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This Week in JAMA
August 22/29, 2001

This Week in JAMA

JAMA. 2001;286(8):887. doi:10.1001/jama.286.8.887
Physical Inactivity, Obesity, and Pancreatic Cancer Risk

Research suggests that impaired glucose tolerance and hyperinsulinemia may play a role in pancreatic carcinogenesis. Using data from 2 large cohort studies, Michaud and colleaguesArticle found that tall height and obesity (body mass index [BMI] ≥30 kg/m2) were independently and positively associated with pancreatic cancer risk, and physical activity of moderate intensity was inversely associated with risk. Total physical activity was not associated with risk of pancreatic cancer among individuals with a BMI less than 25 kg/m2, but was inversely associated with risk among those with a BMI of 25 kg/m2 or greater. In an editorial, Gapstur and GannArticle discuss other research findings that suggest that the risk of pancreatic cancer may be reduced by lifestyle modifications.

Prevalence of Nonprescription Weight Loss Product Use

To determine the prevalence of nonprescription weight loss product use, Blanck and colleagues analyzed data from 14 679 adults aged 18 years or older from 5 states who participated in the 1998 Behavioral Risk Factor Surveillance System survey. Seven percent of respondents reported using nonprescription weight loss products during the previous 2 years, 2% reported using phenylpropanolamine, and 1% reported using ephedra products. Overall use was especially common among young obese women, and 8% of normal-weight women reported using nonprescription weight loss products.

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In epidemiologic studies, a high homocysteine level has been identified as an independent risk factor for coronary heart disease (CHD) events and death. Both folic acid and cyanocobalamin have been shown to reduce homocysteine levels. Tice and colleagues estimated the potential effect of grain fortification with folic acid on CHD events and the cost-effectiveness of additional supplementation with folic acid and cyanocobalamin. Grain fortification with folic acid was predicted to decrease CHD events by 8% in women and 13% in men, with comparable reductions in CHD mortality. Approximately 310 000 fewer CHD deaths were projected to occur over a 10-year period if all persons with known CHD were also treated with folic acid and cyanocobalamin supplementation compared with grain fortification alone. Folic acid and cyanocobalamin supplementation in addition to grain fortification was found to be cost-effective for several population subgroups.

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Immunonutrition vs Standard Nutrition for Critically Ill

Enteral nutrition supplemented with nutrients that have been shown to influence immunologic and inflammatory responses has been used to provide nutritional support to critically ill patients. In this meta-analysis of 22 randomized trials that compared immunonutrition with standard enteral nutrition in surgical and critically ill patients, Heyland and colleagues found that immunonutrition was associated with a significantly lower rate of infectious complications and a shorter length of hospital stay, but mortality rates were not significantly different. Heterogeneity of the results across the studies was significant, and treatment effect varied depending on the type of experimental diet, the patient population, and the methodological quality of the study.

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A 47-Year-Old Woman With Tension-type Headaches

Ms T has frequent, often severe, tension-type headaches that have failed to respond to a variety of pharmacologic agents and behavioral approaches. She was recently treated with injections of botulinum toxin into the pericranial muscles. Welch discusses the epidemiology, pathogenesis, diagnosis, and treatment of episodic and chronic tension-type headaches.

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Contempo Updates

Advances in the treatment of chronic myelogenous leukemia.

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Medical News & Perspectives

Advanced imaging techniques have recently shown that the mechanism of action of methylphenidate, which is taken daily by as many as 6 million US children for attention-deficit/hyperactivity disorder, is much like that of cocaine.

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COX-2 Inhibitors and Adverse CV Events

Analysis of trials of selective cyclooxygenase 2 (COX-2) inhibitors suggests that these medications may be associated with increased risk of cardiovascular (CV) thrombotic events.

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Diabetes Mellitus

Original research reports, reviews, and commentaries are invited for a JAMA theme issue on diabetes mellitus scheduled for May 2002.

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JAMA Patient Page

For your patients: Information about leukemia.

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JAMA's Annual Medical Education Issue