The American Medical Group Association (AMGA) and the American Medical Group Foundation (AMGF) are pleased to announce an opportunity for AMGA members to participate in a learning collaborative on care management for patients with COPD. The Best Practices Learning Collaborative is for organizations that are striving to improve the care of patients with COPD. Participants will work together to develop an optimal care framework that includes a comprehensive, patient-centered, value-based approach to chronic care.

The learning collaborative will support improvements in chronic care management systems that focus on improving the care of patients across care settings. Up to fifteen groups will be invited to participate in the collaborative; five will receive $10,000 in educational support over a one-year period; an additional ten organizations will receive travel stipends to attend the collaborative meetings.

Medical groups, IPAs, academic practices, and integrated delivery systems that wish to incorporate the management of COPD into their chronic care models are encouraged to submit an application. Organizations interested in a population-based effort or wanting to launch a pilot program are welcome to participate.

An expert panel of judges will review each application for commitment to common goals such as:

– Early identification and diagnosis of patients at risk for or currently suffering with symptoms of COPD

– Improved medication adherence and compliance

– Continuity of care across settings and transitions of care

– Increased efficiency and reduction of unnecessary or duplicative services and waste

– Increased ability to self-manage symptoms and disease progression through healthier lifestyles

– Improved health and well-being, and patient satisfaction

– Improved physician/patient relationships

– Overall impact on patient care in the community or region

Chronic Obstructive Pulmonary Disease Best Practices Learning Collaborative is an educational service supported by Boehringer Ingelheim Pharmaceuticals, Inc.

Source: American Medical Group Association (AMGA) Continue reading →

BioHorizons announces that its 2009 Global Symposium will take place Thursday, April 30, to Saturday, May 2, at the Hilton Chicago. This educational event will focus on recent advances in digital dentistry, treatment planning, implant surface treatments, tissue regeneration and implant specific restorations.

Scientific sessions will bring together the outstanding and diverse expertise of top dental clinicians such as Drs. Carl E. Misch, Michael A. Pikos, Maurice Salama, Edward P. Allen, and Scott Ganz to provide insight into today’s most challenging implant and regeneration topics, including technical advances in diagnostic three-dimensional imaging and treatment planning software. Each clinician-moderated session will feature a panel discussion of audience-submitted questions that fosters a highly interactive learning environment. The three days of continuing education will include hands-on training sessions and dedicated educational tracks for auxiliary and office staff.

Presenters and moderators include Drs. Carl E. Misch, Maurice Salama, Michael A. Pikos, Scott Ganz, Edward P. Allen, David Garber, Jack Ricci, Natalie Wong, Ray Yukna, Michael Reddy, Hamid Shafie, Jay Malmquist, Michael Klein, and Murray Arlin.

BioHorizons continues to be one of the fastest growing dental implant companies in the industry because of unique offerings like Laser-Lok(R) microchannels, VIP 2.1 treatment planning software and gold-hued esthetic abutments provided with every bone level implant system. Symposium presentations will illustrate the unique position of BioHorizons to assist dental clinicians throughout the continuum of care.

“Each year, the BioHorizons Global Symposium stimulates invaluable interaction within the dental implant community,” said Steve Boggan, BioHorizons President & CEO. “In the current global economic climate, it is important to develop advanced knowledge and strong relationships to achieve superior esthetic results for patients and generate new opportunities for dental practices.”

About BioHorizons, Inc.

BioHorizons is a leading oral reconstructive device company at the forefront of digital dentistry. The company has a broad product offering, including dental implants, surgical planning software, regenerative products, CAD/CAM and traditional dental restorations. BioHorizons has a direct sales force in the U.S., Canada, Germany, Spain, United Kingdom, Australia, Mexico, and Chile. Products are distributed in the rest of the world via a network of independent distributors.

BioHorizons
biohorizons Continue reading →

Kelly Weber’s tennis racket hasn’t been retired, after all.

A car accident five years ago destroyed two disks between three bones in Weber’s spine, bringing her active lifestyle to a sudden stop. But minimally invasive spine surgery performed at Cedars-Sinai Medical Center is giving the Greeley, Colo., resident a chance to return to the tennis court and ski slopes without the pain that made even sitting in a car a difficult task.

“I couldn’t extend my right leg because I’d have pain going down it. So I’d have to keep the steering wheel really close and my leg bent, and sometimes I couldn’t even drive because of the pain,” said the 40-year-old mother of two.

According to Weber, who used to play on a United States Tennis Association (USTA) league and is a water aerobics and water therapy instructor, after the accident, she was unable to even hug her then 3- and 5-year-old daughters in a normal way. “I’d have to sit down and then have them sit on my lap,” she remembers.

After the crash, Weber underwent a surgical procedure called lumbar laminectomy in which pieces of damaged disk material were removed to take pressure off a pinched nerve root exiting the spinal column. Disks act as firm cushions between the vertebrae.

Surgical fusion of the area – lumbar vertebrae 3, 4 and 5 – was discussed, but knowing that this would require a long period of recuperation and limited mobility, Weber wanted to wait until technology provided a less-invasive option for multiple-disk replacement.

While waiting, Weber sought pain relief and healing through medical treatment and a variety of complementary approaches, including massage therapy, acupuncture, chiropractic, water therapy, and Bikram yoga. If nothing else, she reasoned, she would be in good physical condition when it was time to try surgery. Selective nerve root blocks, in which an anesthetic and a steroid were injected into the inflamed area, provided some short-term relief but no long-term solutions.

Last May, Weber learned of a minimally invasive operation to replace two or more adjacent disks. She researched the work of neurosurgeon Burak Ozgur, M.D., a minimally invasive spine surgery specialist who is one of the top surgeons experienced in the technique. Weber arranged a Nov. 2 consultation with Ozgur, who had joined Cedars-Sinai’s Department of Neurosurgery in October. Surgery was performed Nov. 14.

Ozgur said the procedure, which was completed in about three and a half hours, is performed in two steps. “First, we approach from the side, exactly 90 degrees from the spine, and access the two disk spaces. We remove the disks and put in ‘cages’ that contain bone graft materials and a protein that enhances and speeds up the fusion process. Then from the back, we insert screws and rods to stabilize the spine.”

Using a scope and special instruments, the entire operation is performed through four incisions, each measuring about an inch and a half. These are closed with melt-away stitches and glue, resulting in very small scars. More importantly, the procedure spares the muscle injury and significant blood loss that is common with traditional back surgery, along with the long, painful months of recuperation.

Weber was discharged from the hospital after three days and stayed with family in the Los Angeles area. Her mother returned with her to Greeley on Nov. 23, staying about three weeks for support.

“I cannot believe how good I felt right afterward. I went Christmas shopping. My mom had to make me slow down,” said Weber, noting that without constant pain she has more energy and feels “full of life.” Although she has to pace herself for a while, she expects to gradually resume her normal routine.

“I think this procedure is revolutionizing spinal fusions because it’s changing how people are recovering,” Ozgur said. “Compared to invasive surgery, the end result looks the same as far as the construct, but the recovery is much improved. And it can be an option for other indications, such as adult degenerative scoliosis, which is usually more complicated and involving more levels. I’ve done five- and six-level cases with this type of approach.”

The first in Southern California and one of only 10 hospitals in the state whose nurses have been honored with the prestigious Magnet designation, Cedars-Sinai Medical Center is one of the largest nonprofit academic medical centers in the Western United States. For 19 consecutive years, it has been named Los Angeles’ most preferred hospital for all health needs in an independent survey of area residents. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities as well as breakthroughs in biomedical research and superlative medical education. It ranks among the top 10 non-university hospitals in the nation for its research activities and is fully accredited by the Association for the Accreditation of Human Research Protection Programs, Inc. (AAHRPP).

Cedars-Sinai Medical Center Continue reading →

A new study finds that combining the newer diabetes drug exenatide with insulin provides better blood sugar control in patients with type 2 diabetes than insulin alone and helps promote weight loss.

“This study may be the best result ever for patients whose diabetes is inadequately controlled on a combination of pills and insulin,” said John Buse, MD, PhD, lead author of the study and chief of the Division of Endocrinology and Metabolism in the University of North Carolina at Chapel Hill School of Medicine.

“Until now, it was inconceivable that you could get such patients under excellent control with weight loss and no significant problems with hypoglycemia,” Buse said.

Type 2 diabetes is a devastating disease, a leading contributor to blindness, amputations, kidney failure, heart attack, stroke and even cancer. But the most powerful diabetes drug, a formulation of insulin called Lantus, is associated with weight gain and low blood sugar reactions that may limit the success of more intensive treatment.

Exenatide (brand name: Byetta) is a newer diabetes drug whose active ingredient was first discovered in the saliva of the Gila monster, a large lizard from the Arizona desert. “It has the advantages of not leading to low blood sugar and in fact promotes weight loss,” Buse said.

“Because Byetta and Lantus have very different strengths, we thought that combining the two had the potential to give us the best of both. It is wonderful, when you guess right.”

The study was published online on Dec. 7, 2010 by the Annals of Internal Medicine and will appear in the Jan. 18, 2011 print issue of the journal.

The 30-week study was conducted at 59 centers in five countries (Greece, Israel, Mexico, the U.K. and the U.S.) with 261 participants. All were adults with type 2 diabetes who were taking once-daily injections of Lantus, either alone or with diabetes pills. They were randomly assigned to receive twice-daily injections of Byetta or placebo in addition to the diabetes medications that they were taking.

Among the 138 patients on Byetta, 60 percent achieved near normal blood sugar levels, compared to 35 percent of those on placebo. Byetta recipients also lost an average of four pounds during the study while placebo recipients gained an average of two pounds. There were no differences in the rates of hypoglycemia between the two groups.

Byetta recipients reported side effects more frequently than placebo recipients, particularly nausea, vomiting and diarrhea, but only in 10 percent of cases were the side effects bad enough to cause patients to stop the drug.

The study was funded and sponsored by an alliance of Eli Lilly and Company and Amylin Pharmaceuticals, who are collaborating to market Byetta.

In addition to Buse, authors of the study are Richard M. Bergenstal, MD; Leonard C. Glass, MD; Cory R. Heilmann, PhD; Michelle S. Lewis, PhD; Anita Y.M. Kwan, MS; Byron J. Hoogwerf, MD; and Julio Rosenstock, MD.

Source: University of North Carolina at Chapel Hill School of Medicine

View drug information on Byetta; Lantus.

Continue reading →

The American Medical Association and America’s Health Insurance Plans this week are launching “dueling advertising campaigns” over Senate votes on a House-passed bill (HR 6331) to avert a 10.6% reduction to Medicare physician fees that was scheduled to go into effect on Tuesday, CongressDaily reports (Edney, CongressDaily, 7/1). In the Senate last week, the measure failed by one vote to receive the 60 votes required to gain cloture. Senate Majority Leader Harry Reid (D-Nev.) plans to bring up the measure again when the Senate returns from the Fourth of July recess. The House last month passed the measure by a veto-proof margin. The bill is similar to a measure (S 3101) proposed by Senate Finance Committee Chair Max Baucus (D-Mont.), which also failed to receive enough votes for cloture (Kaiser Daily Health Policy Report, 7/1).

A temporary hold on the fee reduction will give the Senate another chance to vote on the measure, according to the Wall Street Journal (Goldstein, “Health Blog,” Wall Street Journal, 7/1). The hold will last until July 15.

Ads
AMA’s advertisements, which began running Tuesday, target by name 10 Republican senators who voted against the measure: John Cornyn (Texas), Kay Bailey Hutchison (Texas), John Sununu (N.H.), John Barrasso (Wyo.), Mike Enzi (Wyo.), Bob Corker (Tenn.), Lamar Alexander (Tenn.), Roger Wicker (Miss.), Thad Cochran (Miss.) and Arlen Specter (Pa.). Seven of the senators face re-election this year (Wayne, CQ Today, 7/1). The television and radio ads, which are running in six states, reference the Fourth of July and say, “There’s no celebrating for the millions of seniors, the disabled and military families who will lose their access to health care. A group of U.S. senators voted to protect the powerful insurance companies at the expense of Medicare patients’ access to doctors” (Yen, AP/Tampa Tribune, 7/1).

AHIP’s ads say that reducing payments to Medicare Advantage plans to offset the reduction in physicians’ fees will limit access and benefits for beneficiaries (CongressDaily, 7/1). The ads say, “Millions more will have to pay higher out-of-pocket costs for health care and lose important benefits they depend on” (AP/Tampa Tribune, 7/1). AHIP President and CEO Karen Ignagni said, “Congress needs to address the physician payment issue without putting seniors at risk.” According to CongressDaily, AHIP and AMA officials did not disclose the amount of spending on their ad campaigns (CongressDaily, 7/1).

Specter Request
Meanwhile, Specter on Saturday sent a letter to the White House requesting that President Bush order Congress back from its Fourth of July recess specifically to address the Medicare physician fee reduction, CQ Today reports. Specter wrote, “This is too important to the country to have this procedural morass affect medical care for our seniors” (CQ Today, 7/2).

C-SPAN’s “Washington Journal” on Tuesday reported on the Medicare physician fee reduction and the House bill that would delay it. The segment includes comments from AMA President Nancy Nielsen and calls from viewers (Brawner, “Washington Journal,” C-SPAN, 7/1).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

It is well known that cancer patients undergoing chemotherapy and radiation therapy often experience nausea and loss of appetite. But until now, few researchers have looked into why this happens and what can be done to ensure that cancer patients maintain a healthy diet during treatment.

Researchers at the University of Alberta studying the effects of chemotherapy and radiation therapy on the senses report that most advanced cancer patients experience unique and persistent taste and smell abnormalities, believed to be a key factor in malnutrition and poor quality of life. The condition, known as chemosensory dysfunction, is believed to last long after patients have finished active chemotherapy or radiation therapy.

Taste distortion, heightened sensitivity to odours and a persistent bad taste in the mouth were the most common symptoms described by participants in the recent study conducted by Dr. Wendy Wismer and Dr. Vickie Baracos. However, Wismer says that every patient with chemosensory dysfunction has unique symptoms, and a diet tailored to her needs would likely improve quality of life.

“With taste and smell, and even with food consumption, we tend to draw broad conclusions and make sweeping recommendations,” she says. For example, individuals with severe chemosensory dysfunction will often end up on a diet of soup or oral nutritional supplements such as Boost because their heightened or distorted senses make it difficult to eat much else.

“We’re looking at how an altered sense of taste and smell affects the food you select. We argue that altered chemosensory perception is unique to the individual. In the same way that people need unique corrective lenses for their eyesight, patients need unique solutions for chemosensory distortion,” Wismer explains.

Wismer and Baracos studied 66 patients with advanced cancer receiving palliative care and asked them to evaluate their own taste and smell functions using a validated questionnaire and three-day food diaries to assess their dietary intake. The vast majority – 86 per cent of participants – reported some level of chemosensory abnormality. While this study focused on advanced cancer patients, Wismer believes the findings are relevant to any patient who has received chemotherapy or radiation therapy.

Further research will look at appropriate strategies to alleviate chemosensory dysfunction and explore how matching foods to an individual’s unique chemosensory profile might help to prevent high rates of weight loss and malnutrition and improve quality of life.

###

The study is published in the February 2007 issue of the Journal of Pain and Symptom Management.

For more information, please contact:

Dr. Wendy Wismer,
Department of Agricultural Food & Nutritional Science
University of Alberta

Dr. Vickie Baracos,
Department of Oncology
University of Alberta

Isabela C. Varela

University of Alberta Continue reading →

Luke Mangan will join sporting stars Harry Kewell, Cathy Freeman and Kieran Perkins in the Commonwealth Government’s campaign to tackle Australia’s obesity problem.

As a Healthy Active Ambassador, Luke will bring an expert perspective to promoting good nutrition, particularly among young people.

“I am pleased to be involved with this initiative. It is so easy to eat junk food but what’s even easier is to eat healthy food and live a healthy lifestyle,” Luke said.

Luke is the executive chef of glass brasserie at the Hilton Sydney and is the originator of the Lexus Young Chef of the Year Awards.

The Government is pleased to have his involvement in this important program.

The Healthy Active Ambassador program is a Commonwealth Government initiative to combat the rising incidence of obesity in Australia. Other ambassadors will be announced as they are appointed.

health.au Continue reading →

President Obama signed legislation today reauthorizing the State Children’s Health Insurance Program (SCHIP) and expanding its coverage, bringing California a total of $1.5 billion in much-needed funding for 2009.

The California Medical Association praised the measure, which will help meet the growing need for children’s health coverage, and encouraged state lawmakers to commit the state funding required to get the maximum federal dollars.

In California, SCHIP funds the Healthy Families program. It currently serves 900,000 kids but is growing by 30,000 a month, as job losses mount and the ranks of uninsured swell. Under the legislation, the federal government provides $2 for the program for every $1 spent by the state.

“The best thing state legislators can do for kids right now is to lock in the state matching funds,” said Dr. Dev A. GnanaDev, CMA president. “The president and Congress have given California a great opportunity, and now it’s up to state lawmakers to make the most of it.”

The SCHIP legislation boosts California’s portion of the federal funding from $800 million to $1.5 billion a year.

Healthy Families offers coverage to children who do not qualify for Medi-Cal, the government’s health insurance program for the poor, but whose parents cannot afford health care.

In addition, the legislation provides federal funds to cover legal immigrant pregnant women and children who have been in the country for less than five years. Previously, the state covered that population without any federal assistance, meaning the change in law will save Healthy Families $12 million a year.

The program is essential to ensure that youngsters get the medical attention they need, regardless of their families’ economic circumstances. Making sure that children remain healthy and see a doctor when necessary helps protect California’s public health, emergency rooms and classroom efforts.

CMA has long been a leader in advocating for children’s health care. The association pushed for the creation of SCHIP on the federal level and played a key role in legislation establishing its California counterpart, the Healthy Families program.

The California Medical Association represents more than 35,000 physicians in all modes of practice and specialties. CMA is dedicated to the health of all patients in California.

California Medical Association Continue reading →

Although overall mortality from cancer is decreasing in the European Union, its incidence increased by almost 20%, from 2.1 million new cases in 2002 to 2.5 million in 2008, says a special issue [1] of the European Journal of Cancer (the official journal of ECCO – the European CanCer Organisation) on cancer prevention.

The current economic crisis threatens to affect cancer incidence in a number of areas, says a paper by Dr. Jos?© M. Martin-Moreno from the University of Valencia, Spain, and colleagues. Public donations to cancer research funded by charitable organisations will fall, and governments as well as the pharmaceutical industry are likely to cut research and development budgets, say the researchers.

The prospects for disease caused by occupational exposure to carcinogens are also likely to worsen, they say. “Both private companies and governments tend to take shortcuts in occupational safety controls during periods of economic hardship,” said Dr. Martin-Moreno “and this is especially true for small companies and in developing countries.”

For example, a Korean study [2] carried out in the late 1990s linked the reduction of health and safety costs directly to the ability to avoid bankruptcy. “This exemplifies the terrible choice businesses have to make in times of economic downturn – reduced safety for workers or economic ruin,” said Dr. Martin-Moreno. For industries with potentially high levels of carcinogenic contamination such as mining this effect is compounded, he said.

Cancer prevention, like cancer itself, encompasses a large number of diverse factors including lifestyle choices, genetics, environment, occupation, infections and access to preventive healthcare, the researchers say. Cancer control efforts, therefore, can overlap with everything from the control of hypertension to the reduction of greenhouse gases. Unless forceful action is undertaken now, the cancer burden will only continue to grow, leading to enormous human cost and placing an unsustainable burden on health systems.

However, prevention efforts can also be more effective in times of crisis. As people give up or reduce unhealthy lifestyle habits in order to reduce costs, they may be particularly receptive to new and healthier choices, say the researchers. “Governments could also play their part by taking the opportunity to levy higher taxes on tobacco, alcohol and other unhealthy goods like trans fats or processed sugar and channelling the revenue thus derived towards job-creating disease prevention and social welfare programmes,” said Dr. Martin-Moreno.

The issue places special emphasis on the need to address cancer prevention using a holistic and global approach, focusing on the ‘big four’ risk factors of smoking, obesity, alcohol and physical inactivity. This represents a fundamental shift away from the reductive approach of earlier research, which meant looking narrowly, often in isolation, at multiple micro-components of diet and lifestyle, say the editors.

A paper by Dr. Esther de Vries, from the Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands and colleagues, looks at the impact of preventing weight gain and increasing physical activity on colon cancer incidence in seven European countries. The researchers used the PREVENT [3] statistical modelling method to make projections of future colon cancer incidence, both with and without realistic intervention scenarios involving physical activity and BMI reductions. Data studied came from cancer registries in the Czech Republic, Denmark, France, Latvia, The Netherlands, Spain, and the United Kingdom.

The incidence of colon cancer in Europe has increased since 1975, and comprised 13.6% of the estimated European cancer burden by 2008. It is the second most common cancer in Europe and also the second most common cause of cancer death.

“Yet we know that large numbers of colon cancer cases could be avoided by reducing exposure to risk factors, two of the most easily controllable of which are related to physical inactivity and excess weight,” said Dr. Andrew Renehan, from the University of Manchester, United Kingdom, one of the co-authors of the paper. While these risk factors are clearly intertwined – in general, physical inactivity increases with increasing body mass index (BMI) and increased physical activity contributes to avoidance of weight gain – increased physical activity does not necessarily result in weight reduction in overweight people.

“The predictive modelling is beginning to tease out the independent relevance of each of these factors in the prevention of colon cancer,” said Dr. Renehan.

Despite the benefits of physical activity and avoiding overweight, an increasing proportion of the European population has a BMI higher than the recommended maximum of 25, and few Europeans engage in the amounts of physical activity recommended by the current guidelines – at least 30 minutes of moderate physical activity on five or more days per week.

In the hypothetical scenario where overweight and obesity levels in European countries increased during the period 2009- at the same rate as has been observed in the US, the projected increase in rates of colon cancer ranged between 1.7 (UK) and 2.8 more (Spain) cases for 100,000 person-years for males. Increases for females ranged from 0.1 (Czech Republic) and 0.6 more cases (The Netherlands) per 100,000 person-years. These rates would translate to increases in numbers of new colon cancer cases of between 0.7 and 3.8%, the researchers say.

If a whole population obtained a mean BMI of 21, between 0.6 (Czech Republic, females) and 11 (Spain, males) per 100,000 new colon cancer cases would be avoided by 2040, translating into a population avoidable fraction (PAF) of overweight and BMI for colon cancer of 2/3% to 18%. PAFs for excess weight were much higher for males (between 13.5% and 18.2%) than for females 2.3% to 4.6%), and highest for British males (18%), the researchers say.

In the physical activity scenario, if all countries adopt the physical activity levels as observed for The Netherlands, which had the highest levels observed overall, between 0.5 (Czech Republic, males) and 5.1 (Spain; females) per 100,000 colon cancer cases per 100,000 person-years, or up to 17.5% of new colon cancer cases might be prevented in 2040. The highest PAF for physical activity was projected to be 21% for Spanish females.

“We found interesting patterns in these models,” said Dr. Renehan. “Preventing weight gain and encouraging weight reduction would seem to be most beneficial in men, but for women a strategy with a great emphasis on increasing physical activity would be more effective.”

Throughout the various papers in the special issue, the authors understand that modifying lifestyle is difficult. “We can safely say increasing physical activity across Europe to the level already achieved in The Netherlands, where everyone cycles, would be of substantial benefit,” said Professor Jan-Willem Coebergh, from Erasmus University, The Netherlands, and one of the co-editors. “But we will always need sound evidence before prevention strategies can be implemented,” he added.

Professor Michael Baumann, from the University Hospital and Medical Faculty, Dresden, Germany, and ECCO President, said: “Cancer prevention may not be foremost in the policy-makers’ minds at present, but right now it is more relevant than it has ever been before. The recession confronts them with a clear choice – either to introduce short-term cost-containment strategies, which will simply increase long-term costs, or to use the financial crisis as an opportunity to strengthen evidence-based prevention policies. We hope that the evidence so amply provided in this special issue of the EJC will help make them decide to follow the right road and take a major step towards reducing the incidence of cancer in Europe over the years to come.”

Notes:

Co-editors of the special issue were Professor Jan-Willem Coebergh and Dr Isabelle Soerjomataram, from Erasmus University, The Netherlands; Dr Jos?© M. Martin-Moreno from the University of Valencia, Spain; and Dr Andrew Renehan, from the University of Manchester, United Kingdom.

1. European Journal of Cancer, volume 46, issue 14 (September 2010), “Implementing Cancer Prevention in Europe”.

2. Kim J, Paek D. Safety and health in small-scale enterprises and bankruptcy during economic depression in Korea. J Occupational Health 2000; 42(5): 270-5.

3. The PREVENT cancer statistical modelling software was designed at Erasmus University, The Netherlands, over a decade ago and is now used in many other European countries through the EU’s EUROCADET programme.

4. Many of the studies reported in the special issue were funded through the Eurocadet project, financed by the European Commission.

5. The European Journal of Cancer is the official journal of ECCO – the European CanCer Organisation.

Source:
Mary Rice

ECCO-the European CanCer Organisation Continue reading →

A new US study concluded that as long as a diet is heart-healthy and reduces calorie intake it helps you lose weight, no matter what proportions
of fat, protein or carbohydrate it contains. However, in an accompanying editorial a nutrition expert questioned the conclusions because the
differences between the diets tested were actually much smaller than the researchers had planned, and there was also a tendency for the participants to
start putting weight back on again toward the end of the 2 year trial.

The study was the work of researchers from the Preventing Overweight Using Novel Dietary Strategies (POUNDS LOST) study, and was based at
Harvard University School of Public Health in Boston, Massachusetts, and at the Pennington Biomedical Research Center of Louisiana State
University in Baton Rouge, Louisianna to reflect the diverse range of culinary preferences from the two regions.

The study was published online in the 26 February issue of the New England Journal of Medicine and was funded by the National Heart, Lung,
and Blood Institute (NHLBI) of the National Institutes of Health.

The last few decades have seen an unprecedented surge in different kinds of diet for weight loss, with different emphases on protein, fat and
carbohydrate intake, but there are no prolonged studies that compare the relative advantages of such regimens.

For this study the researchers randomly assigned 811 overweight adults aged 30 to 70 to one of four diets, each with different calorie targets for fat,
protein and carbohydrate, as follows:

Low-fat, average protein: 20 percent fat, 15 percent protein, 65 percent carbohydrate.
Low-fat, high protein: 20 percent fat, 25 percent protein, 55 percent carbohydrate.
High-fat, average protein: 40 percent fat, 15 percent protein, 45 percent carbohydrate.
High-fat, high-protein: 40 percent fat, 25 percent protein, 35 percent carbohydrate.

The diets had similar foods and met recognized healthy heart guidelines (low in saturated fat and cholesterol while high in dietary fiber). The
participants also had group (twice a month) and individual (every two months) counselling for 2 years.

The participants’ targets for daily calorie intake ranged from 1,200 to 2,400 a day so that each person’s allowance was less than his or her daily
need.

38 per cent of the participants were men and 22 per cent represented ethnic minorities. They were all asked to do a moderate level of exercise, like
brisk walking, for at least 90 minutes a week, and none had diabetes or severe heart disease, although some had other risk factors such as high blood
pressure or high cholesterol.

The researchers measured weight loss after 6 months and 2 years. The main outcome measure was the change in body weight after 2 years according
to type of diet.

The results showed that:

After 6 months, participants on each diet had shed an average of 6 kg (13.2 lbs) which was about 7 per cent of their starting weight.
The participants began to regain weight after 12 months.
80 per cent of the participants completed the trial and after 2 years the average weight loss was 4kg (8.8 lbs).
After 2 years, the weight loss across the groups was very similar, regardless of fat, protein and carbohydrate content of their diet.
Weight loss in those on 15 per cent protein was similar to those on the 25 per cent protein (3.0 and 3.6 kg respectively).
Weight loss in those on 20 per cent fat was the same as those on 40 per cent fat (3.3 kg for both).
And in those on 65 per cent carbohydrate and 35 per cent carbohydrate the weight loss was also similar (2.9 and 3.4 kg respectively).
14 to 15 per cent of participants lost at least 10 per cent of their initial body weight over the 2 years.
Attendance at counselling sessions, satiety, hunger, and satisfaction with the diet were similar in all groups.
Attendance at counselling sessions was strongly linked to weight loss: 0.2 kg per session attended.
All the diets reduced risk factors due to blood fats and fasting levels of insulin.
Both at six months and two years, the improved risk factors included reduced levels of triglycerides, LDL (bad) cholesterol, lowered blood
pressure, and increased HDL (good) cholesterol.
All the diets also reduced presence of metabolic syndrome, a cluster of related conditions that includes: being overweight, having high triglycerides, high blood
sugar, high blood pressure, and low HDL cholesterol, which increases heart disease risk.
Participants also reduced their waistlines by 1 to 3 inches by the end of the study.

The authors concluded that:

“Reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize.”

Dr Elizabeth G. Nabel, director of NHLBI said in a press statement that:

“These results show that, as long as people follow a heart-healthy, reduced-calorie diet, there is more than one nutritional approach to achieving and
maintaining a healthy weight.”

“This provides people who need to lose weight with the flexibility to choose an approach that they’re most likely to sustain — one that is most suited to
their personal preferences and health needs,” she added.

Co-author Dr Catherine M. Loria, a nutritional epidemiologist at NHLBI said they were “encouraged that, in addition to achieving and maintaining
weight loss, study participants experienced other positive health changes as well”.

“The findings emphasize the importance of weight loss in reducing heart disease risk,” she said.

Dr Frank M. Sacks, principal investigator of POUNDS LOST and Professor of Cardiovascular Disease Prevention in the Nutrition Department at the
Harvard School of Public Health, said:

“This new information should focus weight loss approaches on reducing calorie intake rather than any particular proportions of fat, protein or
carbohydrate.”

“This is important information for health professionals who prescribe weight loss for their patients, and for adults who are seeking ways to sustain a
healthful eating pattern,” he added.

However, at least one expert remained sceptical about whether the study really did compare the diets as effectively as the researchers had
anticipated.

In an accompanying editorial, titled Weight-Loss Diets for the Prevention and Treatment of Obesity, Dr Martijn Katan, a nutrition professor at
the Institute of Health Sciences, VU University, Amsterdam, wrote that based on his calculations of their figures, the contrasts between high and low protein,
fat and carbohydrate in the diets varied much less than the researchers had planned.

For example the protein levels were supposed to vary by 10 per cent and only did so by 1 or 2 per cent and the difference in carbohydrate count was
supposed to be 30 per cent and only 6 per cent was actually achieved.

Katan said the study didn’t show that the diets had the same result but rather reinforced findings already established a number of times, that people find it very hard to keep the
weight loss in the long term:

“Even these highly motivated, intelligent participants who were coached by expert professionals could not achieve the weight losses needed to reverse
the obesity epidemic,” explained Katan.

He suggested in terms of public intervention it might be better to address the community rather than the individual, such making sure there are good
facilities to encourage people to exercise and avoid unhealthy eating.

“The most important determinant of success might not be the composition of the diet. It might be whether your community promotes exercise and
curbs high-calorie foods,” he wrote.

“Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates.”
Sacks, Frank M., Bray, George A., Carey, Vincent J., Smith, Steven R., Ryan, Donna H., Anton, Stephen D., McManus, Katherine, Champagne,
Catherine M., Bishop, Louise M., Laranjo, Nancy, Leboff, Meryl S., Rood, Jennifer C., de Jonge, Lilian, Greenway, Frank L., Loria, Catherine M.,
Obarzanek, Eva, Williamson, Donald A.
N Engl J Med 2009 360: 859-873.
Published online, February 26, 2009.

Click here for Article.

Sources: NEJM article and editorial, NHLBI press release.

: Catharine Paddock, PhD

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