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This Week in JAMA
January 4, 2012

This Week in JAMA

JAMA. 2012;307(1):7. doi:10.1001/jama.2011.1947

To assess how diet composition influences the response to overeating and energy expenditure, Bray and colleagues randomly assigned 25 healthy and weight-stable (BMI between 19 and 30)young adults who resided on an inpatient metabolic unit to a diet that provided 40% more calories per day than required for weight maintenance and contained 5%, 15%, or 25% of energy from protein. The authors found that consumption of the 5% (low) protein diet resulted in less weight gain than the 15% (normal) or 25% (high) protein diets, without an increase in resting or total energy expenditure, or body protein. In contrast, consumption of the normal- and high-protein diets was associated with increases in resting energy expenditure and lean body mass. Body fat increased similarly regardless of dietary protein content. In an editorial, Li and Hebera discuss implications of these findings for advising patients about healthy weight management.


Obesity is a risk factor for cardiovascular events; however, evidence that weight loss—whether by lifestyle intervention or surgery—reduces the risk of cardiovascular events is lacking. In an analysis of data from the Swedish Obese Subjects study, a nonrandomized prospective study of 2010 obese individuals who underwent bariatric surgery and 2037 contemporaneously matched obese individuals who received usual care, Sjöström and colleagues examined the association between bariatric surgery, weight loss, and cardiovascular events through a median of 14.7 years' follow-up. The authors report that compared with usual care, bariatric surgery—but not weight loss—was associated with a reduction in cardiovascular deaths and nonfatal cardiovascular events. In an editorial, Livingston highlights the inadequacy of BMI as a measure of fatness or of the risks obesity poses for individual patients and discusses the inadequacy of BMI as a criterion for obesity treatment or bariatric surgery.


To assess international variation in and predictors of 30-day hospital readmission rates after ST-elevation myocardial infarction, Kociol and colleagues analyzed data from 5745 patients who participated in a multinational (North America, Australia, New Zealand, and Europe) clinical trial that compared intravenous pexelizumab with placebo prior to primary percutaneous coronary intervention. The authors found that 30-day readmission rates were higher in the United States than in other countries but were no longer higher after adjustment for length of stay and that readmission was associated with multivessel disease and residence in the United States.


Dr J, an internal medicine resident at an academic medical center, experienced a needlestick injury while attempting to resuscitate a patient. Henderson discusses prevention of needlestick injuries and the assessment and management of occupational exposures to the human immunodeficiency virus and hepatitis B and hepatitis C viruses.


Continued high rates of misuse and abuse of prescription opioid pain medications are prompting efforts by federal agencies to promote judicious prescribing of these drugs.


Reversals of established medical practices


Where are the health care cost savings?


Monitoring the effects of the Affordable Care Act


Withholds: a better deal than cuts


“After two years in public service, I came to believe that listening is one of the most powerful and constructive things that a senior federal health official (perhaps any senior manager) can do.” From “A Physician Goes to Washington . . . and Safely Returns.”


Viewpoints and other new developments at JAMA


Dr Bauchner summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

Join Harold C. Sox, MD, on January 18, at 2 PM eastern time to discuss the new American Cancer Society process for creating trustworthy cancer screening guidelines. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about ulcerative colitis.