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.
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.
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
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.
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.
Advances in the treatment of chronic myelogenous leukemia.
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
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.
Original research reports, reviews, and commentaries are invited for
a JAMA theme issue on diabetes mellitus scheduled for May 2002.
For your patients: Information about leukemia.
JAMA's Annual Medical Education Issue
This Week in JAMA. JAMA. 2001;286(8):887. doi:10.1001/jama.286.8.887