authors write.
Parenting techniques may be available to help children develop an ability to delay gratification, the authors note. "Some strategies that have been described in prior studies have been keeping the desired item (in this case, food) out of sight (and therefore out of mind) or distracting the child's attention from the food to another engaging activity. Another possibility is simply providing a logical structure to snacks and mealtimes such that the child learns that food is not to be eaten the moment it is desired, but to wait until the next snack or meal time," the authors write.
Editor's Note: Please see the articles for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. Editorial: Possibilities Exist for Improving Children's Self-Control
"Can a child's self-regulation capacity be changed or is it an innate and immutable human trait?" write Robert C. Whitaker, M.D., M.P.H., and Rachel A. Gooze, B.A., of Temple University, Philadelphia, in an accompanying editorial. "Self-regulation is shaped by both nature and nurture; it is influenced by environments and experiences during early childhood."
"There are not yet any tested ‘office-based' interventions for improving children's capacity for self-regulation," they write. "However, there are promising results from randomized controlled trials showing that interventions in preschools can increase children's positive social behaviors."
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. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 6, 2009
Reducing Sugar and Increasing Fiber Intake May Improve Diabetes Risk Factors in Latino Teens+
CHICAGO—Reducing sugar intake by the equivalent of one can of soda per day and increasing fiber intake by the amount equivalent to one half cup of beans per day appears to improve risk factors associated with type 2 diabetes in Latino adolescents, according to a report in the April issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. Almost 40 percent of Mexican American adolescents age 12 to 19 were overweight or at risk for overweight from 2003 to 2006, according to background information in the article. "Latino children are more insulin resistant and thus more likely to develop obesity-related chronic diseases than their white counterparts," the authors write. "To date, only a few studies have examined the effects of a high-fiber, low-sugar diet on metabolic health in overweight youth, and to our knowledge, none have tested the effects of this type of intervention in a mixed-sex group of Latino youth." Emily Ventura, M.P.H., of Keck School of Medicine, University of Southern California, Los Angeles and colleagues conducted a 16-week study to examine if reductions in added sugar intake or increases in fiber intake would affect risk factors for developing type 2 diabetes in 54 overweight Latino adolescents (average age 15.5). Participants were split into three groups: control, nutrition (receiving one nutrition class per week) or nutrition plus strength training (receiving one nutrition class per week along with strength training twice a week). Fifty-five percent of participants decreased their sugar intake by an average of 47 grams per day (equal to the sugar in one can of soda) and 59 percent increased their fiber intake by an average of 5 grams per day (equal to the fiber in a half cup of beans) across all intervention groups, including controls. Participants who decreased their sugar intake had an average 33 percent decrease in insulin secretion and those who increased their fiber intake had an average 10 percent reduction in visceral adipose tissue volume. "A reduction in visceral fat indicates a reduction in risk for type 2 diabetes, considering that to a greater degree than total body fat, visceral fat [fat surrounding the internal organs] has been shown to be negatively associated with insulin sensitivity," the authors note. "Those who increased fiber intake had a significant reduction in body mass index (-2 percent vs. 2 percent) and visceral adipose tissue (-10 percent vs. no change) compared with those who decreased fiber intake," the authors write.
"Our results suggest that intensive interventions may not be necessary to achieve modifications in sugar and fiber intake. Accordingly, nutritional guidance given in the primary care or community setting may be sufficient to promote the suggested dietary changes in some individuals," the authors conclude. "In addition, policies that promote reduced intake of added sugar and increased intake of fiber could be effective public health strategies for the prevention of type 2 diabetes in this high-risk population."
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 JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 6, 2009
Studies Investigate Childhood Obesity, Diabetes and Related Conditions
Archives of Pediatrics & Adolescent Medicine theme issue examines risk factors and interventions CHICAGO—Factors identified early in childhood could predict obesity in the teen years and beyond, and researchers continue to assess methods to prevent and treat excess weight gain and its consequences in children and teens, according to several reports published in the April issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. The issue—a theme issue on childhood obesity and diabetes—is being published in conjunction with a JAMA theme issue on diabetes. The March issue of Archives of Ophthalmology and Archives of Neurology, along with the April issues of Archives of Dermatology and Archives of Surgery, also feature research on diabetes, obesity and their related co-morbidities. Studies featured in this issue include the following: School-Based Intervention Changes Some, But Not All, Behaviors and Measures of Obesity
An interdisciplinary program designed to increase awareness of obesity and change the behaviors of Dutch school children appears to have reduced the amount of sugary beverages consumed by boys and girls and also improved body composition in girls alone, but did not seem to affect other behaviors. Amika S. Singh, Ph.D., and colleagues at VU University Medical Center, EMGO Institute, Amsterdam, the Netherlands, assessed the effectiveness of the intervention among 1,108 adolescents (average age 12.7). The program included 11 lessons in biology, physical education and lifestyle changes over eight months. Students at the 10 schools that participated in the program drank fewer sugar-sweetened beverages at the end of the intervention (287 milliliters per day less for boys and 249 milliliters per day less for girls) and 12 months later (233 milliliters per day less for boys and 271 milliliters per day less for girls) than did those in the eight schools that did not participate. In addition, at a 20-month follow-up, the intervention remained effective in preventing unfavorable increases in the sum of all skinfold measurements (taken at the triceps, biceps, below the shoulder and between the hip joint and ribcage) in girls. However, no changes were seen in consumption of snacks or in walking or biking to school. "Hence, our results do not show consistently positive findings on all anthropometric and behavioral outcome measures. Our findings are important, especially when considering the need for evidence on the long-term effectiveness of interventions in the field of obesity prevention," the authors write. "Reducing intake of sugar-containing beverages should therefore be considered a good behavioral target for future interventions aimed at the prevention of overweight among adolescents."
Schools remain "an obvious and important channel for providing obesity-prevention programs, as the vast majority of youth spend a great deal of time each week throughout their development from childhood to young adulthood in schools," writes Leslie A. Lytle, Ph.D., of the University of Minnesota, Minneapolis, in an accompanying editorial. "However, as the extent of the published research in this field is substantial and the findings consistently mixed and modest, it may be time to re-evaluate where the research needs to move."
Replacing Sugary Beverages With Water Is Associated With Decreases in Children and Teens' Calorie Intake
Encouraging children and teens to drink water instead of sugary beverages is associated with decreases in their total calorie intake of an average of 235 per day. Y. Claire Wang, M.D., Sc.D., of Columbia Mailman School of Public Health, New York, and colleagues assessed data from 3,098 children and teens (age 2 to 19) participating in the 2003-2004 National Health and Nutritional Examination Survey. The participants reported which beverages they consumed during two separate 24-hour periods. Every additional 8-ounce serving of sugary beverages the children and teens drank corresponded to an additional 106 calories in their daily diet—similar to the amount of calories in each beverage, suggesting that individuals do not compensate for these calories by eating less. "Our results also indicate that replacing sugar-sweetened beverages with water is associated with a significant decrease in total energy intake," the authors write. "Each 1 percent of beverage replacement was associated with a 6.6-calorie lower total energy intake, a reduction not negated by compensatory increases in other food or beverages."
The results suggest that reducing the amount of sugary beverages children drink could reduce their risk for obesity, but only if those beverages are replaced with water instead of milk or juice, the authors note.
Study Identifies Racial Disparities in Childhood Obesity
Obesity appears twice as common among American Indian and Native Alaskan children than non-Hispanic white or Asian children at age 4. Sarah E. Anderson, Ph.D., of The Ohio State University College of Public Health, Columbus, and Robert C. Whitaker, M.D., M.P.H., of Temple University, Philadelphia, studied a nationally representative sample of 8,550 U.S. children born in 2001. In 2005, 18.4 percent of the 4-year-olds were obese, including 31.2 percent of American Indian/Native Alaskan children, 22 percent of Hispanic children, 20.8 percent of non-Hispanic black children, 15.9 percent of non-Hispanic white children and 12.8 percent of Asian children.
"To help arrest the trends in childhood obesity, both the Surgeon General and the Institute of Medicine have recommended that obesity-prevention efforts begin early in life," the authors write. "These efforts might benefit from a better understanding of how differences in obesity risk between racial/ethnic groups emerge early in the life course. Because families are the social units with the greatest influence on very young children, future research might focus on racial/ethnic differences in household behaviors that affect obesity and how these behaviors are influenced by the community context."
Teens Who Give Birth More Likely to Be Overweight
Girls who give birth between ages 15 and 19 appear to be substantially heavier, with more abdominal fat, regardless of their childhood weight or of other risk factors for weight gain. Erica P. Gunderson, Ph.D., of Kaiser Permanente, Oakland, Calif., and colleagues studied 1,890 girls (983 black and 907 white) who were age 9 to 10 at the beginning of the study in 1987-1988. After nine to 10 years—in 1996-1997—31 percent of black girls and 10 percent of white girls had given birth during adolescence or young adulthood. Those who did were more likely to experience increases in weight, body mass index, hip circumference and percentage of body fat. The association was stronger among black women than white women.
"Our findings are potentially important because adolescence has been identified as one of the critical periods of development that set the stage for the onset of obesity later in life," the authors write. "Earlier age at a first birth (younger than 20 years) has been associated with increased rates of coronary heart disease in women. Thus, the influence of gestational weight gain on changes in growth and adiposity during adolescence is an important aspect for future investigation."
Diabetes and Blood Pressure Medication Prescriptions Increase Among Children and Teens
The number of children and teens prescribed medicine to treat high blood pressure or diabetes appears to have increased between 2004 and 2007. Joshua N. Liberman, Ph.D., of CVS Caremark in Hunt Valley, Md., and colleagues analyzed the prescription records of more than 5 million commercially insured individuals ages 6 to 18 covered by a pharmacy benefits manager. The prevalence of children and teens who were prescribed medications for hypertension (high blood pressure), dyslipidemia (abnormal cholesterol) or diabetes (including insulin) increased 15.2 percent, from 3.3 per 1,000 youths in November 2004 to 3.8 per 1,000 youths in June 2007. "The increasing use of oral anti-diabetic and antihypertensive pharmacotherapy among children and adolescents, especially in the younger age group, indicates either an increased awareness of treatment needs or increased incidence of cardiovascular risk factors typically associated with adult populations," the authors write. When assessed separately, cholesterol-controlling therapy was uncommon (prescribed to 0.2 per 1,000 youths overall) and declined 22.9 percent during the study period. "The decrease in treatment of dyslipidemia may reflect the ongoing controversy regarding statin use," the authors conclude.
The results indicate that these drugs are not currently being overused in this population, writes Stephen R. Daniels, M.D., Ph.D., of the University of Colorado Denver School of Medicine, in an accompanying editorial. "While the potential for misuse of these medications remains, that does not appear to be happening at this time. Nevertheless, it will be important to collect data in an ongoing manner to monitor use of these medications but also to identify appropriateness of use and ultimate reduction of risk factor levels in children and adolescents."
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 JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 6, 2009
Two Non-Drug Treatments Appear to Reduce Depression After Heart Surgery
CHICAGO—Two non-pharmacological interventions—cognitive behavior therapy and supportive stress management—appear more effective than usual care for treating depression after coronary artery bypass surgery, according to a report in the April issue of Archives of General Psychiatry, one of the JAMA/Archives journals. About one in every five patients experiences a major depressive episode following coronary artery bypass graft (CABG) surgery and at least that many develop milder forms of depression, according to background information in the article. "Depression around the time of surgery predicts postoperative complications, longer physical and emotional recovery, worse quality of life and increased rates of cardiac events and mortality [death]," the authors write, and may also be linked to problems with thinking, learning and memory. Kenneth E. Freedland, Ph.D., of the Washington University School of Medicine, St. Louis, and colleagues conducted a randomized clinical trial involving 123 patients who had major or minor depression within one year after CABG surgery. Of these, 40 were randomly assigned to usual care as determined by primary care or other physicians and the other patients were assigned to one of two treatment groups. This included 41 patients who underwent 12 weeks of cognitive behavior therapy, shown to be an effective treatment for depression in other populations. The individual, 50- to 60-minute sessions with a psychologist or social worker involved identifying problems and developing cognitive techniques for overcoming them, including challenging distressing automatic thoughts and changing dysfunctional attitudes. The other 42 patients received 12 weeks of supportive stress management, in which a social worker or psychologist counseled the patient about improving his or her ability to cope with stressful life events. Depressive symptoms were assessed at the beginning of the study and again after three, six and nine months. After three months, more patients in the cognitive behavior therapy group (71 percent) and supportive stress management group (57 percent) experienced remission of their depression than in the usual care group (33 percent). The differences narrowed at the six-month follow-up but differed again at nine months (73 percent for the cognitive behavior therapy group, 57 percent for the supportive stress management group and 35 percent for the usual care group). "Cognitive behavior therapy was also superior to usual care on most secondary psychological outcomes, including anxiety, hopelessness, perceived stress and the mental (but not the physical) component of health-related quality of life. On most of these measures, differences between cognitive behavior therapy and usual care were found at all three follow-up assessments," the authors write. "Supportive stress management was superior to usual care only on some of these measures."
"In conclusion, this randomized, controlled trial showed that cognitive behavior therapy was an efficacious treatment for depression in patients with a recent history of coronary bypass surgery," they continue. "Supportive stress management was also superior to usual care for depression in these patients, but it had smaller and less durable effects than cognitive behavior therapy."
Editor's Note: This study was supported by grants from the National Institute of Mental 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.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 6, 2009
Mental Health Problems in Childhood May Predict Later Suicide Attempts in Males
CHICAGO—Most males who commit suicide or need hospital care for suicide attempts during their teen or early adult years appear to have high levels of psychiatric problems at age 8, according to a report in the April issue of Archives of General Psychiatry, one of the JAMA/Archives journals. However, later suicide attempts in females are not predicted by mental health issues at this age. "Suicide among adolescents and young adults is a major public health concern worldwide," the authors write as background information in the article. "The rates of mortality [death] by suicide have been found to be high among those with medically serious suicide attempts. For effective prevention, knowledge of the key risk factors for suicide is essential." Andre Sourander, M.D., of Turku University Hospital, Turku, Finland, and colleagues studied 5,302 Finnish individuals born in 1981. Eight years later, information about psychiatric conditions, school performance and family demographics was gathered from children, parents and teachers. Participants were then tracked through national registers through 2005. Between ages 8 and 24, 40 participants died, including 24 males and 16 females. Of those, 13 males and two females died from suicide. A total of 54 males and females (1 percent) either completed suicide or made a suicide attempt serious enough to result in hospitalization. Of the 27 males who either seriously attempted or completed suicide, 78 percent screened positive for psychiatric conditions at age 8, compared with 11 percent of 27 females who had serious or completed suicide attempts. In addition, males who would go on to make life-threatening or completed suicide attempts were more likely at age 8 to live in a family that did not consist of two biological parents, have psychological problems as reported by a teacher or have conduct, hyperactive or emotional problems. However, none of these factors at age 8 predicted later suicidal behavior in females, and depression at age 8 was not associated with suicide attempts for either sex. "The main finding of our study is that severe suicidality in adolescence and early adulthood has different childhood trajectories among males and females," the authors write. "The present study shows that among males severe suicidality (i.e., completed suicide or serious, life-threatening attempts) shows a pathway of persistence throughout the life cycle, starting in early childhood. Four out of five of these males showed a high level of psychiatric symptoms at the age of 8 years." Previous research has shown that in females, suicide is associated with depression and other affective disorders, which increase sharply after the beginning of puberty. This may explain why childhood psychiatric conditions do not predict later suicidal behavior in girls, the authors note.
"These findings have considerable public health significance," they conclude. "The development of measures to effectively screen, detect and treat childhood disorders is a key issue in the effort to prevent suicide among males. This focus is particularly important among males with severe conduct problems because, during adolescence, they usually do not seek mental health services. Further studies are warranted to examine the efficacy of such preventive measures in childhood in the reduction of suicide rates among males."
Editor's Note: This study has been supported by a grant from the Sigrid Juselius Foundation. 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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