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Copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2009
Previous studies have suggested that consumption of coffee, decaffeinated coffee, and tea is associated with a reduced risk in the development of type 2 diabetes mellitus (DM). In this meta-analysis of 20 prospective cohorts with information on 500 000 individuals, among whom there were over 21 000 cases of DM, every additional cup of coffee consumed in a day was associated with 5% to 10% lower risk of incident DM after adjustment for potential confounders. Similar associations were shown with both decaffeinated coffee and tea. If such beneficial effects were observed in interventional trials, then the implications for the millions of individuals who have or who are at future risk of developing DM would be substantial.
The average adult watches almost 5 hours of television (TV) per day, an amount associated with increased risks for obesity. Otten et al enrolled 36 adults with a body mass index of 25 to 50 kg/m2 in a randomized controlled trial to examine the effects of TV reduction on energy intake, energy expenditure, energy balance, body mass index, and sleep in adults. The intervention consisted of reducing TV viewing by 50% of each subjects' objectively measured baseline time and was enforced by an electronic lock-out system. Reducing TV in this sample produced a significant mean increase in energy expenditure of 119 kcal/d, but no apparent change in energy intake after 3 weeks of intervention. Reducing TV viewing should be further explored as a method to reduce and prevent obesity in adults.
On the basis of data from the Women's Health Initiative, Smoller et al report that antidepressant use is associated with an increased risk of stroke and all-cause mortality, but not coronary heart disease, in a study of 136 293 postmenopausal women with a mean follow-up of 5.9 years. Selective serotonin reuptake inhibitor (SSRI) use was associated with increased risk of stroke (hazard ratio [HR], 1.45) and all-cause mortality (HR, 1.32). In analyses by stroke type, SSRI use was associated with incident hemorrhagic (HR, 2.12) and fatal stroke (HR, 2.10). However, there were no significant differences between SSRI and tricyclic agent use in risk of cardiovascular event or mortality. The authors suggest that physicians should be vigilant about controlling other modifiable cardiovascular risk factors in older women taking antidepressants.
In this comparative effectiveness study, 45 501 patients attending routine appointments in 12 primary care clinics were screened for tobacco use by medical assistants to recruit participants for a smoking cessation clinical trial. Among 10 225 smokers, 1346 smokers were randomly assigned to the following 5 active pharmacotherapies: 3 monotherapies (nicotine patch, nicotine lozenge, and bupropion hydrochloride sustained release) and 2 combination therapies (patch + lozenge and bupropion + lozenge). Patients were referred to a state-sponsored telephone quit line for cessation counseling. At 6 months after the quit date, bupropion + lozenge was superior to all of the monotherapies (odds ratios, 0.46 to 0.56) and patch + lozenge was superior to patch and bupropion monotherapies (odds ratios, 0.56 and 0.54, respectively). One in 5 smokers attending a routine primary care appointment was willing to make a serious quit attempt that included evidence-based counseling and medication. Provision of free cessation medications plus quit line counseling arranged in the primary care setting holds promise for assisting large numbers of smokers to quit.
Berrington de González et al used radiation risk models and recent survey data to estimate the number of future cancers that could be related to computed tomographic (CT) scan use in the United States according to age, sex, and scan type. Overall, the authors estimated that approximately 29 000 future cancers could be related to CT scans performed in 2007. Abdomen-pelvis CT scans made the largest contribution to the total risk (14 000 cancers), followed by chest CT scans (4000 cancers). One-third of the cancers were from scans performed at ages 35 to 54 years, and two-thirds were in women.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2009;169(22):2044. doi:10.1001/archinternmed.2009.416