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Some evidence suggests that breastfeeding in infancy protects against
overweight later in life. In this analysis of data from the Third National
Health and Nutrition Examination Survey, Hediger and colleaguesArticle found that
among children aged 3 to 5 years, the risk of having a body mass index (BMI)
between the 85th and 94th percentiles (at risk of overweight) was reduced
among children ever breastfed compared with those who were never breastfed.
However, no difference in the risk of overweight (BMI in the 95th percentile
or higher) was observed, and there was no clear dose-dependent effect of the
duration of exclusive breastfeeding on either weight outcome. To assess whether
breastfeeding in infancy is associated with a reduced risk of overweight in
adolescence, Gillman and colleaguesArticle analyzed survey data from children in
the Growing Up Today Study, a study of the sons and daughters aged 9 to 14
years of women participating in the Nurses' Health Study II. Children who
had been mostly or only breastfed, or breastfed for longer periods, had a
reduced risk of being overweight at age 9 to 14 years. In an editorial, DietzArticle
considers possible explanations for the disparity in the findings of these
2 studies and mechanisms by which breastfeeding may protect against overweight.
In the Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin
Therapy (ESPRIT) trial, patients scheduled to undergo nonurgent coronary stent
implantation who received eptifibatide, a competitive inhibitor of platelet
glycoprotein IIb/IIIa, had significantly better outcomes 30 days after the
percutaneous coronary intervention than patients who received placebo. In
this 6-month follow-up study, O'Shea and colleagues report that the primary
composite end point, rates of death or myocardial infarction (MI), continued
to be significantly lower in the eptifibatide group. Composite rates of death,
MI, or target vessel revascularization were also lower in the eptifibatide
group, but there was no significant difference in 6-month mortality alone.
Treatments for hallux valgus include conservative management with orthoses
and surgical correction. Torkki and colleagues compared these treatments with
no treatment (control group) among patients with a painful bunion and a hallux
valgus angle of 35° or less. At 6 months, pain intensity during walking
was less in the 2 active treatment groups than in the control group. At 12
months, however, there was no significant difference in pain intensity in
the orthoses and control groups, whereas pain intensity continued to decrease
in the surgery group. Number of painful days, cosmetic disturbance, and footwear
problems were lowest in the surgical group, and satisfaction with treatment
and patient global assessment were better than in the other 2 groups.
Using data from the Physicians' Health Study, a prospective cohort of
healthy male US physicians aged 40 to 84 years at baseline, Ridker and colleagues
conducted a nested case-control study to evaluate biomarkers as risk factors
for the development of symptomatic peripheral arterial disease (PAD). Lipid
biomarkers included total cholesterol, high-density lipoprotein cholesterol
(HDL-C), low-density lipoprotein cholesterol, total cholesterol to HDL-C ratio,
triglycerides, lipoprotein(a), and apolipoproteins A-1 and B-100. Nonlipid
biomarkers included homocysteine and 2 inflammatory markers, fibrinogen and
C-reactive protein. In multivariable analyses, total cholesterol to HDL-C
ratio was the strongest lipid predictor of PAD; and C-reactive protein, the
strongest nonlipid predictor.
"There was a time when I could not imagine life without practicing medicine;
now I consider other choices." From "Visiting the Sadness."
Successful treatment of many children with cancer has led to a need
to find and address factors contributing to the negative consequences that
can occur later in their lives.
The third report of the National Cholesterol Education Program Expert
Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in
Adults (Adult Treatment Panel III)Article emphasizes primary prevention of coronary
heart disease in persons with multiple risk factors and early and aggressive
lipid-lowering therapy for those at highest risk.Article
How to assess whether a patient with a stated penicillin allergy is
truly allergic to penicillin.
For your patients: Information about cholesterol and atherosclerosis.
This Week in JAMA . JAMA. 2001;285(19):2415. doi:10.1001/jama.285.19.2415