STUDY: Body fat distribution is a more powerful predictor than is BMI for risk factors, diseases, and mortality

JOURNAL: Am J Clin Nutr. 2002; 76:743-9; 699-700

AUTHORS: Michael J. Lean and Thang S. Han

ABSTRACT: Waist circumference is a better indicator of cardiovascular (CV) risk than is body mass index (BMI), according to results from the National Health and Nutrition Examination Survey (NHANES) III published the American Journal of Clinical Nutrition.

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COMMENTARY: Body fat distribution is a more powerful predictor than is BMI for risk factors, diseases, and mortality. Measurements that are more sensitive to individual differences in abdominal fat might be more useful than BMI for identifying obesity-associated risk factors.

Waist circumference correlated more directly than did BMI with overall CV risk. Cutoffs of 90 cm (35 inches) for men and 83 cm (33 inches) for women we found. To minimize CV risk, they recommend advising patients with waist circumference at least as large as the cutoff value to lose weight.

Waist circumference is more closely linked to CV disease risk factors than is BMI [so] it is inappropriate to base waist circumference thresholds on their association with BMI thresholds.

STUDY:

JOURNAL: Neurology 2002;51:97-105

AUTHORS: Haid

ABSTRACT: A comparison of two different surgical techniques used to fuse vertebrae together and thereby repair unstable sections of the back found that while men experienced fewer temporary complications after undergoing the less-invasive operation, they were much more likely to suffer ejaculation problems caused by nerve damage.

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COMMENTARY: During the more invasive "mini-open" procedure, doctors reach the diseased vertebrae by making a series of small incisions, while in the less invasive laparoscopic or "keyhole" approach, doctors use a small video camera and specialized tools inserted through even smaller incisions to repair the area.

Researchers based at the Emory Clinic in Atlanta, Georgia, reviewed the records of 98 patients who had undergone either mini-open or laparoscopic procedures, and found that nearly 18% of mini-open patients experienced complications, as opposed to only 4% of those given the laparoscopic procedure.

However, the investigators also found that 45% of men who underwent laparoscopy experienced a condition known as retrograde ejaculation after the procedure, during which they are able to become aroused and have an erection, but cannot ejaculate any semen. This complication was seen in only 6% of the men who received the mini-open surgery, the authors note. The researchers were unable to determine how long the problem lasted.

According to the report in Neurosurgery, Haid's team found that preparation and procedure time was longer in patients who underwent laparoscopy, while patients often needed to stay in the hospital a bit longer after the mini-open procedure.

Haid explained that given the relatively high risk of ejaculation problems following the laparoscopic approach, he often recommends that younger men opt for the mini-open procedure. Losing the ability to ejaculate will affect a man's fertility, he pointed out, and also likely cause some significant emotional effects.

STUDY:

JOURNAL: Cancer. 2002;95:2455-2464

AUTHORS:

ABSTRACT: Continuous hormonal replacement therapy (HRT) is associated with an increased risk of lobular breast cancer but not of ductal carcinoma.

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COMMENTARY: "The incidence of invasive lobular carcinoma has been increasing among post-menopausal women in some parts of the U.S," writes Janet R. Daling, PhD, from the Fred Hutchinson Cancer Research Center in Seattle, Washington, and colleagues. "Part of this may be due to changes in classification over time. However, the use of combined estrogen and progestin HRT has also increased during the last decade and may account in part for the increase in invasive lobular breast cancer."



This study used data from the NICHD Women's Contraceptive and Reproductive Experiences (CARE) Study, a large case-control breast cancer study of white and African-American women. The investigators conducted in-person interviews of 1,749 postmenopausal women diagnosed with their first invasive breast tumor before the age of 65 years, and compared their responses with those of 1,953 postmenopausal controls identified through random digit dialing.

History of use of unopposed estrogen therapy was not associated with an increase in risk of any histologic type of breast cancer. Women currently using combined HRT had twice the risk of invasive lobular breast cancer.

Although the increase in risk was greater for mixed lobular-ductal than for the pure lobular type, this difference was not statistically significant.

Women who used continuous combined HRT (more than 25 days per month of progestin) for at least five years appeared to be at greater risk of lobular breast cancer than those who used sequential HRT (fewer than 25 days per month of progestin. Use of combined HRT was not associated with risk of ductal breast cancer.

"Post-menopausal women who take combined HRT appear to be at an increased risk of lobular breast cancer," the authors write.

Data from this study suggest that neither unopposed estrogen-HRT use nor combined HRT substantially increase the risk of ductal breast cancer among women less than 65 years of age.

STUDY: Homocycteine, B12 and Folic Acid

JOURNAL: J Am Coll Cardiol 2002;40:766-772.

AUTHORS: Dr. Frank F. Willems

ABSTRACT: Treatment with folic acid and cobalamin appears to improve coronary endothelial function in hyperhomocysteinemic patients with coronary artery disease.

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COMMENTARY: The researchers studied 15 patients with hyperhomocysteinemia and coronary artery disease. They were randomized to daily treatment with folic acid 5 mg in combination with cobalamin 400 mcg or to placebo.

At the end of the 6-month study, homocysteine levels fell by 31% in the

combination group, but did not change in placebo patients.

Furthermore, although at baseline, all patients showed severe coronary

endothelial dysfunction after acetylcholine infusion, there was a

significant improvement in coronary blood flow after the combination

therapy.

Placebo patients showed a 16% decrease in coronary blood flow,

whereas combination patients demonstrated a 96% increase.

Coronary endothelial dysfunction predicts cardiovascular mortality, and

they were able to demonstrate that folic acid and cobalamin can improve

coronary endothelial function thereby lowering the future risk.

Bottom line is get your B12 and folic acid.

STUDY:

JOURNAL:

AUTHORS:

ABSTRACT: Some vitamin and dietary supplements are sporting a new certification seal from the U.S. Food and Drug Administration (FDA) designated representative in hopes of assuring consumers that the product lives up to its ingredient labeling claims.

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COMMENTARY: The United States Pharmacopeia (USP), an independent agency that serves as the government's official compendium for dietary supplement standards, has begun to issue the certification on hundreds of products that it has independently tested as part of its Dietary Supplement Verification Program (DSVP).

This new program is voluntary and open to all manufacturers of dietary supplements operating in the U.S., a $17-billion-a-year market that includes vitamins, minerals, herbs, botanicals, and sports supplements sold over the counter and consumed by two of every three Americans.

To receive the certification, manufacturers must submit products they select to a "vigorous" seven-step testing and evaluation process that the USP says it ensures meets all labeling claims — first in independent laboratories and then on store shelves. This process includes testing and auditing of declared ingredients, their amounts or dosages, and meeting requirements of limits on contaminants.

So far, hundreds of supplements by two leading manufacturers have been tested and issued the certification. Products that will receive the certification label include those by Nature Made, which just began to hit shelves at some 30,000 stores nationwide, and those under the Kirkland brand, which will be displayed at Costo stores beginning next week.

Together, Nature Made and Kirkland produce about 30% of all vitamins and minerals consumed nationally, and about 20% of the total supplement market, said Richard Wailes, USP's head of sales and marketing. Four other manufacturers have signed up for the certification program and their products will carry the "Dietary Supplement Verified" certification in 2003.

Under the program, manufacturers can submit any products they choose and pay for all testing by USP, which has been establishing drug and other product standards since 1820 and has worked hand-in-hand with the FDA since the federal agency was created in 1938.

Because the FDA regulates dietary supplements as foods and not "conventional" medicines, manufacturers typically do not have to get FDA approval before producing or selling dietary supplements. The FDA can take action only if a product is deemed unsafe and is already on the market.