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In This Issue of JAMA Internal Medicine
July 2017


JAMA Intern Med. 2017;177(7):901-903. doi:10.1001/jamainternmed.2016.6154

In this randomized clinical trial, Trepanowski and colleagues assigned 100 metabolically healthy obese adults to an alternate-day fasting intervention, a daily calorie restriction intervention, or a control group (no intervention) for 1 year. Weight loss after 1 year in the alternate-day fasting group was not significantly different from that of the daily calorie restriction group relative to the control group. Moreover, the alternate-day fasting diet did not improve cardiovascular disease risk indicators more favorably than the daily calorie restriction diet. These findings suggest that alternate-day fasting does not produce superior weight loss or improvements in cardiovascular disease risk indicators when compared with daily calorie restriction.

For the PRICE trial, a randomized clinical trial conducted at 3 hospitals, Sedrak and colleagues evaluated whether displaying Medicare allowable fees in electronic health records at the time of ordering inpatient laboratory tests impacted clinician ordering behavior. A 1-year intervention and a 1-year preintervention period were compared, and after adjusting for time trends and patient characteristics, it was discovered that displaying Medicare allowable fees for inpatient laboratory tests did not lead to a significant change in overall clinician ordering behavior or associated fees. Sinaiko and Chien provide the Invited Commentary.

Invited Commentary

For this post hoc secondary analysis of the ALLHAT-LLT randomized clinical trial, Han and colleagues assessed the effect of statin therapy when used among adults 65 years and older who did not have evidence of atherosclerotic cardiovascular disease at baseline. No benefit was found when pravastatin was given for primary prevention to older adults with moderate hyperlipidemia and hypertension, and a nonsignificant direction toward increased all-cause mortality with pravastatin was observed among adults 75 years and older.

Editor’s Note

In this randomized clinical trial, Reuland and colleagues collected data at 2 community health centers serving vulnerable populations. Patients ages 50 to 75 years who had average colorectal cancer (CRC) risk, spoke English or Spanish, were not current with recommended CRC screening, and were attending primary care visits were recruited and randomized 1:1 to intervention or control arms. Intervention participants viewed a CRC screening decision aid that presented colonoscopy and fecal occult blood testing as screening options in English or Spanish immediately before their clinician encounter. Reuland and colleagues found that a combined intervention that included visit-based delivery of a CRC screening decision aid plus patient navigation increased CRC screening test completion rates by 40 percentage points, compared with usual care.

In this longitudinal study, Poti and colleagues studied a nationwide sample of over 170 000 US households that used barcode scanners to record all packaged foods and beverages purchased from grocery stores, supermarkets, and other retail stores. Nutrition label data for approximately 1.5 million products in the US food supply were collected and analyzed, and it was found that sodium acquired by US households from packaged food purchases decreased significantly between 2000 and 2014. Sodium content decreased significantly for packaged foods overall, as well as for all top food sources of sodium. Nonetheless, more than 98% of households had packaged food purchases with sodium density exceeding optimal levels.

Editor’s Note

For this observational study, Kershaw and colleagues examined a cohort of 2280 black participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study and found that increases in neighborhood-level racial residential segregation were associated with small but statistically significant increases in systolic blood pressure while reductions in segregation levels were associated with more than a 1–mm Hg decrease in systolic blood pressure. This study adds to the small but growing body of evidence that policies that reduce segregation may have meaningful health benefits.

Using death registration data from the National Vital Statistics System, Dwyer-Lindgren and colleagues analyzed spatial and temporal trends in US county life expectancy from 1980 to 2014 and found that geographic inequalities in life expectancy were substantial. In 2014, life expectancy differed by 2 decades between the counties with the lowest and highest life expectancy, and from 1980 to 2014, geographic inequality in life expectancy had increased. Over the same period, geographic inequality in the risk of death decreased among children and adolescents but increased among older adults. When combined, race/ethnicity factors, behavioral and metabolic risk factors, and health care factors explained 74% of county-level variation in life expectancy.

Continuing Medical Education

For this difference-in-differences case-control study, Li and colleagues examined 18 Medicare Advantage (MA) plans that introduced copayments for home health care between 2007 and 2011 and 18 concurrent control MA plans. The study included 135 302 enrollees in plans that introduced copayment and 155 892 enrollees in matched control plans. Results showed no evidence that imposing copayments reduced the use of home health services among older adults. More intensive use of home health services was associated with increased rates of disenrollment in MA plans. Grabowski provides the Invited Commentary.

Invited Commentary