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This Week in JAMA
April 20, 2005

This Week in JAMA

JAMA. 2005;293(15):1829. doi:10.1001/jama.293.15.1829
BMI, Death, and Cardiovascular Risk

Trends in weight-related morbidity and mortality are the focus of 2 articles in this issue of JAMA. First, Flegal and colleaguesArticle used nationally representative data from NHANES I, II, and III and follow-up data collected through 2000 to estimate the number of excess deaths in 2000 associated with body mass index (BMI), categorized as underweight, normal weight, and obese. They found that compared with normal weight, both underweight and obesity were associated with increased mortality, and the risk associated with obesity declined over time. In the second article describing 40-year trends in cardiovascular disease risk factors by BMI categories, Gregg and colleaguesArticle report that the prevalence of high cholesterol levels, hypertension, and current smoking have declined, particularly among overweight and obese persons. Diabetes was the only risk factor found to have a stable prevalence over the 40 years. In an editorial,Article Mark discusses challenges in assessing obesity-related health risks.

Blood Mercury and Neurobehavioral Function

Although fish consumption is encouraged for older adults, fish are known to contain the neurotoxicant methylmercury, which might contribute to cognitive decline. To assess this possibility, Weil and colleagues investigated the association of blood mercury levels with neurobehavioral test scores in adults 50 to 70 years of age. After adjusting for many factors associated with cognitive decline, they found no definitive evidence that blood mercury levels are adversely associated with neurobehavioral test scores in older adults.

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Optimizing Use of Live Donor Kidneys

Live donor renal transplantation may narrow the existing gap between organ need and supply for patients with end-stage renal disease, but many patients and their willing donor are not compatible. Kidney paired donation (KPD), where an incompatible donor/recipient pair matches a kidney with another incompatible donor/recipient pair, may offer an opportunity to optimize the use of live donor kidneys. To assess the impact of an optimal KPD program, Segev and colleagues conducted a simulation exercise comparing transplant numbers and outcomes under a national matching algorithm with existing local and regional match options. They found that a national matching program would result in more transplants with less HLA disparity between donors and recipients and a reduction in the number of donor/recipient pairs required to travel.


Low Birth Weight, Lipoproteins, and Adult CVD

Low-birth-weight infants have an increased risk of cardiovascular disease (CVD) in adulthood, for reasons that are not fully understood. To explore potential mechanisms, Kwiterovich and colleagues analyzed cord blood samples for levels of cholesterol, triglycerides, low-density and high-density lipoprotein cholesterol, apolipoproteins, lipoprotein subclasses, and lipoprotein density. The authors identified a subclass of large high-density lipoprotein enriched in apolipoprotein C-I—a known promoter of hypertriglyceridemia, atherosclerosis, and apoptosis of cultured human arterial smooth muscle cells—which was elevated in infants of low birth weight compared with infants born small for gestational age.

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A Piece of My Mind

“Medicine had helped Martin only so much. Now he needed something more. He needed a whole houseful of ren chingwei.” From “The Pastor and the Party of the Century.”

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Medical News & Perspectives

New studies identifying a gene variant that may be responsible for about half of US cases of age-related macular degeneration are providing clues to the underlying cause of the disorder.

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Mortality and Nesiritide

In a pooled analysis of data from randomized trials, nesiritide was associated with an increased 30-day risk of death compared with noninotrope-based therapy for acute decompensated heart failure.

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The Rational Clinical Examination
The value of symptoms, signs, and provocative test results when considering a diagnosis of myasthenia gravis.

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World Response to Emergencies

Varying levels of political risk may explain how nations respond to natural disasters and complex emergencies around the globe.

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JAMA Patient Page

For your patients: Information about myasthenia gravis.

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