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For Improving Fitness: Less Exercise Better Than None
For Improving Fitness Less Exercise Better Than None Jennifer P. Hellwig, MS, RD, ELS
e
Even small amounts of physical activity, approximately 75 minutes a week, can help improve fitness levels of postmenopausal women who are sedentary and overweight or obese, according to a study in the May 16 issue of JAMA. Researchers in Louisiana examined the effect of 50 percent, 100 percent and 150 percent of the National Institutes of Health Consensus Panel physical activity recommendations on cardiorespiratory fitness in sedentary, overweight or obese postmenopausal women with elevated blood pressure. The panel recommends at least 30 minutes of moderate-intensity physical activity on most, preferably all, days of the week. The study included 464 women whose body mass index ranged from 25.0 to 43.0 and whose systolic blood pressure ranged from 120.0 to 159.9 mm Hg. Even those women who exercised at the lowest levels experienced improvements in fitness compared with women who didn’t exercise at all. “This information can be used to support future recommendations,” wrote the authors, “and should be encouraging to sedentary adults who find it difficult to find the time for 150 minutes of activity per week, let alone 60 minutes per day.”
Human Papillomavirus Linked to Throat Cancer Human papillomavirus (HPV) is associated with throat cancers in both men and women, according to a study in the May 10 issue of the New England Journal of Medicine. The researchers found that oral HPV infection is the strongest risk factor for the disease, regardless of tobacco and alcohol use, and that having multiple oral sex partners tops the list of sex practices that boost risk for HPV-linked throat cancer. In the study of 100 men and women newly diagnosed with oropharyngeal cancer, those who had evidence of prior HPV infection were 32 times more
likely to develop the cancer. This was much higher than the rate increase of 3-fold for people who smoked and 2.5-fold for people who drank alcohol. Study participants who reported having more than six oral sex partners in their lifetime were 8.6 times more likely to develop the HPV-linked cancer. “It’s important for health care providers to know that people without the traditional risk factors of tobacco and alcohol use can nevertheless be at risk for oropharyngeal cancer,” says Gypsyamber D’Souza, PhD, a co-author of the study and assistant scientist at the
Johns Hopkins Bloomberg School of Public Health.
DOI: 10.1111/j.1751-486X.2007.00203.x
362
© 2007, AWHONN
http://nwh.awhonn.org
Computer-aided Detection and Mammogram Accuracy
Fiber, Magnesium and Diabetes Higher dietary intake of fiber from grains and cereals and of magnesium may each be associated with a lower risk of type 2 diabetes, according to a report and a meta-analysis in the May 14 issue of Archives of Internal Medicine. Projections indicate that the number of people diagnosed with diabetes worldwide may increase from 171 million in 2000 to 370 million by 2030, according to background information in the article, and the authors contend that the associated illness, death and
Projections indicate that the number of people diagnosed with diabetes worldwide may increase from 171 million in 2000 to 370 million by 2030. health care costs emphasize the need for effective prevention. The study involved 9,702 men and 15,365 women ages 35 to 65 years. Participants completed a food questionnaire when they enrolled in the study between 1994 and 1998 and then were followed up through 2005—an average of seven years—to see if they developed diabetes. In addition, the
researchers performed a meta-analysis of previously published work related to intake of fiber or magnesium and risk of diabetes. During the follow-up period, 844 individuals in the study developed type 2 diabetes. Those who consumed more fiber through cereal, bread and other grain products (cereal fiber) were less likely to develop diabetes than were those who ate less fiber. Participants who ate the most fiber (an average of 17 g per day) had a 27 percent lower risk of developing diabetes than those who ate the least (an average of 7 g per day). Eating more fiber overall or from fruits and vegetables was not associated with diabetes risk. In the meta-analysis, the researchers identified nine studies of fiber and eight studies of magnesium intake. Based on the results of all the studies in which participants were classified into either four or five groups according to their intake of fiber or magnesium, those who consumed the most cereal fiber had a 33 percent lower risk of developing diabetes than those who took in the least, while those who consumed the most magnesium had a 23 percent lower risk than those who consumed the least.
Computer-aided detection (CAD) that uses software designed to improve how radiologists interpret mammograms may instead make readings less accurate, according to a study published in the April 5 issue of the New England Journal of Medicine. The results show that women who got screening mammograms at centers using CAD devices were more likely to be told their mammogram was abnormal and thus undergo a biopsy to rule out breast cancer. CAD software analyzes the mammogram image and marks suspicious areas for radiologists to review, thus assisting them in determining which images could lead to serious tumors. CAD was approved by the U.S. Food and Drug Administration in 1998 and has been incorporated into many mammography imaging practices, but its effect on the accuracy of interpretation has been unclear. “This study points out the need for the use of other techniques to find cancer at its earliest stages,” said Dr. John E. Niederhuber, director of the National Cancer Institute. “In the end, technology facilitates screening. Ultimately, treatment requires radiologists working with the examining physician and the responsible surgeon to put everything together. We worry about false positives, but we certainly don’t want to miss any cancers, either.”
NEWS NUGGET
How Common is Bipolar Disorder? Approximately 4.4 percent of U.S. adults may have some form of bipolar disorder during some point in their lifetime, including about 2.4 percent with a “sub-threshold” condition, according to an article in the May issue of Archives of General Psychiatry.
August | September 2007
Nursing for Women’s Health
363
Magnetic Resonance Imaging for Breast Screening
Jennifer Hellwig, MS, RD, ELS, is managing editor of Nursing for Women’s Health.
Magnetic resonance imaging (MRI) scans of women who were diagnosed with cancer in one breast detected more than 90 percent of cancers in the other breast that were missed by mammography and clinical breast exam at initial diagnosis, according to a study published in the March 29 issue of the New England Journal of Medicine. Given the established rates of mammography and clinical breast exams for detecting cancer in the opposite, or contralateral breast, the authors contend that adding an MRI scan to the diagnostic evaluation effectively doubled the number of cancers immediately found in these women.
“One in ten women diagnosed with cancer in one breast will develop the disease in the opposite breast,” said Dr. Elias A. Zerhouni, director of the National Institutes of Health. “Having a better technique to find these cancers as early as possible will increase the chances of successful treatment.”
Smoking, Pregnancy and Mental Disorders Research published in the April issue of Obstetrics & Gynecology has identified an association between mental disorders and nicotine dependence among pregnant women in the United States, not unlike what’s been reported in the general population. The presence of these mental disorders in nicotine-addicted pregnant women may make quitting smoking more difficult. The study included 1,516 pregnant women at least 18 years old who took part in the 2001 to 2002 National Epidemiologic Survey of Alcohol and Related Conditions. Researchers found that 21.7 percent of the pregnant women in the study used cigarettes,
364
Nursing for Women’s Health
and among those women, 57.2 percent were nicotine dependent. These results indicate that in the United States an estimated 12.4 percent of pregnant women are addicted to cigarettes. Women with nicotine dependence were more likely to meet criteria for at
chronic depressive condition), major depressive disorder and panic disorder. “There is tremendous value in screening pregnant women who are unable to abstain from smoking for mental disorders,” said Dr. Nora D. Volkow, director of the National
Women with nicotine dependence were more likely to meet criteria for at least one mental disorder compared with those who didn’t use cigarettes during pregnancy. least one mental disorder compared with those who didn’t use cigarettes during pregnancy. Significant associations were found for dysthymia (a
Institute on Drug Abuse, “to not only identify and treat those who have been undiagnosed but also to improve successful quit smoking attempts.”
Volume 11
Issue 4
BY THE NUMBERS
Body Measurements The average height, weight and waist circumference for adults ages 20 years and over* are:
T R E N D W AT C H
Diabetes Contributing to Cardiovascular Disease
MEN
A study published in the March 27
Height (inches): 69.3
issue of Circulation shows that as rates
Weight (pounds): 190
of diabetes have risen in the United
Waist circumference: 39.0
States, the proportion of cardiovascular
WOMEN
disease (CVD) linked to diabetes has
Height (inches): 63.8
also increased. According to data from
Weight (pounds): 163
the Framingham Heart Study, the risk
Waist circumference: 36.5
attributable to diabetes in the group studied between 1952 and 1974 was
Source: National Center for Health Statistics
5.2 percent. By 1975 to 1998, it had
* Data are from 1999–2002.
jumped to 7.8 percent. The scientists also reported that the prevalence of
Weight and Conception If both partners in a couple are overweight or obese, they’re more likely to have to wait longer before successfully conceiving a child, according to research published in the March 7 online edition of the journal Human Reproduction. Researchers in Denmark studied 47,835 Danish couples between 1996 and 2002 and found that if both partners were obese, the chances of the couple having to wait for more than a year before the woman became pregnant were nearly three times higher (2.74) than for a normal-weight couple. If both partners were overweight, the likelihood they would have to wait longer than a year was 1.4 times higher. “If overweight and obesity actually is a cause of subfecundity, and if
diabetes among those with CVD almost doubled between the earlier and later time periods and there was also an increase in the prevalence of obesity.
Infant Mortality Rate Steady The infant mortality rate in the United States in 2004 was 6.78 infant deaths per 1,000 live births, which is not significantly different from the rate of 6.84 in 2003, according to the Centers for Disease Control and
the obesity epidemic continues, this reduced capacity to reproduce could become a serious public health problem. Further research in this area is needed,” said Cecilia Ramlau-Hansen, lead author of the study.
Prevention. Non-Hispanic black women had the highest infant mortality rate in the United States in 2004—13.60 per 1,000 live births compared with 5.66 per 1,000 births among non-Hispanic white women. Women of Cuban ethnicity in the United States had the lowest
NEWS NUGGET
Drug Dependence
infant mortality rate—4.55 per 1,000 live births.
Approximately 10.3 percent of U.S. adults appear to have problems with drug use or abuse during their lives, including 2.6 percent who become drug dependent at some point, according to a report in the May issue of Archives of General Psychiatry.
August | September 2007
Nursing for Women’s Health
365
e
Even small amounts of physical activity, approximately 75 minutes a week, can help improve fitness levels of postmenopausal women who are sedentary and overweight or obese, according to a study in the May 16 issue of JAMA. Researchers in Louisiana examined the effect of 50 percent, 100 percent and 150 percent of the National Institutes of Health Consensus Panel physical activity recommendations on cardiorespiratory fitness in sedentary, overweight or obese postmenopausal women with elevated blood pressure. The panel recommends at least 30 minutes of moderate-intensity physical activity on most, preferably all, days of the week. The study included 464 women whose body mass index ranged from 25.0 to 43.0 and whose systolic blood pressure ranged from 120.0 to 159.9 mm Hg. Even those women who exercised at the lowest levels experienced improvements in fitness compared with women who didn’t exercise at all. “This information can be used to support future recommendations,” wrote the authors, “and should be encouraging to sedentary adults who find it difficult to find the time for 150 minutes of activity per week, let alone 60 minutes per day.”
Human Papillomavirus Linked to Throat Cancer Human papillomavirus (HPV) is associated with throat cancers in both men and women, according to a study in the May 10 issue of the New England Journal of Medicine. The researchers found that oral HPV infection is the strongest risk factor for the disease, regardless of tobacco and alcohol use, and that having multiple oral sex partners tops the list of sex practices that boost risk for HPV-linked throat cancer. In the study of 100 men and women newly diagnosed with oropharyngeal cancer, those who had evidence of prior HPV infection were 32 times more
likely to develop the cancer. This was much higher than the rate increase of 3-fold for people who smoked and 2.5-fold for people who drank alcohol. Study participants who reported having more than six oral sex partners in their lifetime were 8.6 times more likely to develop the HPV-linked cancer. “It’s important for health care providers to know that people without the traditional risk factors of tobacco and alcohol use can nevertheless be at risk for oropharyngeal cancer,” says Gypsyamber D’Souza, PhD, a co-author of the study and assistant scientist at the
Johns Hopkins Bloomberg School of Public Health.
DOI: 10.1111/j.1751-486X.2007.00203.x
362
© 2007, AWHONN
http://nwh.awhonn.org
Computer-aided Detection and Mammogram Accuracy
Fiber, Magnesium and Diabetes Higher dietary intake of fiber from grains and cereals and of magnesium may each be associated with a lower risk of type 2 diabetes, according to a report and a meta-analysis in the May 14 issue of Archives of Internal Medicine. Projections indicate that the number of people diagnosed with diabetes worldwide may increase from 171 million in 2000 to 370 million by 2030, according to background information in the article, and the authors contend that the associated illness, death and
Projections indicate that the number of people diagnosed with diabetes worldwide may increase from 171 million in 2000 to 370 million by 2030. health care costs emphasize the need for effective prevention. The study involved 9,702 men and 15,365 women ages 35 to 65 years. Participants completed a food questionnaire when they enrolled in the study between 1994 and 1998 and then were followed up through 2005—an average of seven years—to see if they developed diabetes. In addition, the
researchers performed a meta-analysis of previously published work related to intake of fiber or magnesium and risk of diabetes. During the follow-up period, 844 individuals in the study developed type 2 diabetes. Those who consumed more fiber through cereal, bread and other grain products (cereal fiber) were less likely to develop diabetes than were those who ate less fiber. Participants who ate the most fiber (an average of 17 g per day) had a 27 percent lower risk of developing diabetes than those who ate the least (an average of 7 g per day). Eating more fiber overall or from fruits and vegetables was not associated with diabetes risk. In the meta-analysis, the researchers identified nine studies of fiber and eight studies of magnesium intake. Based on the results of all the studies in which participants were classified into either four or five groups according to their intake of fiber or magnesium, those who consumed the most cereal fiber had a 33 percent lower risk of developing diabetes than those who took in the least, while those who consumed the most magnesium had a 23 percent lower risk than those who consumed the least.
Computer-aided detection (CAD) that uses software designed to improve how radiologists interpret mammograms may instead make readings less accurate, according to a study published in the April 5 issue of the New England Journal of Medicine. The results show that women who got screening mammograms at centers using CAD devices were more likely to be told their mammogram was abnormal and thus undergo a biopsy to rule out breast cancer. CAD software analyzes the mammogram image and marks suspicious areas for radiologists to review, thus assisting them in determining which images could lead to serious tumors. CAD was approved by the U.S. Food and Drug Administration in 1998 and has been incorporated into many mammography imaging practices, but its effect on the accuracy of interpretation has been unclear. “This study points out the need for the use of other techniques to find cancer at its earliest stages,” said Dr. John E. Niederhuber, director of the National Cancer Institute. “In the end, technology facilitates screening. Ultimately, treatment requires radiologists working with the examining physician and the responsible surgeon to put everything together. We worry about false positives, but we certainly don’t want to miss any cancers, either.”
NEWS NUGGET
How Common is Bipolar Disorder? Approximately 4.4 percent of U.S. adults may have some form of bipolar disorder during some point in their lifetime, including about 2.4 percent with a “sub-threshold” condition, according to an article in the May issue of Archives of General Psychiatry.
August | September 2007
Nursing for Women’s Health
363
Magnetic Resonance Imaging for Breast Screening
Jennifer Hellwig, MS, RD, ELS, is managing editor of Nursing for Women’s Health.
Magnetic resonance imaging (MRI) scans of women who were diagnosed with cancer in one breast detected more than 90 percent of cancers in the other breast that were missed by mammography and clinical breast exam at initial diagnosis, according to a study published in the March 29 issue of the New England Journal of Medicine. Given the established rates of mammography and clinical breast exams for detecting cancer in the opposite, or contralateral breast, the authors contend that adding an MRI scan to the diagnostic evaluation effectively doubled the number of cancers immediately found in these women.
“One in ten women diagnosed with cancer in one breast will develop the disease in the opposite breast,” said Dr. Elias A. Zerhouni, director of the National Institutes of Health. “Having a better technique to find these cancers as early as possible will increase the chances of successful treatment.”
Smoking, Pregnancy and Mental Disorders Research published in the April issue of Obstetrics & Gynecology has identified an association between mental disorders and nicotine dependence among pregnant women in the United States, not unlike what’s been reported in the general population. The presence of these mental disorders in nicotine-addicted pregnant women may make quitting smoking more difficult. The study included 1,516 pregnant women at least 18 years old who took part in the 2001 to 2002 National Epidemiologic Survey of Alcohol and Related Conditions. Researchers found that 21.7 percent of the pregnant women in the study used cigarettes,
364
Nursing for Women’s Health
and among those women, 57.2 percent were nicotine dependent. These results indicate that in the United States an estimated 12.4 percent of pregnant women are addicted to cigarettes. Women with nicotine dependence were more likely to meet criteria for at
chronic depressive condition), major depressive disorder and panic disorder. “There is tremendous value in screening pregnant women who are unable to abstain from smoking for mental disorders,” said Dr. Nora D. Volkow, director of the National
Women with nicotine dependence were more likely to meet criteria for at least one mental disorder compared with those who didn’t use cigarettes during pregnancy. least one mental disorder compared with those who didn’t use cigarettes during pregnancy. Significant associations were found for dysthymia (a
Institute on Drug Abuse, “to not only identify and treat those who have been undiagnosed but also to improve successful quit smoking attempts.”
Volume 11
Issue 4
BY THE NUMBERS
Body Measurements The average height, weight and waist circumference for adults ages 20 years and over* are:
T R E N D W AT C H
Diabetes Contributing to Cardiovascular Disease
MEN
A study published in the March 27
Height (inches): 69.3
issue of Circulation shows that as rates
Weight (pounds): 190
of diabetes have risen in the United
Waist circumference: 39.0
States, the proportion of cardiovascular
WOMEN
disease (CVD) linked to diabetes has
Height (inches): 63.8
also increased. According to data from
Weight (pounds): 163
the Framingham Heart Study, the risk
Waist circumference: 36.5
attributable to diabetes in the group studied between 1952 and 1974 was
Source: National Center for Health Statistics
5.2 percent. By 1975 to 1998, it had
* Data are from 1999–2002.
jumped to 7.8 percent. The scientists also reported that the prevalence of
Weight and Conception If both partners in a couple are overweight or obese, they’re more likely to have to wait longer before successfully conceiving a child, according to research published in the March 7 online edition of the journal Human Reproduction. Researchers in Denmark studied 47,835 Danish couples between 1996 and 2002 and found that if both partners were obese, the chances of the couple having to wait for more than a year before the woman became pregnant were nearly three times higher (2.74) than for a normal-weight couple. If both partners were overweight, the likelihood they would have to wait longer than a year was 1.4 times higher. “If overweight and obesity actually is a cause of subfecundity, and if
diabetes among those with CVD almost doubled between the earlier and later time periods and there was also an increase in the prevalence of obesity.
Infant Mortality Rate Steady The infant mortality rate in the United States in 2004 was 6.78 infant deaths per 1,000 live births, which is not significantly different from the rate of 6.84 in 2003, according to the Centers for Disease Control and
the obesity epidemic continues, this reduced capacity to reproduce could become a serious public health problem. Further research in this area is needed,” said Cecilia Ramlau-Hansen, lead author of the study.
Prevention. Non-Hispanic black women had the highest infant mortality rate in the United States in 2004—13.60 per 1,000 live births compared with 5.66 per 1,000 births among non-Hispanic white women. Women of Cuban ethnicity in the United States had the lowest
NEWS NUGGET
Drug Dependence
infant mortality rate—4.55 per 1,000 live births.
Approximately 10.3 percent of U.S. adults appear to have problems with drug use or abuse during their lives, including 2.6 percent who become drug dependent at some point, according to a report in the May issue of Archives of General Psychiatry.
August | September 2007
Nursing for Women’s Health
365