Patrice Wendling

TUCSON, ARIZ. — There are 1.2 million previously unidentified normal-weight adolescents nationally who may be at increased risk of insulin resistance, Dr. Ann Rodden, said at the annual meeting of the North American Primary Care Research Group.

Adolescents with a body mass index (BMI) in the 75th-84.9th percentile and those who have low levels of physical activity were at increased risk for insulin resistance, according to data obtained in a secondary analysis of the National Health and Nutrition Examination Survey (NHANES) during 1999–2002.

Prevalence estimates suggest that more than 8.5 million American adolescents have insulin resistance. Of these, more than 1.2 million are in the 75th-84.9th BMI percentile. The American Diabetes Association considers adolescents with a BMI at or above the 85th percentile to be at risk for insulin resistance, said Dr. Rodden, department of family medicine, Medical University of South Carolina, Charleston.

“There is a population of adolescents that right now we do not consider to be at risk of insulin resistance and that we should be looking at in addition to those already identified,” she said.

The analysis was based on a nationally representative sample of 1,806 nondiabetic, nonpregnant adolescents aged 12–19 years who were participating in the NHANES study. Insulin resistance was calculated using the Homeostasis Model Assessment (HOMA) method, with a value of more than 3.16 used as the cutoff for insulin resistance.

Of these, 581 adolescents had insulin resistance, representing 30,855,840 adolescents in the U.S. population. Their mean age was 15 years. Overall, 28% of all females and 27% of all males who were evaluated had insulin resistance. Among individual ethnic groups, whites were less likely to have insulin resistance (28.2%) than were blacks (34.9%) or Hispanics (34.5%). Among those who reported physical activity levels of less than an hour a week of heavy activity, 38% had insulin resistance.

Only 9.2% of those in the under-50th BMI percentile and 13.3% in the 50th-74.9th percentile had insulin resistance. Of note was that about one-third (33.8%) of normal-weight adolescents in the 75th-84.9th BMI percentile had insulin resistance, as did 37.8% in the 85th-94.9th percentile and 72.8% in the 95th or higher BMI percentile, Dr Rodden reported.

With a logistic regression analysis adjusting for age, ethnicity, gender, poverty income ratio, and carbohydrate intake, the odds of developing insulin resistance were four times higher for adolescents in the 75th-84.9th percentile (odds ratio 4.28) and the 85th-94.9th percentile (OR 4.30), and nearly 18 times higher for overweight adolescents in the 95th or higher percentile (OR 17.91). The risk was not significantly increased for adolescents in the two lowest BMI percentiles.

Being less active was also significantly associated with increased risk of insulin resistance, particularly among those with less than an hour a week of heavy activity (OR 4.38). But cardiovascular fitness level was not. This finding suggests that physical activity may have metabolic benefits irrespective of the level of fitness achieved, Dr. Rodden said.

The study was limited by the lack of a universally accepted definition for insulin resistance in adolescents, and self-reported physical activity data.

TUCSON, ARIZ. — There are 1.2 million previously unidentified normal-weight adolescents nationally who may be at increased risk of insulin resistance, Dr. Ann Rodden, said at the annual meeting of the North American Primary Care Research Group.

Adolescents with a body mass index (BMI) in the 75th-84.9th percentile and those who have low levels of physical activity were at increased risk for insulin resistance, according to data obtained in a secondary analysis of the National Health and Nutrition Examination Survey (NHANES) during 1999–2002.

Prevalence estimates suggest that more than 8.5 million American adolescents have insulin resistance. Of these, more than 1.2 million are in the 75th-84.9th BMI percentile. The American Diabetes Association considers adolescents with a BMI at or above the 85th percentile to be at risk for insulin resistance, said Dr. Rodden, department of family medicine, Medical University of South Carolina, Charleston.

“There is a population of adolescents that right now we do not consider to be at risk of insulin resistance and that we should be looking at in addition to those already identified,” she said.

The analysis was based on a nationally representative sample of 1,806 nondiabetic, nonpregnant adolescents aged 12–19 years who were participating in the NHANES study. Insulin resistance was calculated using the Homeostasis Model Assessment (HOMA) method, with a value of more than 3.16 used as the cutoff for insulin resistance.

Of these, 581 adolescents had insulin resistance, representing 30,855,840 adolescents in the U.S. population. Their mean age was 15 years. Overall, 28% of all females and 27% of all males who were evaluated had insulin resistance. Among individual ethnic groups, whites were less likely to have insulin resistance (28.2%) than were blacks (34.9%) or Hispanics (34.5%). Among those who reported physical activity levels of less than an hour a week of heavy activity, 38% had insulin resistance.

Only 9.2% of those in the under-50th BMI percentile and 13.3% in the 50th-74.9th percentile had insulin resistance. Of note was that about one-third (33.8%) of normal-weight adolescents in the 75th-84.9th BMI percentile had insulin resistance, as did 37.8% in the 85th-94.9th percentile and 72.8% in the 95th or higher BMI percentile, Dr Rodden reported.

With a logistic regression analysis adjusting for age, ethnicity, gender, poverty income ratio, and carbohydrate intake, the odds of developing insulin resistance were four times higher for adolescents in the 75th-84.9th percentile (odds ratio 4.28) and the 85th-94.9th percentile (OR 4.30), and nearly 18 times higher for overweight adolescents in the 95th or higher percentile (OR 17.91). The risk was not significantly increased for adolescents in the two lowest BMI percentiles.

Being less active was also significantly associated with increased risk of insulin resistance, particularly among those with less than an hour a week of heavy activity (OR 4.38). But cardiovascular fitness level was not. This finding suggests that physical activity may have metabolic benefits irrespective of the level of fitness achieved, Dr. Rodden said.

The study was limited by the lack of a universally accepted definition for insulin resistance in adolescents, and self-reported physical activity data.

TUCSON, ARIZ. — There are 1.2 million previously unidentified normal-weight adolescents nationally who may be at increased risk of insulin resistance, Dr. Ann Rodden, said at the annual meeting of the North American Primary Care Research Group.

Adolescents with a body mass index (BMI) in the 75th-84.9th percentile and those who have low levels of physical activity were at increased risk for insulin resistance, according to data obtained in a secondary analysis of the National Health and Nutrition Examination Survey (NHANES) during 1999–2002.

Prevalence estimates suggest that more than 8.5 million American adolescents have insulin resistance. Of these, more than 1.2 million are in the 75th-84.9th BMI percentile. The American Diabetes Association considers adolescents with a BMI at or above the 85th percentile to be at risk for insulin resistance, said Dr. Rodden, department of family medicine, Medical University of South Carolina, Charleston.

“There is a population of adolescents that right now we do not consider to be at risk of insulin resistance and that we should be looking at in addition to those already identified,” she said.

The analysis was based on a nationally representative sample of 1,806 nondiabetic, nonpregnant adolescents aged 12–19 years who were participating in the NHANES study. Insulin resistance was calculated using the Homeostasis Model Assessment (HOMA) method, with a value of more than 3.16 used as the cutoff for insulin resistance.

Of these, 581 adolescents had insulin resistance, representing 30,855,840 adolescents in the U.S. population. Their mean age was 15 years. Overall, 28% of all females and 27% of all males who were evaluated had insulin resistance. Among individual ethnic groups, whites were less likely to have insulin resistance (28.2%) than were blacks (34.9%) or Hispanics (34.5%). Among those who reported physical activity levels of less than an hour a week of heavy activity, 38% had insulin resistance.

Only 9.2% of those in the under-50th BMI percentile and 13.3% in the 50th-74.9th percentile had insulin resistance. Of note was that about one-third (33.8%) of normal-weight adolescents in the 75th-84.9th BMI percentile had insulin resistance, as did 37.8% in the 85th-94.9th percentile and 72.8% in the 95th or higher BMI percentile, Dr Rodden reported.

With a logistic regression analysis adjusting for age, ethnicity, gender, poverty income ratio, and carbohydrate intake, the odds of developing insulin resistance were four times higher for adolescents in the 75th-84.9th percentile (odds ratio 4.28) and the 85th-94.9th percentile (OR 4.30), and nearly 18 times higher for overweight adolescents in the 95th or higher percentile (OR 17.91). The risk was not significantly increased for adolescents in the two lowest BMI percentiles.

Being less active was also significantly associated with increased risk of insulin resistance, particularly among those with less than an hour a week of heavy activity (OR 4.38). But cardiovascular fitness level was not. This finding suggests that physical activity may have metabolic benefits irrespective of the level of fitness achieved, Dr. Rodden said.

The study was limited by the lack of a universally accepted definition for insulin resistance in adolescents, and self-reported physical activity data.

TUCSON, ARIZ. — Depression is a risk factor for poor glycemic control in diabetic patients infected with hepatitis C, according to an analysis of data from a preliminary cohort study in 462 patients.

The association between depression and glycemic control is noncausal at this point, but warrants further study and attention by family physicians, said Dr. Anthony Valdini, research director of the Greater Lawrence Family Health Center, Lawrence, Mass.

Type 2 diabetes and depression are common comorbidities among patients infected with the hepatitis C virus (HCV). Interferon, a major component of HCV therapy, often is a cause of depression. But physicians have been hesitant to prescribe antidepressants in this population because of what Dr. Valdini believes are unfounded fears of liver complications.

“This is a group that is miserable,” Dr. Valdini said during a poster presentation at the annual meeting of the North American Primary Care Research Group. “In some series, you will get up to 58% of people who are depressed, so it's really cruel to treat them for hepatitis C and not offer them therapy for their depression.”

Dr. Valdini and colleagues used data from the hepatitis C registry to identify 462 patients with hepatitis C, aged 21 years or older, who had visited an inner-city community health center between April 2003 and April 2005.

Patients were coded as either depressed or diabetic if these diagnoses were found in their medical records. The most recent hemoglobin A1c (HbA1c) value was used for calculations. They compared hepatitis-positive diabetes patients with and without depression by using chi-squared statistics, after categorizing HbA1c results into tertiles representing levels of glycemic control (< 7%, 7%–9.5%, > 9.5%).

Overall, 139 patients (30%) were depressed and 83 (18%) had type 2 diabetes. Of the diabetic patients, 28 (34%) were depressed. Mean HbA1c for the diabetic plus depressed group was 7.5%, compared with 7.2% for the nondepressed diabetic group. The mean ages were similar (54 years vs. 55 years).

Although there were more men than women in both the depressed and nondepressed groups, there were no significant differences in their proportions across the glycemic control categories. All of the diabetic patients received education on glycemic control and were given access to dieticians and diabetes nurse educators, Dr. Valdini noted.

Full data available on 26 patients in the depressed group show that 12 patients (46%) at the target HbA1c of < 7%, whereas the nondepressed diabetics were at target in 31 of 52 (60%) cases, the authors reported. This difference was significant when tested with chi-squared statistics.

At the center, patients with hepatitis are screened for multiple comorbidities and are treated with SSRIs if depressed. The rule of thumb is to consult with a gastroenterologist regarding the decision to start medications or not if transaminases are more than twice the upper limit of normal, Dr. Valdini said.

TUCSON, ARIZ. — Depression is a risk factor for poor glycemic control in diabetic patients infected with hepatitis C, according to an analysis of data from a preliminary cohort study in 462 patients.

The association between depression and glycemic control is noncausal at this point, but warrants further study and attention by family physicians, said Dr. Anthony Valdini, research director of the Greater Lawrence Family Health Center, Lawrence, Mass.

Type 2 diabetes and depression are common comorbidities among patients infected with the hepatitis C virus (HCV). Interferon, a major component of HCV therapy, often is a cause of depression. But physicians have been hesitant to prescribe antidepressants in this population because of what Dr. Valdini believes are unfounded fears of liver complications.

“This is a group that is miserable,” Dr. Valdini said during a poster presentation at the annual meeting of the North American Primary Care Research Group. “In some series, you will get up to 58% of people who are depressed, so it's really cruel to treat them for hepatitis C and not offer them therapy for their depression.”

Dr. Valdini and colleagues used data from the hepatitis C registry to identify 462 patients with hepatitis C, aged 21 years or older, who had visited an inner-city community health center between April 2003 and April 2005.

Patients were coded as either depressed or diabetic if these diagnoses were found in their medical records. The most recent hemoglobin A1c (HbA1c) value was used for calculations. They compared hepatitis-positive diabetes patients with and without depression by using chi-squared statistics, after categorizing HbA1c results into tertiles representing levels of glycemic control (< 7%, 7%–9.5%, > 9.5%).

Overall, 139 patients (30%) were depressed and 83 (18%) had type 2 diabetes. Of the diabetic patients, 28 (34%) were depressed. Mean HbA1c for the diabetic plus depressed group was 7.5%, compared with 7.2% for the nondepressed diabetic group. The mean ages were similar (54 years vs. 55 years).

Although there were more men than women in both the depressed and nondepressed groups, there were no significant differences in their proportions across the glycemic control categories. All of the diabetic patients received education on glycemic control and were given access to dieticians and diabetes nurse educators, Dr. Valdini noted.

Full data available on 26 patients in the depressed group show that 12 patients (46%) at the target HbA1c of < 7%, whereas the nondepressed diabetics were at target in 31 of 52 (60%) cases, the authors reported. This difference was significant when tested with chi-squared statistics.

At the center, patients with hepatitis are screened for multiple comorbidities and are treated with SSRIs if depressed. The rule of thumb is to consult with a gastroenterologist regarding the decision to start medications or not if transaminases are more than twice the upper limit of normal, Dr. Valdini said.

TUCSON, ARIZ. — Depression is a risk factor for poor glycemic control in diabetic patients infected with hepatitis C, according to an analysis of data from a preliminary cohort study in 462 patients.

The association between depression and glycemic control is noncausal at this point, but warrants further study and attention by family physicians, said Dr. Anthony Valdini, research director of the Greater Lawrence Family Health Center, Lawrence, Mass.

Type 2 diabetes and depression are common comorbidities among patients infected with the hepatitis C virus (HCV). Interferon, a major component of HCV therapy, often is a cause of depression. But physicians have been hesitant to prescribe antidepressants in this population because of what Dr. Valdini believes are unfounded fears of liver complications.

“This is a group that is miserable,” Dr. Valdini said during a poster presentation at the annual meeting of the North American Primary Care Research Group. “In some series, you will get up to 58% of people who are depressed, so it's really cruel to treat them for hepatitis C and not offer them therapy for their depression.”

Dr. Valdini and colleagues used data from the hepatitis C registry to identify 462 patients with hepatitis C, aged 21 years or older, who had visited an inner-city community health center between April 2003 and April 2005.

Patients were coded as either depressed or diabetic if these diagnoses were found in their medical records. The most recent hemoglobin A1c (HbA1c) value was used for calculations. They compared hepatitis-positive diabetes patients with and without depression by using chi-squared statistics, after categorizing HbA1c results into tertiles representing levels of glycemic control (< 7%, 7%–9.5%, > 9.5%).

Overall, 139 patients (30%) were depressed and 83 (18%) had type 2 diabetes. Of the diabetic patients, 28 (34%) were depressed. Mean HbA1c for the diabetic plus depressed group was 7.5%, compared with 7.2% for the nondepressed diabetic group. The mean ages were similar (54 years vs. 55 years).

Although there were more men than women in both the depressed and nondepressed groups, there were no significant differences in their proportions across the glycemic control categories. All of the diabetic patients received education on glycemic control and were given access to dieticians and diabetes nurse educators, Dr. Valdini noted.

Full data available on 26 patients in the depressed group show that 12 patients (46%) at the target HbA1c of < 7%, whereas the nondepressed diabetics were at target in 31 of 52 (60%) cases, the authors reported. This difference was significant when tested with chi-squared statistics.

At the center, patients with hepatitis are screened for multiple comorbidities and are treated with SSRIs if depressed. The rule of thumb is to consult with a gastroenterologist regarding the decision to start medications or not if transaminases are more than twice the upper limit of normal, Dr. Valdini said.

VERONA, ITALY — The prevalence of impaired glucose tolerance is far more common among obese and overweight Italian children than was previously thought, Dr. Marco Cappa said.

He reported on a study of 215 overweight and obese Italian children in which the prevalence of impaired glucose tolerance (IGT) was 11%, compared with 4.5% as previously reported among this population (Diabetes Care 2003;26:118–24).

The finding is of concern, but it comes nowhere near the prevalence rate of 23% reported in a multiethnic cohort of 167 obese American children and adolescents (N. Engl. J. Med. 2002; 346:802–10), said Dr. Cappa, who presented the study at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

The increase in IGT may be caused by unknown factors or by inactivity and increased caloric intake, which are often cited for the alarming rate of IGT and obesity among American children, he explained. “Childhood obesity is an increasing problem in Italy, as in other developed countries,” said Dr. Cappa, of the Bambino Gesù Children's Hospital in Rome.

National growth curves of Italian children published in 2006 show a dramatic shift toward obesity. Another recent Italian study (Obesity 2006;14:765–9) indicated that when using the U.S. Centers for Disease Control and Prevention reference charts, the prevalence of overweight and obesity in Italian children is close to that reported in U.S. children (32% vs. 32.7%).

The cross-sectional study also found that the prevalence of overweight and obesity was higher in the southern sampling area of Messina than it was in the northern area of Verona, most likely because of differences in diet, Dr. Cappa said.

In his study, 24 of the 215 children had IGT, none had impaired fasting glucose, and one had type 2 diabetes mellitus. Their mean age was 12 years (range 5–18 years).

In a multivariate analysis that controlled for gender, family history of obesity and type 2 diabetes, and pubertal stage, age was the only parameter significantly related to glucose tolerance status, Dr. Cappa and his colleagues reported. The incidence of IGT was found to increase during midpuberty (Tanner stages 3 and 4), at around age 13.5 years.

Metabolic syndrome had an overall prevalence of 22% and was present in 20% of girls and 24% of boys, even though the average weight of the girls was higher, he said. Metabolic syndrome was defined by three or more of the following criteria: BMI greater than two standard deviations; triglycerides greater than the 95th percentile; an HDL cholesterol level less than the 5th percentile; systolic or diastolic blood pressure greater than the 95th percentile; and impaired glucose tolerance.

The findings compare favorably to an American study, in which the prevalence of metabolic syndrome was 39% in moderately obese participants and reached 50% in severely obese participants among 439 obese, 31 overweight, and 20 nonobese American children and adolescents (N. Engl. J. Med. 2004;350:2362–74).

Because patients with metabolic syndrome have an increased risk of cardiovascular disease prior to the development of IGT or diabetes, early identification and intervention is essential for these children, Dr. Cappa said.

VERONA, ITALY — The prevalence of impaired glucose tolerance is far more common among obese and overweight Italian children than was previously thought, Dr. Marco Cappa said.

He reported on a study of 215 overweight and obese Italian children in which the prevalence of impaired glucose tolerance (IGT) was 11%, compared with 4.5% as previously reported among this population (Diabetes Care 2003;26:118–24).

The finding is of concern, but it comes nowhere near the prevalence rate of 23% reported in a multiethnic cohort of 167 obese American children and adolescents (N. Engl. J. Med. 2002; 346:802–10), said Dr. Cappa, who presented the study at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

The increase in IGT may be caused by unknown factors or by inactivity and increased caloric intake, which are often cited for the alarming rate of IGT and obesity among American children, he explained. “Childhood obesity is an increasing problem in Italy, as in other developed countries,” said Dr. Cappa, of the Bambino Gesù Children's Hospital in Rome.

National growth curves of Italian children published in 2006 show a dramatic shift toward obesity. Another recent Italian study (Obesity 2006;14:765–9) indicated that when using the U.S. Centers for Disease Control and Prevention reference charts, the prevalence of overweight and obesity in Italian children is close to that reported in U.S. children (32% vs. 32.7%).

The cross-sectional study also found that the prevalence of overweight and obesity was higher in the southern sampling area of Messina than it was in the northern area of Verona, most likely because of differences in diet, Dr. Cappa said.

In his study, 24 of the 215 children had IGT, none had impaired fasting glucose, and one had type 2 diabetes mellitus. Their mean age was 12 years (range 5–18 years).

In a multivariate analysis that controlled for gender, family history of obesity and type 2 diabetes, and pubertal stage, age was the only parameter significantly related to glucose tolerance status, Dr. Cappa and his colleagues reported. The incidence of IGT was found to increase during midpuberty (Tanner stages 3 and 4), at around age 13.5 years.

Metabolic syndrome had an overall prevalence of 22% and was present in 20% of girls and 24% of boys, even though the average weight of the girls was higher, he said. Metabolic syndrome was defined by three or more of the following criteria: BMI greater than two standard deviations; triglycerides greater than the 95th percentile; an HDL cholesterol level less than the 5th percentile; systolic or diastolic blood pressure greater than the 95th percentile; and impaired glucose tolerance.

The findings compare favorably to an American study, in which the prevalence of metabolic syndrome was 39% in moderately obese participants and reached 50% in severely obese participants among 439 obese, 31 overweight, and 20 nonobese American children and adolescents (N. Engl. J. Med. 2004;350:2362–74).

Because patients with metabolic syndrome have an increased risk of cardiovascular disease prior to the development of IGT or diabetes, early identification and intervention is essential for these children, Dr. Cappa said.

VERONA, ITALY — The prevalence of impaired glucose tolerance is far more common among obese and overweight Italian children than was previously thought, Dr. Marco Cappa said.

He reported on a study of 215 overweight and obese Italian children in which the prevalence of impaired glucose tolerance (IGT) was 11%, compared with 4.5% as previously reported among this population (Diabetes Care 2003;26:118–24).

The finding is of concern, but it comes nowhere near the prevalence rate of 23% reported in a multiethnic cohort of 167 obese American children and adolescents (N. Engl. J. Med. 2002; 346:802–10), said Dr. Cappa, who presented the study at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

The increase in IGT may be caused by unknown factors or by inactivity and increased caloric intake, which are often cited for the alarming rate of IGT and obesity among American children, he explained. “Childhood obesity is an increasing problem in Italy, as in other developed countries,” said Dr. Cappa, of the Bambino Gesù Children's Hospital in Rome.

National growth curves of Italian children published in 2006 show a dramatic shift toward obesity. Another recent Italian study (Obesity 2006;14:765–9) indicated that when using the U.S. Centers for Disease Control and Prevention reference charts, the prevalence of overweight and obesity in Italian children is close to that reported in U.S. children (32% vs. 32.7%).

The cross-sectional study also found that the prevalence of overweight and obesity was higher in the southern sampling area of Messina than it was in the northern area of Verona, most likely because of differences in diet, Dr. Cappa said.

In his study, 24 of the 215 children had IGT, none had impaired fasting glucose, and one had type 2 diabetes mellitus. Their mean age was 12 years (range 5–18 years).

In a multivariate analysis that controlled for gender, family history of obesity and type 2 diabetes, and pubertal stage, age was the only parameter significantly related to glucose tolerance status, Dr. Cappa and his colleagues reported. The incidence of IGT was found to increase during midpuberty (Tanner stages 3 and 4), at around age 13.5 years.

Metabolic syndrome had an overall prevalence of 22% and was present in 20% of girls and 24% of boys, even though the average weight of the girls was higher, he said. Metabolic syndrome was defined by three or more of the following criteria: BMI greater than two standard deviations; triglycerides greater than the 95th percentile; an HDL cholesterol level less than the 5th percentile; systolic or diastolic blood pressure greater than the 95th percentile; and impaired glucose tolerance.

The findings compare favorably to an American study, in which the prevalence of metabolic syndrome was 39% in moderately obese participants and reached 50% in severely obese participants among 439 obese, 31 overweight, and 20 nonobese American children and adolescents (N. Engl. J. Med. 2004;350:2362–74).

Because patients with metabolic syndrome have an increased risk of cardiovascular disease prior to the development of IGT or diabetes, early identification and intervention is essential for these children, Dr. Cappa said.

VERONA, ITALY — Contrary to conventional wisdom, obese patients may not be protected against osteoporosis and could present with significant bone loss, new data show.

In a study of 233 morbidly obese patients, 34% showed a significant decrease in bone mineral density at the lumbar spine with a median T score of −1.98 (range −1.1 to −4.2), Dr. Carlo Lubrano and his colleagues reported in a poster at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

Low bone mass is defined as a bone density at the spine or hip between 1.0 and 2.4 standard deviations below the average for healthy young adults, which translates to a T score of −1 to −2.5, according to the World Health Organization. Bone density 2.5 standard deviations or more below the young adult mean is categorized as osteoporosis.

The 195 women and 38 men in the study had an average body mass index of 37 kg/m2 and a mean age of 44 years. Bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry.

Overall, 31.5% of the women showed a median BMD of 0.971 g/cm

It had been thought that obesity might protect the skeleton against osteoporosis. Recent evidence suggests that obesity may actually weaken the skeleton and increase the risk of fractures. The authors concluded that a “specific and careful characterization of skeletal metabolism might be useful in both female and male obese subjects.”

VERONA, ITALY — Contrary to conventional wisdom, obese patients may not be protected against osteoporosis and could present with significant bone loss, new data show.

In a study of 233 morbidly obese patients, 34% showed a significant decrease in bone mineral density at the lumbar spine with a median T score of −1.98 (range −1.1 to −4.2), Dr. Carlo Lubrano and his colleagues reported in a poster at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

Low bone mass is defined as a bone density at the spine or hip between 1.0 and 2.4 standard deviations below the average for healthy young adults, which translates to a T score of −1 to −2.5, according to the World Health Organization. Bone density 2.5 standard deviations or more below the young adult mean is categorized as osteoporosis.

The 195 women and 38 men in the study had an average body mass index of 37 kg/m2 and a mean age of 44 years. Bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry.

Overall, 31.5% of the women showed a median BMD of 0.971 g/cm

It had been thought that obesity might protect the skeleton against osteoporosis. Recent evidence suggests that obesity may actually weaken the skeleton and increase the risk of fractures. The authors concluded that a “specific and careful characterization of skeletal metabolism might be useful in both female and male obese subjects.”

VERONA, ITALY — Contrary to conventional wisdom, obese patients may not be protected against osteoporosis and could present with significant bone loss, new data show.

In a study of 233 morbidly obese patients, 34% showed a significant decrease in bone mineral density at the lumbar spine with a median T score of −1.98 (range −1.1 to −4.2), Dr. Carlo Lubrano and his colleagues reported in a poster at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

Low bone mass is defined as a bone density at the spine or hip between 1.0 and 2.4 standard deviations below the average for healthy young adults, which translates to a T score of −1 to −2.5, according to the World Health Organization. Bone density 2.5 standard deviations or more below the young adult mean is categorized as osteoporosis.

The 195 women and 38 men in the study had an average body mass index of 37 kg/m2 and a mean age of 44 years. Bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry.

Overall, 31.5% of the women showed a median BMD of 0.971 g/cm

It had been thought that obesity might protect the skeleton against osteoporosis. Recent evidence suggests that obesity may actually weaken the skeleton and increase the risk of fractures. The authors concluded that a “specific and careful characterization of skeletal metabolism might be useful in both female and male obese subjects.”

VERONA, ITALY — Contrary to conventional wisdom, obese patients may not be protected against osteoporosis and could present with significant bone loss, new data show.

In a study of 233 morbidly obese patients, 34% showed a significant decrease in bone mineral density at the lumbar spine with a median T score of −1.98 (range −1.1 to −4.2), Dr. Carlo Lubrano and his colleagues reported in a poster at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

Low bone mass is defined as a bone density at the spine or hip between 1.0 and 2.4 standard deviations below the average for healthy young adults, which translates to a T score of −1 to −2.5, according to the World Health Organization. Bone density 2.5 standard deviations or more below the young adult mean is categorized as osteoporosis.

The 195 women and 38 men in the study had an average body mass index of 37 kg/m

Overall, 31.5% of the women showed a median BMD of 0.971 g/cm

Few data are available on potential skeletal modifications in patients affected by severe obesity. It had been thought that, although obese patients are often affected by hypertension, dyslipidemia, impaired glucose metabolism, and an increase in cardiovascular diseases, obesity might protect the skeleton against osteoporosis. Recent evidence suggests that obesity may actually weaken the skeleton and increase the risk of fractures.

Given their findings, the authors concluded that a “specific and careful characterization of skeletal metabolism might be useful in both female and male obese subjects.”

VERONA, ITALY — Contrary to conventional wisdom, obese patients may not be protected against osteoporosis and could present with significant bone loss, new data show.

In a study of 233 morbidly obese patients, 34% showed a significant decrease in bone mineral density at the lumbar spine with a median T score of −1.98 (range −1.1 to −4.2), Dr. Carlo Lubrano and his colleagues reported in a poster at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

Low bone mass is defined as a bone density at the spine or hip between 1.0 and 2.4 standard deviations below the average for healthy young adults, which translates to a T score of −1 to −2.5, according to the World Health Organization. Bone density 2.5 standard deviations or more below the young adult mean is categorized as osteoporosis.

The 195 women and 38 men in the study had an average body mass index of 37 kg/m

Overall, 31.5% of the women showed a median BMD of 0.971 g/cm

Few data are available on potential skeletal modifications in patients affected by severe obesity. It had been thought that, although obese patients are often affected by hypertension, dyslipidemia, impaired glucose metabolism, and an increase in cardiovascular diseases, obesity might protect the skeleton against osteoporosis. Recent evidence suggests that obesity may actually weaken the skeleton and increase the risk of fractures.

Given their findings, the authors concluded that a “specific and careful characterization of skeletal metabolism might be useful in both female and male obese subjects.”

VERONA, ITALY — Contrary to conventional wisdom, obese patients may not be protected against osteoporosis and could present with significant bone loss, new data show.

In a study of 233 morbidly obese patients, 34% showed a significant decrease in bone mineral density at the lumbar spine with a median T score of −1.98 (range −1.1 to −4.2), Dr. Carlo Lubrano and his colleagues reported in a poster at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

Low bone mass is defined as a bone density at the spine or hip between 1.0 and 2.4 standard deviations below the average for healthy young adults, which translates to a T score of −1 to −2.5, according to the World Health Organization. Bone density 2.5 standard deviations or more below the young adult mean is categorized as osteoporosis.

The 195 women and 38 men in the study had an average body mass index of 37 kg/m

Overall, 31.5% of the women showed a median BMD of 0.971 g/cm

Few data are available on potential skeletal modifications in patients affected by severe obesity. It had been thought that, although obese patients are often affected by hypertension, dyslipidemia, impaired glucose metabolism, and an increase in cardiovascular diseases, obesity might protect the skeleton against osteoporosis. Recent evidence suggests that obesity may actually weaken the skeleton and increase the risk of fractures.

Given their findings, the authors concluded that a “specific and careful characterization of skeletal metabolism might be useful in both female and male obese subjects.”

Color and duplex Doppler ultrasound may be useful in diagnosing ankylosing spondylitis and assessing response to therapy, new data suggest.

Dr. Ercüment Ünlü and colleagues presented data from a study demonstrating that color and duplex Doppler ultrasound can be used to determine the degree of sacroiliitis and spinal inflammation in patients with ankylosing spondylitis (AS).

The study included 39 consecutive patients with AS and 14 healthy, age- and gender-matched controls. Standardized ultrasound settings were applied including color Doppler gain 60–120 dB, wall filter 51–65 Hz, and pulse repetition frequency 300–850 Hz.

Patients with AS had significantly lower resistive index (RI) values in bilateral sacroiliac joints and in lumbar vertebral and thoracal vertebral paraspinal areas than healthy controls. RI is a measure of vascularity, and is expected to be lower in patients with active inflammation because of increased vascularization.

Patients with active disease, according to the Bath AS Disease Activity Index, had significantly higher mean lumbar vertebral and thoracal vertebral RI values (0.820 and 0.789, respectively) than patients with inactive disease (0.863 and 0.825, respectively). The mean RI tended to be lower around the sacroiliac joints in the active group, but the difference was not statistically significant (J. Rheumatol. 2007;34:110–6).

“The difference in spinal inflammation between active and inactive groups was prominent; however the difference in the degree of inflammation of SI [sacroiliac] joints between active and inactive groups became less significant because of the long disease duration of our AS patients,” the authors wrote. The mean disease duration was nearly 10 years.

Among patients with active disease, the ratio of men was significantly higher, as were average erythrocyte sedimentation rates, and C-reactive protein values.

A subset of 11 patients (7 men and 4 women with an average of age 38 years) was administered anti-tumor necrosis factor (TNF) therapy during the study period. Seven patients received infliximab 5 mg/kg IV initially and at week 2, 6, and 12, and four patients received etanercept 25 mg subcutaneous injections twice weekly. Doppler ultrasound measurements were performed at baseline and week 12 of therapy.

After 12 weeks of anti-TNF therapy, there were significant increases from baseline in average sacroiliac RI (0.814 to 0.884) and lumbar vertebral RI (0.821 to 0.883) values, but no significant change in thoracal vertebral RI (0.812 to 0.855), according to the authors from Trakya University Medical Facility in Edirne, Turkey, where the study was conducted.

An editorial accompanying the study called the data interesting, but said it was unfortunate that there was no comparison with MRI findings in the patients and controls (J. Rheumatol. 2007;34:5–7). MRI has been suggested as the best method of detecting sacroiliitis, but practical considerations such as cost and availability limit its use in the clinical setting.

Contrast-enhanced color Doppler ultrasonography has been shown previously to compare favorably with MRI in its ability to demonstrate sacroiliac joint inflammation. Ultrasound is also being used in the area of spondyloarthropathy to detect enthesitis and to assess its response to therapy, according to the editorial.

“The presence or absence of sacroiliitis as detected by whatever reliable, reproducible, and affordable method will continue to be a cornerstone for earlier diagnosis of AS,” the editorial stated. “Doppler ultrasonography may be a useful tool in diagnosing patients with AS and assessing response to therapy.

Further work is definitely warranted in this area.”

Color and duplex Doppler ultrasound may be useful in diagnosing ankylosing spondylitis and assessing response to therapy, new data suggest.

Dr. Ercüment Ünlü and colleagues presented data from a study demonstrating that color and duplex Doppler ultrasound can be used to determine the degree of sacroiliitis and spinal inflammation in patients with ankylosing spondylitis (AS).

The study included 39 consecutive patients with AS and 14 healthy, age- and gender-matched controls. Standardized ultrasound settings were applied including color Doppler gain 60–120 dB, wall filter 51–65 Hz, and pulse repetition frequency 300–850 Hz.

Patients with AS had significantly lower resistive index (RI) values in bilateral sacroiliac joints and in lumbar vertebral and thoracal vertebral paraspinal areas than healthy controls. RI is a measure of vascularity, and is expected to be lower in patients with active inflammation because of increased vascularization.

Patients with active disease, according to the Bath AS Disease Activity Index, had significantly higher mean lumbar vertebral and thoracal vertebral RI values (0.820 and 0.789, respectively) than patients with inactive disease (0.863 and 0.825, respectively). The mean RI tended to be lower around the sacroiliac joints in the active group, but the difference was not statistically significant (J. Rheumatol. 2007;34:110–6).

“The difference in spinal inflammation between active and inactive groups was prominent; however the difference in the degree of inflammation of SI [sacroiliac] joints between active and inactive groups became less significant because of the long disease duration of our AS patients,” the authors wrote. The mean disease duration was nearly 10 years.

Among patients with active disease, the ratio of men was significantly higher, as were average erythrocyte sedimentation rates, and C-reactive protein values.

A subset of 11 patients (7 men and 4 women with an average of age 38 years) was administered anti-tumor necrosis factor (TNF) therapy during the study period. Seven patients received infliximab 5 mg/kg IV initially and at week 2, 6, and 12, and four patients received etanercept 25 mg subcutaneous injections twice weekly. Doppler ultrasound measurements were performed at baseline and week 12 of therapy.

After 12 weeks of anti-TNF therapy, there were significant increases from baseline in average sacroiliac RI (0.814 to 0.884) and lumbar vertebral RI (0.821 to 0.883) values, but no significant change in thoracal vertebral RI (0.812 to 0.855), according to the authors from Trakya University Medical Facility in Edirne, Turkey, where the study was conducted.

An editorial accompanying the study called the data interesting, but said it was unfortunate that there was no comparison with MRI findings in the patients and controls (J. Rheumatol. 2007;34:5–7). MRI has been suggested as the best method of detecting sacroiliitis, but practical considerations such as cost and availability limit its use in the clinical setting.

Contrast-enhanced color Doppler ultrasonography has been shown previously to compare favorably with MRI in its ability to demonstrate sacroiliac joint inflammation. Ultrasound is also being used in the area of spondyloarthropathy to detect enthesitis and to assess its response to therapy, according to the editorial.

“The presence or absence of sacroiliitis as detected by whatever reliable, reproducible, and affordable method will continue to be a cornerstone for earlier diagnosis of AS,” the editorial stated. “Doppler ultrasonography may be a useful tool in diagnosing patients with AS and assessing response to therapy.

Further work is definitely warranted in this area.”

Color and duplex Doppler ultrasound may be useful in diagnosing ankylosing spondylitis and assessing response to therapy, new data suggest.

Dr. Ercüment Ünlü and colleagues presented data from a study demonstrating that color and duplex Doppler ultrasound can be used to determine the degree of sacroiliitis and spinal inflammation in patients with ankylosing spondylitis (AS).

The study included 39 consecutive patients with AS and 14 healthy, age- and gender-matched controls. Standardized ultrasound settings were applied including color Doppler gain 60–120 dB, wall filter 51–65 Hz, and pulse repetition frequency 300–850 Hz.

Patients with AS had significantly lower resistive index (RI) values in bilateral sacroiliac joints and in lumbar vertebral and thoracal vertebral paraspinal areas than healthy controls. RI is a measure of vascularity, and is expected to be lower in patients with active inflammation because of increased vascularization.

Patients with active disease, according to the Bath AS Disease Activity Index, had significantly higher mean lumbar vertebral and thoracal vertebral RI values (0.820 and 0.789, respectively) than patients with inactive disease (0.863 and 0.825, respectively). The mean RI tended to be lower around the sacroiliac joints in the active group, but the difference was not statistically significant (J. Rheumatol. 2007;34:110–6).

“The difference in spinal inflammation between active and inactive groups was prominent; however the difference in the degree of inflammation of SI [sacroiliac] joints between active and inactive groups became less significant because of the long disease duration of our AS patients,” the authors wrote. The mean disease duration was nearly 10 years.

Among patients with active disease, the ratio of men was significantly higher, as were average erythrocyte sedimentation rates, and C-reactive protein values.

A subset of 11 patients (7 men and 4 women with an average of age 38 years) was administered anti-tumor necrosis factor (TNF) therapy during the study period. Seven patients received infliximab 5 mg/kg IV initially and at week 2, 6, and 12, and four patients received etanercept 25 mg subcutaneous injections twice weekly. Doppler ultrasound measurements were performed at baseline and week 12 of therapy.

After 12 weeks of anti-TNF therapy, there were significant increases from baseline in average sacroiliac RI (0.814 to 0.884) and lumbar vertebral RI (0.821 to 0.883) values, but no significant change in thoracal vertebral RI (0.812 to 0.855), according to the authors from Trakya University Medical Facility in Edirne, Turkey, where the study was conducted.

An editorial accompanying the study called the data interesting, but said it was unfortunate that there was no comparison with MRI findings in the patients and controls (J. Rheumatol. 2007;34:5–7). MRI has been suggested as the best method of detecting sacroiliitis, but practical considerations such as cost and availability limit its use in the clinical setting.

Contrast-enhanced color Doppler ultrasonography has been shown previously to compare favorably with MRI in its ability to demonstrate sacroiliac joint inflammation. Ultrasound is also being used in the area of spondyloarthropathy to detect enthesitis and to assess its response to therapy, according to the editorial.

“The presence or absence of sacroiliitis as detected by whatever reliable, reproducible, and affordable method will continue to be a cornerstone for earlier diagnosis of AS,” the editorial stated. “Doppler ultrasonography may be a useful tool in diagnosing patients with AS and assessing response to therapy.

Further work is definitely warranted in this area.”

TUCSON, ARIZ. — Patients with a parental history of stroke should be screened early for raised blood pressure, Dr. Nigel Hart said at the annual meeting of the North American Primary Care Research Group.

The recommendation was drawn from Dr. Hart's Stroke Offspring Study in which systolic and diastolic blood pressures were significantly higher in patients with a parental history of stroke, compared with matched controls. Stroke offspring also consumed more alcohol than their paired controls but did not differ significantly with respect to body mass index, lipids, diabetes mellitus, diet, smoking status, or exercise.

“Given the very-well-established relationship between blood pressure and stroke risk, these results suggest that higher blood pressure in stroke offspring may contribute to their increased risk of stroke,” said Dr. Hart of Queen's University, in Belfast, Ireland.

“This group may particularly benefit from a blood pressure screening strategy,” he added.

Questionnaires were sent to randomly selected individuals, aged 40–64 years, from 11 general practices representing 6% of the population of Northern Ireland. From the returns, those with a parental history of stroke (cases) were matched on age, gender, and socioeconomic status to those with no parental history of stroke (controls).

Matched pairs answered questions about smoking, alcohol, and medical history, and underwent a clinical evaluation. A total of 458 individuals were screened, and complete data were available on 398 individuals or 199 case-control pairs.

Systolic and diastolic blood pressures were significantly higher in cases than in controls; (systolic 146.2 mm Hg vs. 140.6 mm Hg) and (diastolic 87.7 mm Hg vs. 85.0 mm Hg).

There were no significant differences between groups in total cholesterol, homosysteine levels, smoking status, or presence of diabetes, Dr. Hart and colleagues reported.

The only variable that was statistically different between groups was alcohol consumption, with cases drinking 3.7 more alcohol units per week than controls (13.8 U vs. 10.1 U). A pint of beer is equal to 2 units, while a glass of wine or hard liquor is equal to 1 unit.

The number of stroke offspring that drank above United Kingdom recommended limits was significantly higher than for controls (57 vs. 40). The recommended allowance for females is 14 U/week and 21 U/week for males.

The mean paired difference in diastolic (2.4 mm Hg) and systolic (5.5 mm Hg) blood pressures was statistically significant between groups even after adjusting for alcohol consumption using a stepwise logistic analysis, he said.

ELSEVIER GLOBAL MEDICAL NEWS

TUCSON, ARIZ. — Patients with a parental history of stroke should be screened early for raised blood pressure, Dr. Nigel Hart said at the annual meeting of the North American Primary Care Research Group.

The recommendation was drawn from Dr. Hart's Stroke Offspring Study in which systolic and diastolic blood pressures were significantly higher in patients with a parental history of stroke, compared with matched controls. Stroke offspring also consumed more alcohol than their paired controls but did not differ significantly with respect to body mass index, lipids, diabetes mellitus, diet, smoking status, or exercise.

“Given the very-well-established relationship between blood pressure and stroke risk, these results suggest that higher blood pressure in stroke offspring may contribute to their increased risk of stroke,” said Dr. Hart of Queen's University, in Belfast, Ireland.

“This group may particularly benefit from a blood pressure screening strategy,” he added.

Questionnaires were sent to randomly selected individuals, aged 40–64 years, from 11 general practices representing 6% of the population of Northern Ireland. From the returns, those with a parental history of stroke (cases) were matched on age, gender, and socioeconomic status to those with no parental history of stroke (controls).

Matched pairs answered questions about smoking, alcohol, and medical history, and underwent a clinical evaluation. A total of 458 individuals were screened, and complete data were available on 398 individuals or 199 case-control pairs.

Systolic and diastolic blood pressures were significantly higher in cases than in controls; (systolic 146.2 mm Hg vs. 140.6 mm Hg) and (diastolic 87.7 mm Hg vs. 85.0 mm Hg).

There were no significant differences between groups in total cholesterol, homosysteine levels, smoking status, or presence of diabetes, Dr. Hart and colleagues reported.

The only variable that was statistically different between groups was alcohol consumption, with cases drinking 3.7 more alcohol units per week than controls (13.8 U vs. 10.1 U). A pint of beer is equal to 2 units, while a glass of wine or hard liquor is equal to 1 unit.

The number of stroke offspring that drank above United Kingdom recommended limits was significantly higher than for controls (57 vs. 40). The recommended allowance for females is 14 U/week and 21 U/week for males.

The mean paired difference in diastolic (2.4 mm Hg) and systolic (5.5 mm Hg) blood pressures was statistically significant between groups even after adjusting for alcohol consumption using a stepwise logistic analysis, he said.

ELSEVIER GLOBAL MEDICAL NEWS

TUCSON, ARIZ. — Patients with a parental history of stroke should be screened early for raised blood pressure, Dr. Nigel Hart said at the annual meeting of the North American Primary Care Research Group.

The recommendation was drawn from Dr. Hart's Stroke Offspring Study in which systolic and diastolic blood pressures were significantly higher in patients with a parental history of stroke, compared with matched controls. Stroke offspring also consumed more alcohol than their paired controls but did not differ significantly with respect to body mass index, lipids, diabetes mellitus, diet, smoking status, or exercise.

“Given the very-well-established relationship between blood pressure and stroke risk, these results suggest that higher blood pressure in stroke offspring may contribute to their increased risk of stroke,” said Dr. Hart of Queen's University, in Belfast, Ireland.

“This group may particularly benefit from a blood pressure screening strategy,” he added.

Questionnaires were sent to randomly selected individuals, aged 40–64 years, from 11 general practices representing 6% of the population of Northern Ireland. From the returns, those with a parental history of stroke (cases) were matched on age, gender, and socioeconomic status to those with no parental history of stroke (controls).

Matched pairs answered questions about smoking, alcohol, and medical history, and underwent a clinical evaluation. A total of 458 individuals were screened, and complete data were available on 398 individuals or 199 case-control pairs.

Systolic and diastolic blood pressures were significantly higher in cases than in controls; (systolic 146.2 mm Hg vs. 140.6 mm Hg) and (diastolic 87.7 mm Hg vs. 85.0 mm Hg).

There were no significant differences between groups in total cholesterol, homosysteine levels, smoking status, or presence of diabetes, Dr. Hart and colleagues reported.

The only variable that was statistically different between groups was alcohol consumption, with cases drinking 3.7 more alcohol units per week than controls (13.8 U vs. 10.1 U). A pint of beer is equal to 2 units, while a glass of wine or hard liquor is equal to 1 unit.

The number of stroke offspring that drank above United Kingdom recommended limits was significantly higher than for controls (57 vs. 40). The recommended allowance for females is 14 U/week and 21 U/week for males.

The mean paired difference in diastolic (2.4 mm Hg) and systolic (5.5 mm Hg) blood pressures was statistically significant between groups even after adjusting for alcohol consumption using a stepwise logistic analysis, he said.

ELSEVIER GLOBAL MEDICAL NEWS

Dimercaptosuccinic acid renal scanning and high serum procalcitonin accurately predict vesicoureteral reflux in children with a first febrile urinary tract infection, according to data from two new studies appearing in the January issue of the Journal of Pediatrics.

An accurate predictor of vesicoureteral reflux (VUR) in children with a first febrile urinary tract infection (UTI) could help avoid unnecessary voiding cystourethrographies (VCUGs). Although a VCUG is routinely recommended for all children with a first febrile UTI, it exposes them to radiation, is painful and expensive, has been associated with a risk of iatrogenic UTI, and is often refused by parents.

“Neither [study] can be considered definitive, yet both are exciting work which may well change practice in the future,” Dr. Thomas Welch, chair of pediatrics at the State University of New York, Syracuse, said in an accompanying editorial (J. Pediatr. 2007;150:A3).

The first study was a 10-year retrospective review of 142 children under age 2 years who presented with an initial UTI and underwent both a VCUG and technetium-99m-labeled dimercaptosuccinic acid (DMSA) renal scan at a tertiary care general hospital. There were 77 boys and 65 girls.

Of these, 139 (98%) children had either positive leukocyte esterase or microscopic evidence of pyuria and 3 (2%) did not have pyuria but were positive for nitrite (J. Pediatr. 2007;150:96–9).

Results of DMSA scanning obtained within 2 days after diagnosis indicated that 99 (70%) had findings compatible with acute pyelonephritis and 2 (1.4%) had evidence of previous renal scarring.

VCUG performed 1 month after diagnosis showed evidence of VUR in 42 (29.6%) children. A total of 63 renal units exhibited reflux on VCUG, including 45 with grade I, II, or III reflux, and 18 with grade IV or V.

The sensitivity and specificity of abnormalities on DMSA renal scan for detecting the presence of VUR on VCUG were 88% and 36%, Dr. Min-Hua Tseng and colleagues from the department of pediatrics, Tri-Service General Hospital, National Defense Medical Center, in Taipei, Taiwan, reported. Positive and negative predictive values were 37% and 88%, respectively.

The authors acknowledge the limitations of a retrospective study, including the possibility of selection bias that might have resulted in the extraordinarily high rate of high-grade reflux.

“Nonetheless, we believe that the data indicating that a normal DMSA renal scan [elimates] the need for VCUG in evaluating young children after first UTI is so striking that it is likely real,” they wrote.

The second study was a secondary analysis of prospective hospital-based cohort studies of 398 patients, aged 1 month to 4 years, with a first febrile UTI conducted at eight centers in seven European countries.

Procalcitonin (PCT), a recently identified early marker of bacterial infection, was prospectively measured in serum at admission with the LUMItest PCT immunoluminometric assay or the BRAHMS PCT-Q semiquantitative rapid test (J. Pediatr. 2007;150:89–95).

Their mean age was 13 months. VUR was diagnosed in 101 (25%) children, and it was grade 3 or higher in 46 (12%). The median serum concentration was significantly higher in children with VUR than it was in those without (1.6 ng/mL vs. 0.7 ng/mL) and increased significantly with the VUR grade, Dr. Sandrine Leroy of Saint-Vincent de Paul Hospital and Université Paris Descartes in Paris and associates reported.

High PCT, defined as 0.5 ng/mL or greater, was significantly associated with VUR (odds ratio 2.3). The association remained significant (OR 2.5) in a logistic regression analysis of 368 patients, even after adjusting for such cofactors as family history of uropathy, male gender, young age, urinary tract dilation on ultrasonography, high serum C-reactive protein at admission, and urine collection technique.

A high PCT level predicted VUR with high sensitivity: 75% for all-grade VUR and 100% for grade 4 or 5 VUR. Specificity was 43% regardless of VUR grade.

Even though high PCT did not offer 100% sensitivity for the prediction of all grades of VUR, the authors propose that the current systematic screening strategy for VUR be replaced with a PCT-based selective approach.

“One way to deal with this lack of [PCT] sensitivity is to accept that VUR will remain undiagnosed for some patients after a first febrile UTI. The potential adverse consequences of this practice should be balanced against the debatable efficacy of treatments (secondary antibiotic prophylaxis and surgery) for children with VUR and the possibility that low-grade VUR and even high-grade VUR can spontaneously disappear,” the authors said.

Additionally, a PCT-based approach would reduce overall costs by 30% by averting 38% of routine VCUGs, which cost about &dollar;150 per test, compared with about &dollar;15 per PCT, the authors concluded.

Dimercaptosuccinic acid renal scanning and high serum procalcitonin accurately predict vesicoureteral reflux in children with a first febrile urinary tract infection, according to data from two new studies appearing in the January issue of the Journal of Pediatrics.

An accurate predictor of vesicoureteral reflux (VUR) in children with a first febrile urinary tract infection (UTI) could help avoid unnecessary voiding cystourethrographies (VCUGs). Although a VCUG is routinely recommended for all children with a first febrile UTI, it exposes them to radiation, is painful and expensive, has been associated with a risk of iatrogenic UTI, and is often refused by parents.

“Neither [study] can be considered definitive, yet both are exciting work which may well change practice in the future,” Dr. Thomas Welch, chair of pediatrics at the State University of New York, Syracuse, said in an accompanying editorial (J. Pediatr. 2007;150:A3).

The first study was a 10-year retrospective review of 142 children under age 2 years who presented with an initial UTI and underwent both a VCUG and technetium-99m-labeled dimercaptosuccinic acid (DMSA) renal scan at a tertiary care general hospital. There were 77 boys and 65 girls.

Of these, 139 (98%) children had either positive leukocyte esterase or microscopic evidence of pyuria and 3 (2%) did not have pyuria but were positive for nitrite (J. Pediatr. 2007;150:96–9).

Results of DMSA scanning obtained within 2 days after diagnosis indicated that 99 (70%) had findings compatible with acute pyelonephritis and 2 (1.4%) had evidence of previous renal scarring.

VCUG performed 1 month after diagnosis showed evidence of VUR in 42 (29.6%) children. A total of 63 renal units exhibited reflux on VCUG, including 45 with grade I, II, or III reflux, and 18 with grade IV or V.

The sensitivity and specificity of abnormalities on DMSA renal scan for detecting the presence of VUR on VCUG were 88% and 36%, Dr. Min-Hua Tseng and colleagues from the department of pediatrics, Tri-Service General Hospital, National Defense Medical Center, in Taipei, Taiwan, reported. Positive and negative predictive values were 37% and 88%, respectively.

The authors acknowledge the limitations of a retrospective study, including the possibility of selection bias that might have resulted in the extraordinarily high rate of high-grade reflux.

“Nonetheless, we believe that the data indicating that a normal DMSA renal scan [elimates] the need for VCUG in evaluating young children after first UTI is so striking that it is likely real,” they wrote.

The second study was a secondary analysis of prospective hospital-based cohort studies of 398 patients, aged 1 month to 4 years, with a first febrile UTI conducted at eight centers in seven European countries.

Procalcitonin (PCT), a recently identified early marker of bacterial infection, was prospectively measured in serum at admission with the LUMItest PCT immunoluminometric assay or the BRAHMS PCT-Q semiquantitative rapid test (J. Pediatr. 2007;150:89–95).

Their mean age was 13 months. VUR was diagnosed in 101 (25%) children, and it was grade 3 or higher in 46 (12%). The median serum concentration was significantly higher in children with VUR than it was in those without (1.6 ng/mL vs. 0.7 ng/mL) and increased significantly with the VUR grade, Dr. Sandrine Leroy of Saint-Vincent de Paul Hospital and Université Paris Descartes in Paris and associates reported.

High PCT, defined as 0.5 ng/mL or greater, was significantly associated with VUR (odds ratio 2.3). The association remained significant (OR 2.5) in a logistic regression analysis of 368 patients, even after adjusting for such cofactors as family history of uropathy, male gender, young age, urinary tract dilation on ultrasonography, high serum C-reactive protein at admission, and urine collection technique.

A high PCT level predicted VUR with high sensitivity: 75% for all-grade VUR and 100% for grade 4 or 5 VUR. Specificity was 43% regardless of VUR grade.

Even though high PCT did not offer 100% sensitivity for the prediction of all grades of VUR, the authors propose that the current systematic screening strategy for VUR be replaced with a PCT-based selective approach.

“One way to deal with this lack of [PCT] sensitivity is to accept that VUR will remain undiagnosed for some patients after a first febrile UTI. The potential adverse consequences of this practice should be balanced against the debatable efficacy of treatments (secondary antibiotic prophylaxis and surgery) for children with VUR and the possibility that low-grade VUR and even high-grade VUR can spontaneously disappear,” the authors said.

Additionally, a PCT-based approach would reduce overall costs by 30% by averting 38% of routine VCUGs, which cost about &dollar;150 per test, compared with about &dollar;15 per PCT, the authors concluded.

Dimercaptosuccinic acid renal scanning and high serum procalcitonin accurately predict vesicoureteral reflux in children with a first febrile urinary tract infection, according to data from two new studies appearing in the January issue of the Journal of Pediatrics.

An accurate predictor of vesicoureteral reflux (VUR) in children with a first febrile urinary tract infection (UTI) could help avoid unnecessary voiding cystourethrographies (VCUGs). Although a VCUG is routinely recommended for all children with a first febrile UTI, it exposes them to radiation, is painful and expensive, has been associated with a risk of iatrogenic UTI, and is often refused by parents.

“Neither [study] can be considered definitive, yet both are exciting work which may well change practice in the future,” Dr. Thomas Welch, chair of pediatrics at the State University of New York, Syracuse, said in an accompanying editorial (J. Pediatr. 2007;150:A3).

The first study was a 10-year retrospective review of 142 children under age 2 years who presented with an initial UTI and underwent both a VCUG and technetium-99m-labeled dimercaptosuccinic acid (DMSA) renal scan at a tertiary care general hospital. There were 77 boys and 65 girls.

Of these, 139 (98%) children had either positive leukocyte esterase or microscopic evidence of pyuria and 3 (2%) did not have pyuria but were positive for nitrite (J. Pediatr. 2007;150:96–9).

Results of DMSA scanning obtained within 2 days after diagnosis indicated that 99 (70%) had findings compatible with acute pyelonephritis and 2 (1.4%) had evidence of previous renal scarring.

VCUG performed 1 month after diagnosis showed evidence of VUR in 42 (29.6%) children. A total of 63 renal units exhibited reflux on VCUG, including 45 with grade I, II, or III reflux, and 18 with grade IV or V.

The sensitivity and specificity of abnormalities on DMSA renal scan for detecting the presence of VUR on VCUG were 88% and 36%, Dr. Min-Hua Tseng and colleagues from the department of pediatrics, Tri-Service General Hospital, National Defense Medical Center, in Taipei, Taiwan, reported. Positive and negative predictive values were 37% and 88%, respectively.

The authors acknowledge the limitations of a retrospective study, including the possibility of selection bias that might have resulted in the extraordinarily high rate of high-grade reflux.

“Nonetheless, we believe that the data indicating that a normal DMSA renal scan [elimates] the need for VCUG in evaluating young children after first UTI is so striking that it is likely real,” they wrote.

The second study was a secondary analysis of prospective hospital-based cohort studies of 398 patients, aged 1 month to 4 years, with a first febrile UTI conducted at eight centers in seven European countries.

Procalcitonin (PCT), a recently identified early marker of bacterial infection, was prospectively measured in serum at admission with the LUMItest PCT immunoluminometric assay or the BRAHMS PCT-Q semiquantitative rapid test (J. Pediatr. 2007;150:89–95).

Their mean age was 13 months. VUR was diagnosed in 101 (25%) children, and it was grade 3 or higher in 46 (12%). The median serum concentration was significantly higher in children with VUR than it was in those without (1.6 ng/mL vs. 0.7 ng/mL) and increased significantly with the VUR grade, Dr. Sandrine Leroy of Saint-Vincent de Paul Hospital and Université Paris Descartes in Paris and associates reported.

High PCT, defined as 0.5 ng/mL or greater, was significantly associated with VUR (odds ratio 2.3). The association remained significant (OR 2.5) in a logistic regression analysis of 368 patients, even after adjusting for such cofactors as family history of uropathy, male gender, young age, urinary tract dilation on ultrasonography, high serum C-reactive protein at admission, and urine collection technique.

A high PCT level predicted VUR with high sensitivity: 75% for all-grade VUR and 100% for grade 4 or 5 VUR. Specificity was 43% regardless of VUR grade.

Even though high PCT did not offer 100% sensitivity for the prediction of all grades of VUR, the authors propose that the current systematic screening strategy for VUR be replaced with a PCT-based selective approach.

“One way to deal with this lack of [PCT] sensitivity is to accept that VUR will remain undiagnosed for some patients after a first febrile UTI. The potential adverse consequences of this practice should be balanced against the debatable efficacy of treatments (secondary antibiotic prophylaxis and surgery) for children with VUR and the possibility that low-grade VUR and even high-grade VUR can spontaneously disappear,” the authors said.

Additionally, a PCT-based approach would reduce overall costs by 30% by averting 38% of routine VCUGs, which cost about &dollar;150 per test, compared with about &dollar;15 per PCT, the authors concluded.

VERONA, ITALY — Radioactive iodine-131 therapy is appropriate for patients with high-risk thyroid cancer, but unjustified in low-risk patients, Dr. Bryan McIver said at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

The practice of thyroid endocrinology underwent radical change after Dr. Ernest Mazzaferri demonstrated that postoperative radioiodine remnant ablation works in patients with differentiated thyroid carcinoma to lower the risk of death and recurrence (Am. J. Med. 1981;70:511–8).

In the wake of his work, some have argued that radioiodine therapy should be the standard of care for all patients with thyroid cancer, with the exception of those with incidentally discovered microcancers. The thinking is that modest doses of radioiodine are safe and decrease the chance of disease recurrence.

But Dr. McIver, of the Mayo Clinic in Rochester, Minn., and others argue for a selective approach to radioiodine therapy in patients with differentiated thyroid cancer, in part because most of these patients are known to have a very low risk of death or recurrence. Data also suggest the increased use of radioiodine remnant ablation in recent decades has not improved the already excellent outcome in patients with papillary thyroid carcinoma managed by near-total thyroidectomy and conservative nodal excision (World J. Surg. 2002;26:879–85).

Neither side has the upper hand based on the current data, Dr. McIver admitted. “The absence of strong data on both sides is a terrible indictment on our community that we haven't done the studies for a treatment that is so often viewed as being standard of care,” he said.

Dr. McIver presented an analysis of data from 527 node-positive patients who had surgery for thyroid carcinoma between 1970 and 2000 at the Mayo Clinic, of whom 303 received postoperative radioiodine therapy and 224 did not. At an average follow-up of 20 years, death rates were identical, with one death apiece in both groups. Recurrence rates also were the same at 20% in both groups.

Morbidity also occurs from radioiodine therapy, although it is uncommon and not severe in many cases, he said. However, a study of 6,841 patients with thyroid cancer, who received an average dose of 162 mCi, found a significantly increased risk of secondary primary malignancy of 27%, and a dose-dependent increase in salivary gland, bone, soft tissue, and colorectal cancers (Br. J. Cancer 2003;89:1638–44).

Dosages of radioactive iodine used to treat patients with no evidence of residual thyroid cancer reached an alarming high of 250 mCi in a separate series of consecutive thyroid cancer patients referred to the Mayo Clinic in 2002–2003, Dr. McIver reported. All of the 100 patients in this series had a score of less than 6 on the MACIS—Metastasis, Age, Completeness of Excision, Invasiveness, and Size—prognostic scoring system, placing them in a “low-risk” group, he said. Of these patients, 22 were referred for consideration of

The American Thyroid Association recommends radioiodine therapy for patients aged 45 years and older with stage III and IV disease, for patients aged 44 years or younger with stage II disease, for most older patients with stage II disease, and for selected patients with stage I disease.

Dr. McIver recommends using

VERONA, ITALY — Radioactive iodine-131 therapy is appropriate for patients with high-risk thyroid cancer, but unjustified in low-risk patients, Dr. Bryan McIver said at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

The practice of thyroid endocrinology underwent radical change after Dr. Ernest Mazzaferri demonstrated that postoperative radioiodine remnant ablation works in patients with differentiated thyroid carcinoma to lower the risk of death and recurrence (Am. J. Med. 1981;70:511–8).

In the wake of his work, some have argued that radioiodine therapy should be the standard of care for all patients with thyroid cancer, with the exception of those with incidentally discovered microcancers. The thinking is that modest doses of radioiodine are safe and decrease the chance of disease recurrence.

But Dr. McIver, of the Mayo Clinic in Rochester, Minn., and others argue for a selective approach to radioiodine therapy in patients with differentiated thyroid cancer, in part because most of these patients are known to have a very low risk of death or recurrence. Data also suggest the increased use of radioiodine remnant ablation in recent decades has not improved the already excellent outcome in patients with papillary thyroid carcinoma managed by near-total thyroidectomy and conservative nodal excision (World J. Surg. 2002;26:879–85).

Neither side has the upper hand based on the current data, Dr. McIver admitted. “The absence of strong data on both sides is a terrible indictment on our community that we haven't done the studies for a treatment that is so often viewed as being standard of care,” he said.

Dr. McIver presented an analysis of data from 527 node-positive patients who had surgery for thyroid carcinoma between 1970 and 2000 at the Mayo Clinic, of whom 303 received postoperative radioiodine therapy and 224 did not. At an average follow-up of 20 years, death rates were identical, with one death apiece in both groups. Recurrence rates also were the same at 20% in both groups.

Morbidity also occurs from radioiodine therapy, although it is uncommon and not severe in many cases, he said. However, a study of 6,841 patients with thyroid cancer, who received an average dose of 162 mCi, found a significantly increased risk of secondary primary malignancy of 27%, and a dose-dependent increase in salivary gland, bone, soft tissue, and colorectal cancers (Br. J. Cancer 2003;89:1638–44).

Dosages of radioactive iodine used to treat patients with no evidence of residual thyroid cancer reached an alarming high of 250 mCi in a separate series of consecutive thyroid cancer patients referred to the Mayo Clinic in 2002–2003, Dr. McIver reported. All of the 100 patients in this series had a score of less than 6 on the MACIS—Metastasis, Age, Completeness of Excision, Invasiveness, and Size—prognostic scoring system, placing them in a “low-risk” group, he said. Of these patients, 22 were referred for consideration of

The American Thyroid Association recommends radioiodine therapy for patients aged 45 years and older with stage III and IV disease, for patients aged 44 years or younger with stage II disease, for most older patients with stage II disease, and for selected patients with stage I disease.

Dr. McIver recommends using

VERONA, ITALY — Radioactive iodine-131 therapy is appropriate for patients with high-risk thyroid cancer, but unjustified in low-risk patients, Dr. Bryan McIver said at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

The practice of thyroid endocrinology underwent radical change after Dr. Ernest Mazzaferri demonstrated that postoperative radioiodine remnant ablation works in patients with differentiated thyroid carcinoma to lower the risk of death and recurrence (Am. J. Med. 1981;70:511–8).

In the wake of his work, some have argued that radioiodine therapy should be the standard of care for all patients with thyroid cancer, with the exception of those with incidentally discovered microcancers. The thinking is that modest doses of radioiodine are safe and decrease the chance of disease recurrence.

But Dr. McIver, of the Mayo Clinic in Rochester, Minn., and others argue for a selective approach to radioiodine therapy in patients with differentiated thyroid cancer, in part because most of these patients are known to have a very low risk of death or recurrence. Data also suggest the increased use of radioiodine remnant ablation in recent decades has not improved the already excellent outcome in patients with papillary thyroid carcinoma managed by near-total thyroidectomy and conservative nodal excision (World J. Surg. 2002;26:879–85).

Neither side has the upper hand based on the current data, Dr. McIver admitted. “The absence of strong data on both sides is a terrible indictment on our community that we haven't done the studies for a treatment that is so often viewed as being standard of care,” he said.

Dr. McIver presented an analysis of data from 527 node-positive patients who had surgery for thyroid carcinoma between 1970 and 2000 at the Mayo Clinic, of whom 303 received postoperative radioiodine therapy and 224 did not. At an average follow-up of 20 years, death rates were identical, with one death apiece in both groups. Recurrence rates also were the same at 20% in both groups.

Morbidity also occurs from radioiodine therapy, although it is uncommon and not severe in many cases, he said. However, a study of 6,841 patients with thyroid cancer, who received an average dose of 162 mCi, found a significantly increased risk of secondary primary malignancy of 27%, and a dose-dependent increase in salivary gland, bone, soft tissue, and colorectal cancers (Br. J. Cancer 2003;89:1638–44).

Dosages of radioactive iodine used to treat patients with no evidence of residual thyroid cancer reached an alarming high of 250 mCi in a separate series of consecutive thyroid cancer patients referred to the Mayo Clinic in 2002–2003, Dr. McIver reported. All of the 100 patients in this series had a score of less than 6 on the MACIS—Metastasis, Age, Completeness of Excision, Invasiveness, and Size—prognostic scoring system, placing them in a “low-risk” group, he said. Of these patients, 22 were referred for consideration of

The American Thyroid Association recommends radioiodine therapy for patients aged 45 years and older with stage III and IV disease, for patients aged 44 years or younger with stage II disease, for most older patients with stage II disease, and for selected patients with stage I disease.

Dr. McIver recommends using

TUCSON, ARIZ. — The benefits of adopting healthy lifestyle habits later in life are significant, Dr. Dana King and colleagues reported at the annual meeting of the North American Primary Care Research Group.

He presented a secondary analysis of the Atherosclerosis Risk in Communities (ARIC) cohort study of 15,792 adults who were aged 45–64 years at the outset. Participants were reexamined every 3 years, with the first baseline screening occurring in 1987–1989, and the fourth and final screening in 1996–1998. Telephone visits were conducted annually.

At baseline, only 1,344 (8.5%) had all of the following four healthy lifestyle habits: They ate at least five fruits and vegetables a day, walked 150 minutes a week or more, were not obese, and did not smoke, “That [low rate was] tremendously disappointing,” said Dr. King, of the department of family medicine at the Medical University of South Carolina, Charleston.

Those less likely to have all four healthy habits tended to be male, black, and aged 45–54 years, and to have hypertension or diabetes mellitus, less than a college education, and an annual family income of less than $35,000.

After 6 years, an additional 970 participants switched to a healthier lifestyle. Women were more likely to switch than men (9.1% vs. 7.4%), he said. The most common changes were improved diet, increased exercise, and smoking cessation. Almost no one changed his or her body mass index category significantly, he said.

For those who adopted all four habits, the benefits were substantial. With an adjusted logistic regression analysis, the relative risk of cardiovascular disease was reduced by 35% and all-cause mortality by 40% in only 4 years, he said. Adopting only three habits was not as beneficial, resulting in a 25% reduction in all-cause mortality and a nonsignificant reduction in cardiovascular disease compared with those who have fewer healthy habits.

Dr. King called the results surprising and powerful because of the substantial benefit in cardiovascular disease and mortality seen after a relatively short period of 4 years. Other studies, such as the Women's Health Study and the Health Professionals Follow-up Study, have shown similar results. But these studies investigated individual habits and didn't focus on people who adopted new, healthy lifestyles in middle age, he said.

“The present study adds new information that adopting a healthy lifestyle later in life is not futile,” Dr. King said. “Doing all the habits is the way to go.”

Dr. King acknowledged that the study was limited by self-report data for diet and exercise; a short mortality and cardiovascular follow-up period; lack of data on the exact timing and consistency of the participants' health habits; and data from only four communities rather than from a nationwide database.

TUCSON, ARIZ. — The benefits of adopting healthy lifestyle habits later in life are significant, Dr. Dana King and colleagues reported at the annual meeting of the North American Primary Care Research Group.

He presented a secondary analysis of the Atherosclerosis Risk in Communities (ARIC) cohort study of 15,792 adults who were aged 45–64 years at the outset. Participants were reexamined every 3 years, with the first baseline screening occurring in 1987–1989, and the fourth and final screening in 1996–1998. Telephone visits were conducted annually.

At baseline, only 1,344 (8.5%) had all of the following four healthy lifestyle habits: They ate at least five fruits and vegetables a day, walked 150 minutes a week or more, were not obese, and did not smoke, “That [low rate was] tremendously disappointing,” said Dr. King, of the department of family medicine at the Medical University of South Carolina, Charleston.

Those less likely to have all four healthy habits tended to be male, black, and aged 45–54 years, and to have hypertension or diabetes mellitus, less than a college education, and an annual family income of less than $35,000.

After 6 years, an additional 970 participants switched to a healthier lifestyle. Women were more likely to switch than men (9.1% vs. 7.4%), he said. The most common changes were improved diet, increased exercise, and smoking cessation. Almost no one changed his or her body mass index category significantly, he said.

For those who adopted all four habits, the benefits were substantial. With an adjusted logistic regression analysis, the relative risk of cardiovascular disease was reduced by 35% and all-cause mortality by 40% in only 4 years, he said. Adopting only three habits was not as beneficial, resulting in a 25% reduction in all-cause mortality and a nonsignificant reduction in cardiovascular disease compared with those who have fewer healthy habits.

Dr. King called the results surprising and powerful because of the substantial benefit in cardiovascular disease and mortality seen after a relatively short period of 4 years. Other studies, such as the Women's Health Study and the Health Professionals Follow-up Study, have shown similar results. But these studies investigated individual habits and didn't focus on people who adopted new, healthy lifestyles in middle age, he said.

“The present study adds new information that adopting a healthy lifestyle later in life is not futile,” Dr. King said. “Doing all the habits is the way to go.”

Dr. King acknowledged that the study was limited by self-report data for diet and exercise; a short mortality and cardiovascular follow-up period; lack of data on the exact timing and consistency of the participants' health habits; and data from only four communities rather than from a nationwide database.

TUCSON, ARIZ. — The benefits of adopting healthy lifestyle habits later in life are significant, Dr. Dana King and colleagues reported at the annual meeting of the North American Primary Care Research Group.

He presented a secondary analysis of the Atherosclerosis Risk in Communities (ARIC) cohort study of 15,792 adults who were aged 45–64 years at the outset. Participants were reexamined every 3 years, with the first baseline screening occurring in 1987–1989, and the fourth and final screening in 1996–1998. Telephone visits were conducted annually.

At baseline, only 1,344 (8.5%) had all of the following four healthy lifestyle habits: They ate at least five fruits and vegetables a day, walked 150 minutes a week or more, were not obese, and did not smoke, “That [low rate was] tremendously disappointing,” said Dr. King, of the department of family medicine at the Medical University of South Carolina, Charleston.

Those less likely to have all four healthy habits tended to be male, black, and aged 45–54 years, and to have hypertension or diabetes mellitus, less than a college education, and an annual family income of less than $35,000.

After 6 years, an additional 970 participants switched to a healthier lifestyle. Women were more likely to switch than men (9.1% vs. 7.4%), he said. The most common changes were improved diet, increased exercise, and smoking cessation. Almost no one changed his or her body mass index category significantly, he said.

For those who adopted all four habits, the benefits were substantial. With an adjusted logistic regression analysis, the relative risk of cardiovascular disease was reduced by 35% and all-cause mortality by 40% in only 4 years, he said. Adopting only three habits was not as beneficial, resulting in a 25% reduction in all-cause mortality and a nonsignificant reduction in cardiovascular disease compared with those who have fewer healthy habits.

Dr. King called the results surprising and powerful because of the substantial benefit in cardiovascular disease and mortality seen after a relatively short period of 4 years. Other studies, such as the Women's Health Study and the Health Professionals Follow-up Study, have shown similar results. But these studies investigated individual habits and didn't focus on people who adopted new, healthy lifestyles in middle age, he said.

“The present study adds new information that adopting a healthy lifestyle later in life is not futile,” Dr. King said. “Doing all the habits is the way to go.”

Dr. King acknowledged that the study was limited by self-report data for diet and exercise; a short mortality and cardiovascular follow-up period; lack of data on the exact timing and consistency of the participants' health habits; and data from only four communities rather than from a nationwide database.