Fewer screening colonoscopies OK for some: study

NEW YORK (Reuters Health) - People who've had a colonoscopy with no signs of cancer may be able to delay the next one or not have it at all, German researchers suggest.

Guidelines from the U.S. Preventive Services Task Force, a federally supported expert panel, currently recommend that people at average risk of colon cancer start screening for the disease at age 50, using one of a number of tests that have all been found to cut the risk of dying from colon cancer.

The advantage of colonoscopy, which costs around $3,000, is that it only has to be repeated once every ten years, as opposed to every year for the much cheaper stool test.

Although the German study isn't definitive, it does suggest that doing even fewer colonoscopies might be reasonable in some cases.

Dr. Hermann Brenner at the German Cancer Research Center in Heidelberg and colleagues asked nearly 2,000 colon cancer patients and 2,400 healthy people whether and when they'd had colonoscopies.

Compared with people who'd never undergone the procedure, those whose test came back negative -- meaning they had no trace of colon tumors -- had five times lower odds of developing cancer down the road.

Writing in the Journal of Clinical Oncology, the German researchers say their results challenge current guidelines.

"The finding of sustained low risk for 20 years and beyond after a negative colonoscopy suggests that a screening colonoscopy might not need to be repeated after 10 years as was previously recommended," they note.

For those who light up, however, that might not be the case. Ten years from a negative test, current smokers had the same colon cancer risk as non-smokers who'd never had a colonoscopy.

According to the American Cancer Society, about one in 20 people get colon cancer, and the disease causes nearly 50,000 U.S. deaths every year.

Longer screening intervals could have a significant impact on the overall cost-effectiveness of colonoscopy as well as lower the rate of colonoscopy-related complications, according to the German team.

Dr. John Inadomi of the University of Washington in Seattle said the new findings are not surprising, because a negative colonoscopy sorts people at low risk of colon cancer from those at higher risk.

He added that the first intervention to prevent a disease is always the most effective because of diminishing returns on any subsequent interventions that cost the same.

Still, he told Reuters Health, "perhaps lengthening the interval between screening colonoscopies is a reasonable proposal" for patients with a negative colonoscopy.

SOURCE: http://bit.ly/mTdu4R Journal of Clinical Oncology, online August 29, 2011.

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Weight Watchers works, study finds

Adults referred to the commercial weight loss programme Weight Watchers shed twice as much weight as people who received standard care over a 12-month period, according to a study published Thursday.

In clinical trials, researchers led by Susan Jebb of the UK Medical Research Council assessed 772 overweight and obese adults in Australia, Germany, and Britain.

About half the patients received a year's standard care, while the other half were given a 12-month free membership for a Weight Watchers group near their homes.

Sixty-one percent of the participants assigned to the commercial programme completed it, while 51 percent of the "standard care" group finished their programme.

Overall, individuals in Weight Watchers lost around twice as much weight as did those in the other group, a mean loss of 5.1 kilograms versus 2.2. Among those who stuck with either programme to the end, the figures were 6.7 against 3.3 kg, respectively.

Participants randomised to Weight Watchers were also more than three times as likely to lose at least five percent of their bodyweight, said the study, published in The Lancet.

Weight Watchers offers weekly weighing and group support. It also promotes a balanced, reduced-energy diet along with increased physical activity.

Primary care providers -- sometimes nurses, sometimes doctors -- generally offer weight-loss treatment in line with national guidelines, but vary in the level of supervision.

"The similar weight losses achieved in Australia, Germany, and the UK implies that this commercial programme, in partnership with primary care providers, is a robust intervention that is generalisable to other economically developed countries," the researchers concluded.

The researchers emphasised the important role of family doctors and primary health-care providers in giving advice, and in making referrals to commercial weight-loss programmes.

"Further research is needed to examine long-term weight loss maintenance, together with a formal analysis of cost-effectiveness," they added.

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Study casts wider net for risky blood pressure in kids

NEW YORK (Reuters Health) - More kids than previously thought could be at risk for dangerously high blood pressure, with as many as a quarter having blood vessels that look like those of much older people, according to a new study.

Because there is a theoretical possibility that some of these kids could suffer a stroke or a heart attack down the road, researchers say the findings mean all kids should have their blood pressure measured.

"I do think it's important that everybody gets screened for high blood pressure," said Dr. Karen Redwine of Arkansas Children's Hospital in Little Rock, whose findings appear in the Journal of Pediatrics.

"The overall rate for developing high blood pressure when you're a teenager is still very low," she added in an interview with Reuters Health. "But there is a subset of people whose rate of developing high blood pressure is anywhere from two to five times that, and a lot of those are children who would now be considered normal."

Those children have slightly elevated blood pressure and are diagnosed with so-called "prehypertension." The label is controversial, however, because it doesn't describe a disease -- rather, it is a risk factor for later developing high blood pressure, which itself is a risk factor for heart disease.

An expert who wasn't part of the new study said he worried it could be used to push medications without evidence that they will do kids any good.

"What troubles me a bit is that they talk about pharmacologic therapy," said Dr. Curt D. Furberg, an expert in heart disease prevention and drug safety at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.

"When I look at the author list, there is one from Bristol-Myers Squibb," he added. "Drug companies want to increase their market. In this area, considering healthy young kids for pharmacologic therapy doesn't make sense."

The National Heart, Lung, and Blood Institute in 2004 defined prehypertension in kids as a top blood pressure number between 120 and 139 or a bottom number between 80 and 89. High blood pressure starts at 140 over 90.

If lifestyle changes like cutting down on salt and exercising aren't enough to control high blood pressure in kids, NHLBI advises trying drugs.

In adults, high blood pressure ups the risk of stroke and heart attack a few percent. For children, however, the NHLBI acknowledges that the long-term consequences of having high blood pressure are unknown for children, as are the side effects of drug treatment.

"In my mind there are many more pressing issues in medicine than screening for hypertension in adolescents, where we don't even know if treatment is beneficial," Furberg, a professor of public health, told Reuters Health.

The new study is an attempt at estimating how often children with prehypertension go on to develop full-blown high blood pressure, or hypertension.

Tapping into data from a large screening study -- funded by drugmakers -- at Texas schools, Redwine and colleagues found that 11 out of 1,006 students developed high blood pressure during the study.

That corresponds to a rate of one in 200 teenagers every year. Although the rate appeared similar for kids with prehypertension, a broader definition created by Redwine and her colleagues nearly tripled the rate.

According to the new definition, just one blood pressure measurement above normal would put a kid in the "at-risk" group.

Up until now, Redwine explained, doctors used to think that one high blood pressure measurement might just be a fluke -- because the kid was nervous or a little sick.

Now, she said, "if it's elevated even once then you need to watch it and monitor it."

Currently, the NHLBI doesn't recommend drug therapy for kids with prehypertension. But the new report suggests investigating the use of medication in those deemed "at risk."

According to the Texas screening study, that could be as many as 26 percent of U.S. teenagers with the new definition -- including healthy kids who aren't overweight.

To Furberg and other critics, prehypertension -- let alone the expanded definition in the new study -- is a concept that comes with threats of overdiagnosis, overtreatment and wasteful health spending.

"This is what the industry is trying to do, to get people on drugs," he said. "They are pushing that for adults, and now they seem to move to kids, which is troublesome."

Redwine countered that, although one of her co-authors is employed by Bristol-Myers Squibb, her report did not advocate drug use in children with prehypertension.

"It is not the point to say that they need to be treated," she told Reuters Health.

The U.S. Preventive Services Task Force, a federally-supported expert panel, recommends screening adults for high blood pressure. It is currently updating its 2003 guidelines for children and adolescents, which noted that the evidence was insufficient to weigh the harms and benefits of screening kids.

SOURCE: http://bit.ly/qwbARr The Journal of Pediatrics, online August 25, 2011.

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Weight Watchers works, scientific study finds

LONDON (Reuters) - Overweight patients told by their doctors to go to Weight Watchers lose around twice as much weight as people receiving standard weight loss care over 12 months, according to the findings of a study published on Thursday.

In the first randomized controlled trial -- considered the gold standard of scientific analysis -- to directly compare a commercial weight-loss program with standard care by family doctors, Weight Watchers was found to be more than twice as effective.

More people stuck to the Weight Watchers diet, they lost more weight and fat mass, and also shaved more off their waist measurements than those assigned to standard care.

Susan Jebb of Britain's Medical Research Council (MRC) Human Nutrition Research Unit, who led the study, said the results showed Weight Watchers is "a robust intervention that is generalisable to other economically developed countries."

"This kind of research is important so that we can identify clinically effective interventions to treat obesity," she said.

The study, published in the Lancet medical journal, comes in the wake of research last month which said obesity is a global epidemic that is fast replacing tobacco as the single most important preventable cause of costly chronic diseases like heart disease, diabetes and cancer.

Worldwide, around 1.5 billion adults are overweight and another 0.5 billion are obese, with 170 million children classified as overweight or obese. Obesity takes up between 2 to 6 percent of healthcare costs in many countries.

In the weight loss study, which was funded by Weight Watchers International but run as an investigator-led trial with all data collection and analysis conducted by the independent research team, researchers assessed 772 overweight and obese adults in Australia, Germany and Britain.

Patients were randomly assigned to receive either 12 months of standard care as usually offered by the primary care team, or referred to and given a 12-month free membership for a Weight Watchers group in their neighborhood.

As well as losing twice as much weight as those in the standard care group, patients referred to Weight Watchers were also more than three times as likely to lose 10 percent or more of their initial body weight. Some 61 percent of patients in the Weight Watchers group lost at least 5 percent of their body weight, compared with 32 percent in the standard care group.

The average weight loss at 12 months was 5.1 kg (11.2 lbs) for those using Weight Watchers versus 2.2 kg for those on standard care. For those who completed the full 12 months, average weight loss was 6.7 kg on Weight Watchers versus 3.3 kg on standard care.

"These important findings show that obesity treatment is effective and structured commercial programs can enhance outcomes," said Nick Finer a consultant endocrinologist and bariatric physician at University College London Hospitals, who was not involved in the research.

In a commentary on the study, Kate Jolly and Paul Aveyard of the school of health and population sciences at Britain's Birmingham University said cost-effectiveness was a key factor in determining whether commercial programs like Weight Watchers become part of publicly funded health care.

They added that "the low cost of these programs -- at present about 50 to 60 pounds ($80 to $95) for 12 weeks -- makes the case for incorporation intuitively appealing."

David Kirchhoff, CEO of Weight Watchers International said the Lancet study "proves that Weight Watchers is part of the solution to help transform the health of nations."

"There is a clear need for practical treatment solutions that are proven effective, affordable and scalable to have a population-wide impact," he said in a statement.

(Reporting by Kate Kelland, editing by Paul Casciato)

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Mom better than dad at soothing baby's pain: study

NEW YORK (Reuters Health) - Preemies show less pain when mom holds them than when dad tries to comfort them, according to a new study of babies having blood drawn at the hospital.

But the differences were small, said an outside researcher, and what's more important is that being held by either parent seemed to help babies get through the heel-stick procedures more easily.

Researchers investigated the effect of so-called "kangaroo care" on the babies' expressions of pain. In kangaroo care, an adult holds the infant, wearing only a diaper, against his or her bare chest, with a sheet or other cover wrapped around the pair.

"There's a big difference between when a baby gets (blood drawn) alone in an incubator and when the mom or dad holds the baby for this procedure," said Dr. Larry Gray, a pediatrician at Comer Children's Hospital at the University of Chicago who was not involved in the new study. "The first take-home is, boy, this really works."

Previous studies have shown that skin-to-skin contact has a number of positive health benefits for the baby, including relieving pain. And that could be especially important in preemies that need extra medical procedures and are more fragile than full-term babies, experts say.

"Here's a little 3-pound baby who says, 'I'd much rather have weighed 6 pounds or 7 pounds at birth, and now I have to keep myself warm, I have to beat my little heart,'" Gray said. With kangaroo care, "the parent provides the warmth, and the breathing regulation, and all of those hidden things," he told Reuters Health.

For the new study, C. Celeste Johnston from the McGill University School of Nursing in Montreal looked at 62 preemies in the neonatal intensive care unit who needed multiple heel stick procedures for blood tests. For each of those procedures, the investigators had the baby's mom and dad alternate who held the baby using kangaroo care.

At the same time, they videotaped the faces of each of the babies during and after the blood draw. The faces were then analyzed for tell-tale expressions of pain, such as squeezed eyes and a furrowed nose and lip. Pain was rated on a 0-to-21 scale.

With dads providing kangaroo care, pain scores were 8.5 and 8.6 at 30 seconds and 1 minute after blood was drawn. When babies were held instead by their moms, the scores were 1.4 to 1.5 points lower at those intervals -- but no different after 1 minute. That compares to pain scores of about 11 to 13 in other studies of babies who got a heel stick while lying in an incubator.

In general, moms reported having a bit more experience with kangaroo care than dads, although Johnston and colleagues said that didn't necessarily seem to explain the differences in babies' pain.

"This supports the hypothesis that there is something unique about the comfort of a mother's contact over and above that of another caring adult," they wrote in the Archives of Pediatrics and Adolescent Medicine. "The difference in the male physique, especially the chest, may be perceived by the infant to be not that of a natural caregiver."

Still, according to Gray, the main message is that "mothers or dads are way better than just having (a painful procedure) done with no kangaroo care, no parent contact," though "mothers who have a little experience with it can do it a little bit better than dads."

He also noted that both moms and dads in the study said they felt positively about doing kangaroo care with their babies and would do it again. Although it's a scary thing to hold a tiny vulnerable baby, he said, the new findings show it does help.

"Mothers and fathers should feel very comforted," he concluded.

SOURCE: http://bit.ly/nP87QH Archives of Pediatrics and Adolescent Medicine, online September 5, 2011.

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Chocolate doesn't have to derail a diet: study

NEW YORK (Reuters Health) - For chocolate lovers trying to drop a few pounds, new research suggests that it's still possible to lose weight while indulging your sweet tooth every day.

Overweight and obese women who added a bit of chocolate or other sweets on top of a healthy diet plan lost about 11 pounds over four months, on average.

The study was funded by Hershey's, which provided its own candy for snacks, and two of the study authors are company employees.

"Women think about going on a diet and think they have to deprive themselves of their favorite foods, but really that's not the case if you incorporate them in a portion-controlled way," said Kathryn Piehowski, who conducted the research while at Pennsylvania State University in University Park.

An outside researcher cautioned that the study had no "control" group of women who didn't eat a sweet snack, so it's impossible to know how much weight those who abstained from sweets, or ate other snacks, would have lost.

"Chocolate ... is a highly-desired food," said Debra Keast, from Food & Nutrition Database Research, Inc in Okemos, Michigan. But, she added, "I really don't think that it would be as effective as some other type of snack" for weight loss.

Snacks that also pack some fiber and protein, she said, would probably help women stay full until their next meal better than candy. For the new study, Piehowski and her colleagues tracked the weight loss of 33 overweight and obese women on a reduced-calorie diet.

Overweight is defined by having a body mass index (BMI) -- a measure of weight in relation to height -- between 25 and 29.9; obese is a BMI above 30. A BMI between 18.5 and 24.9 is considered normal.

All of the women in the study were premenopausal, with BMIs between 25 and 43. All attended weekly nutrition sessions and were taught a diet plan based on food exchanges and portion size that aimed for 1,500 to 1,800 calories per day.

Half of them were also given small dark chocolate snacks to eat twice a day (totaling 90 calories each day) and sugar-free cocoa for breakfast. The other women ate fruit-flavored licorice snacks and had a sugar-free non-cocoa drink in the morning.

Twenty-six women completed the study, 13 in each group. After just over four months, women in both groups had lost an average of 11 pounds. The researchers said that shows that women don't have to totally remove chocolate and other sweet snacks from their diets to see weight-loss success. And the small snacks may reduce cravings for more sweets, they add -- cravings that have been the downfall of many strict diets.

"As soon as someone tells you you can't have something, what do you want? You want that thing," Piehowski, now at Nestle Health Science, told Reuters Health.

A diet with sweet snacks "may provide an effective weight-loss strategy for women who struggle with other more restrictive diet plans," the authors wrote in the Journal of the American Dietetic Association.

"I think allowing snacks and allowing sweets and a reward for exercising or a reward for sticking to your healthy foods is good," Keast, who was not involved in the new study, told Reuters Health.

"But I think there are probably other foods that might be more satiating to eat between meals, if the objective is to hold you over to the next meal so you're not feeling so hungry that you have to gorge when you actually sit down to eat."

She highlighted nuts and low-fat yogurt as two of those ideal snacks, but didn't denounce dark chocolate and its potential health benefits. For any weight-loss diet -- chocolate-enhanced or not -- "you need to eat small amounts frequently and not be on a restrictive diet where you're starving yourself," Keast said.

SOURCE: http://bit.ly/nWmBBK Journal of the American Dietetic Association, August 2011.

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