<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_322"
                     title="Switch to Low-Fat Milk in Schools Shows Benefit"
                     score="0.006"
                     href="http://www.medpagetoday.com/PrimaryCare/DietNutrition/tb/18192?impressionId=1265800451623"
                     
      &lt;p&gt;When New York City public schools made the switch from whole milk to skim or low-fat milk, students cut their annual fat and total calorie consumption, department researchers found.&lt;/p&gt;
&lt;p&gt;Milk-drinking students consumed 5,960 fewer calories and 619 fewer grams of fat per year after they made the switch, Philip M. Alberti, PhD, of the New York Department of Health and Mental Hygiene, and colleagues reported in the Jan. 29 issue of CDC&apos;s &lt;em&gt;Morbidity &amp;amp; Mortality Weekly Report&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;At 3,500 calories per pound, the reduction would be the equivalent of 1.7 pounds of body weight over the course of a year.&lt;/p&gt;
&lt;p&gt;&quot;The switch to lower-fat milk likely has improved the overall nutritional environment of NYC public schoolchildren,&quot; Alberti and colleagues wrote.&lt;/p&gt;
&lt;p&gt;On the other hand, most of the low-fat milk consumed was chocolate milk, which has a substantially higher sugar content than unflavored milk, the researchers found.&lt;/p&gt;
&lt;p&gt;In 2005, the New York City Department of Education began reviewing its food policies and determined that replacing whole milk with fat-free or low-fat milk could decrease students&apos; fat and calorie intake.&lt;/p&gt;
&lt;p&gt;At subsequent board meetings, milk industry advocates suggested that without whole milk or chocolate- or strawberry-flavored milk, student milk consumption would decline, thus decreasing calcium and vitamin intake.&lt;/p&gt;
&lt;p&gt;Nonetheless, the Department of Education began phasing out whole milk in 2005, and limited flavored milk to fat-free chocolate milk.&lt;/p&gt;
&lt;p&gt;The researchers didn&apos;t have data on student consumption of milk, so they analyzed system-wide school milk purchases.&lt;/p&gt;
&lt;p&gt;They found that per-student school milk purchases dropped 8% between 2004 and 2006, but then gradually began to increase. By 2009, purchases had risen 1.3% from five years prior: from 112 per student in 2004 to 114 in 2009.&lt;/p&gt;
&lt;p&gt;Fat-free milk accounted for 42% of all purchases in 2009, compared with less than 7% in 2004.&lt;/p&gt;
&lt;p&gt;In 2004, students purchased more than 18 billion calories and 520 million grams of fat in the form of milk. That fell to less than 14 billion calories and 98 million grams of fat in 2009, representing a 25% and 81% decrease, respectively.&lt;/p&gt;
&lt;p&gt;Over that five-year time period, the researchers calculated that if calorie and fat savings were distributed among all students  --  including those who don&apos;t drink milk  --  they would consume 3,484 fewer calories and 382 fewer grams of fat each year.&lt;/p&gt;
&lt;p&gt;If the data were limited to students who do drink milk during the school day  --  62% of students in 2004 and 63% in 2009  --  the savings increased to 5,960 calories and 619 fat grams per year.&lt;/p&gt;
&lt;p&gt;Alberti and colleagues wrote that the data show the milk policy change reduced fat and calorie intake while still providing protein, calcium, and vitamins A and D.&lt;/p&gt;
&lt;p&gt;&quot;Other school systems can use these results to guide changes to their own school food policies,&quot; they said.&lt;/p&gt;
&lt;p&gt;They noted, however, that the majority of low-fat milk consumed  --  60% of all milk purchases  --  was chocolate milk, a concern because sweetened milk has more calories than reduced-fat white milk and contains twice as much sugar.&lt;/p&gt;
&lt;p&gt;But limiting its availability would &quot;further reduce milk consumption,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;The authors noted that the study was limited because there were no data to evaluate the magnitude of the correlation between milk purchasing and milk consumption. Also, no data were collected on students&apos; diets, so the researchers could not assess the policy&apos;s larger effects on diet.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_265"
                     title="How Many Calories in that Happy Meal? (CME/CE)"
                     score="0.001"
                     href="http://www.medpagetoday.com/PrimaryCare/DietNutrition/tb/18099?impressionId=1265800451623"
                     
      Putting nutrition labels on fast food may lead parents to pick lower-calorie meals for their children, researchers say.&lt;br&gt;
&lt;br&gt;In a small waiting room study, parents ordered about 20% fewer calories for their kids when they chose from a menu with nutrition information on it, Pooja Tandon, MD, of the University of Washington, and colleagues reported online in &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;&quot;One hundred calories over time and at a population level is actually a significant amount in terms of being able to avert weight gain,&quot; Tandon told &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;Many fast-food restaurants don&apos;t provide nutrition information at the point of purchase. In a recent study, just about half  --  54%  --  of the largest chains made some nutritional information available on site. The majority  --  86%  --  provided it only through their Web sites, leaving consumers clueless while ordering.&lt;br&gt;
&lt;br&gt;Labels have long been advocated as a means of lowering calorie consumption. So to determine whether nutrition labeling specifically on fast-food menus would lead to lower-calorie choices for children, the researchers conducted a randomized, controlled experiment in a primary care pediatric clinic in Seattle.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Parents of children ages 3 to 6 were given a McDonald&apos;s menu, and then asked to pick out meals anonymously&lt;strong&gt; &lt;/strong&gt;for themselves and their child.&lt;/p&gt;
&lt;p&gt;The menus were identical, with one exception: those given to parents in the intervention group included nutrition information, while the menus given to parents in the control group had none. The menus did include prices for both groups.&lt;/p&gt;
&lt;p&gt;A total of 99 parents participated between October 2008 and January 2009. Some 62% reported eating fast food one to four times over the previous month, mostly because it was quick, cheap, or fun.&lt;/p&gt;
&lt;p&gt;The researchers found that parents who were given nutritional information ordered an average of 102 fewer calories for their kids than did controls (567.1 cal versus 671.5 cal, &lt;em&gt;P&lt;/em&gt;=0.04).&lt;/p&gt;
&lt;p&gt;On average, the nutrition-labeled menu reduced total calories ordered by 20%, the researchers wrote.&lt;/p&gt;
&lt;p&gt;The difference remained significant after adjustment for gender, race, education, BMI, fast-food frequency, and child&apos;s BMI z-score (&lt;em&gt;P&lt;/em&gt;=0.004).&lt;/p&gt;
&lt;p&gt;&quot;We know that fast food consumption is rising alongside alarming rates of child obesity in this country,&quot; Tandon said. &quot;These results make me optimistic that if parents are given nutritional information at the point of ordering  --  and not on a Web site or tray liner  --  they will have the tools to make healthier, lower-calorie choices for their children.&quot;&lt;/p&gt;
&lt;p&gt;Research has suggested that even small changes in behavior that affect energy balance by about 100 calories per day could avert weight gain in most adults.&lt;/p&gt;
&lt;p&gt;Interestingly, Tandon said, there were no differences between the groups when it came to parents&apos; choices for themselves. Both ordered about the same number of calories.&lt;/p&gt;
&lt;p&gt;&quot;I&apos;m not sure exactly what&apos;s going on with this group of parents, but this is a trend we&apos;ve seen,&quot; Tandon said. &quot;I would hypothesize that there are some other factors at play when people are choosing for themselves and their children in terms of wanting children to eat healthier than they might for themselves.&quot;&lt;/p&gt;
&lt;p&gt;There was also a positive correlation between how many calories the parent ordered and how many calories he or she ordered for the child (&lt;em&gt;P&lt;/em&gt;=0.02).&lt;/p&gt;
&lt;p&gt;&quot;We do know that if a child has one or two parents who are overweight, that increases their chance of being overweight, so [obesity] probably is a combination of genetic and environmental factors,&quot; Tandon said.&lt;/p&gt;
&lt;p&gt;Tandon noted that a growing number of local and state governments have adopted restaurant menu labeling regulations, and legislation for federal labeling standards has been introduced in both the House and the Senate.&lt;/p&gt;
&lt;p&gt;&quot;At a time when menu labeling is being discussed throughout country at the national level, I think these results support the&lt;strong&gt; &lt;/strong&gt;idea that an informed parent will be able to make smarter healthier choices for their child,&quot; she added.&lt;/p&gt;
&lt;p&gt;The study was limited because it was not conducted in a real restaurant setting. Food choices are made within social and environmental contexts, Tandon said, and the results of a mock menu survey in a clinic may not fully represent that reality. A randomized experiment in a real restaurant setting would be an ideal follow-up.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_261"
                     title="Scrubbing Away Germs Can Backfire on Backsides (CME/CE)"
                     score="0"
                     href="http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb/18121?impressionId=1265800451623"
                     
      Rashes from toilet seats are once again afflicting American children, and the rare condition is often misdiagnosed, which may delay proper treatment.&lt;br&gt;
&lt;br&gt;That&apos;s the conclusion from a report based of five-cases of toilet-seat contact dermatitis investigated by researchers at Johns Hopkins University School of Medicine and reported in the Jan. 25 issue of &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;While toilet-seat dermatitis is commonly thought to result from allergies to wooden seats, the report concludes that another source is plastic toilet seats cleaned with harsh detergents.&lt;/p&gt;
&lt;p&gt;&quot;This case series and previous reports have documented that toilet-seat dermatitis is much more common than previously recognized in the U.S. and around the world,&quot; Bernard A. Cohen, MD, and colleagues wrote.&lt;/p&gt;
&lt;p&gt;&quot;Furthermore, the incidence of this condition is rising in North America because of a resurgent popularity of exotic-wood toilet seats and frequent use of detergents that contain highly irritant/sensitizing compounds such as quaternary ammonium compounds, phenol, formaldehyde, etc. in public restrooms.&quot;&lt;/p&gt;
&lt;p&gt;Of the cases analyzed by the authors, two occurred in the U.S. and the other three occurred in India.&lt;/p&gt;
&lt;p&gt;Both U.S. cases were girls, a 6-year-old who had a rash for over two years before it was correctly diagnosed and a 10-year-old whose rash lasted for a year. In both cases, the rashes seemed to worsen during the school year when the girls were using school restrooms. The younger girl&apos;s dermatitis twice became infected with methicillin-resistant &lt;em&gt;Staphylococcus aureus &lt;/em&gt;and required treatment with antibiotics.&lt;/p&gt;
&lt;p&gt;After doctors determined the rashes were the result of contact with toilet seats and instructed the girls to use toilet-seat covers and apply moisturizers and topical steroids to the affected areas, the eruptions cleared up within a few weeks.&lt;/p&gt;
&lt;p&gt;The cases in India included a 14-month old boy and two girls, 12 and 10.&lt;/p&gt;
&lt;p&gt;The boy and the 12-year-old girl were both initially misdiagnosed with ringworm and unsuccessfully treated with clotrimazole cream. The other girl was unsuccessfully treated with ayurvedic and homeopathic topical medications before doctors diagnosed toilet-seat dermatitis. Two of the children were instructed to use soaps that only exacerbated the problem.&lt;/p&gt;
&lt;p&gt;In all three cases, the rashes cleared up with some combination of topical steroids, using toilet-seat covers, replacing the household toilet seat, and limiting time on the toilet.&lt;/p&gt;
&lt;p&gt;The authors distinguished between two types of toilet-seat dermatitis: allergic contact dermatitis, the better described form of the condition, in which a patient develops allergy to wooden toilet seats, and irritant contact dermatitis, in which the rashes result from contact with harsh detergents used on plastic toilet seats.&lt;/p&gt;
&lt;p&gt;They noted that detergents used in public restrooms and in hospitals are potentially more irritating to the skin than those used at home and that alkaline detergents are more likely to cause skin irritation than acidic detergents, because they perturb the body&apos;s natural acidic environment.&lt;/p&gt;
&lt;p&gt;Toilet-seat dermatitis was first identified as an external skin rash in 1927. Exposure to wooden toilet seats and associated varnish, lacquers, and paints led to sensitization and development of an allergic contact dermatitis.&lt;/p&gt;
&lt;p&gt;The condition nearly disappeared in the U.S. in 1980s and 1990s, after public facilities and homeowners in the U.S. changed from wooden to plastic toilet seats and sanitary seat covers became readily available.&lt;/p&gt;
&lt;p&gt;However, in recent years the number of cases has grown as a result of homeowners installing toilet seats made of exotic woods and the increased use of harsh toilet seat detergents.&lt;/p&gt;
&lt;p&gt;Most reports have focused on adults with rashes, but little previous attention has focused on the condition in children. &quot;In this case series we describe toilet-seat contact dermatitis in children and underscore a typical history and physical findings that we hope will aid clinicians in recognizing this disease,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;&quot;It is important to underscore that regular use of toilet-seat covers is the key to success in treatment,&quot; the authors wrote. &quot;Such seat covers can be purchased at any major retailer such as Walmart or online.&lt;/p&gt;
&lt;p&gt;As an alternative, newspaper cutouts could be used to provide barrier protection. Although it is possible to develop an allergy to toilet-seat covers, none have been reported thus far in the literature.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors reported no sources of funding or financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_235"
                     title="Congenital Anomalies Linked to Mom&apos;s Diabetes (CME/CE)"
                     score="-0.003"
                     href="http://www.medpagetoday.com/OBGYN/Pregnancy/tb/18065?impressionId=1265800451623"
                     
      &lt;p&gt;Pregestational maternal diabetes was associated with an increased risk of a major congenital anomaly, but obesity itself was not, a cross-sectional study found.&lt;/p&gt;
&lt;p&gt;In a multivariable logistic model, the major contributor to a rising rate of congenital anomalies was maternal pregestational diabetes (OR 3.8, 95% CI 2.1 to 6.6), according to Joseph R. Biggio, Jr., MD, and colleagues from the University of Alabama at Birmingham.&lt;/p&gt;
&lt;p&gt;&quot;Because hyperglycemia is a major contributor to developmental malformations, interventions to address obesity and identify women at risk for diabetes and hyperglycemia should be considered in efforts to reduce the occurrence of congenital anomalies,&quot; they wrote in the February issue of &lt;em&gt;Obstetrics &amp;amp; Gynecology.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;Maternal obesity has been linked with numerous problems, including preeclampsia, gestational diabetes, fetal and neonatal death, and birth trauma, but scientists have disagreed over whether it also contributes to the risk of fetal malformations, the researchers noted.&lt;/p&gt;
&lt;p&gt;To help settle the issue, Biggio and colleagues used a perinatal database in their university health system that included all women with singletons delivered between 1991 and 2004.&lt;/p&gt;
&lt;p&gt;They divided the cohort into three time periods  --  1991 to 1994, 1995 to 1999, and 2000 to 2004, with a total of 41,902 pregnancies.&lt;/p&gt;
&lt;p&gt;For their primary analysis, they defined maternal obesity as a first prenatal visit weight greater than 200 lb, because during the earlier epochs many women did not have body mass index (BMI) calculated. For their secondary analyses they used BMI greater than 29 kg/m&lt;sup&gt;2&lt;/sup&gt; as the criterion for obesity.&lt;/p&gt;
&lt;p&gt;In each epoch, there were increases in mean maternal weight, mean BMI, the proportion of women weighing more than 200 lb, the proportion with a BMI greater than 29 kg/m&lt;sup&gt;2&lt;/sup&gt;, and the prevalence of pregestational diabetes (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for all).&lt;/p&gt;
&lt;p&gt;Univariable analysis determined that the rate of major anomalies, particularly involving the cardiac and pulmonary systems, also increased during each time period.&lt;/p&gt;
&lt;p&gt;But there was no independent association between congenital anomalies and maternal obesity using either definition, during any of the three time periods or during the study overall.&lt;/p&gt;
&lt;p&gt;Although no direct association was seen between congenital malformations and maternal obesity, the investigators reported that the proportion of anomalies that could be attributed to obesity increased from 0% to 23% during the overall study period.&lt;/p&gt;
&lt;p&gt;The proportion of anomalies that could be attributed to diabetes ranged from 58% to 76%.&lt;/p&gt;
&lt;p&gt;Moreover, for obese women with diabetes the proportion of anomalies attributed to diabetes increased sharply, from 48% in the first epoch to 74% in the third epoch.&lt;/p&gt;
&lt;p&gt;In contrast, for the obstetric population as a whole, the population-attributable risk of congenital malformation related to obesity rose from near zero in the first epoch to 6.1% in the third epoch, while that related to diabetes increased from 3.3% to 9.2%, the investigators reported.&lt;/p&gt;
&lt;p&gt;During the course of the study there was a nearly 15-lb increase in maternal weight and a 30% increase in the proportion of women whose BMI exceeded 29 kg/m&lt;sup&gt;2&lt;/sup&gt;.&lt;/p&gt;
&lt;p&gt;There also was a nearly twofold increase in the rate of major anomalies  --  and a 250% increase in the prevalence of diabetes.&lt;/p&gt;
&lt;p&gt;The authors observed that there has been much interest in the effects of maternal obesity on birth defects.&lt;/p&gt;
&lt;p&gt;Although the pathophysiologic basis for this possible association have not been identified, hypotheses have included increased serum insulin, lower levels of folic acid, chronic hypoxia, and increased inflammatory mediators.&lt;/p&gt;
&lt;p&gt;&quot;Our study provides evidence that the defects may not be due solely to the maternal obesity per se but may be due to undiagnosed diabetes,&quot; the investigators wrote.&lt;/p&gt;
&lt;p&gt;From a public health standpoint, the study findings suggest that efforts to reduce the prevalence of congenital anomalies should be focused less on obesity and aimed more closely at correcting hyperglycemia.&lt;/p&gt;
&lt;p&gt;&quot;If euglycemia could be achieved before pregnancy, or at least embryogenesis and organogenesis, the majority of these anomalies could potentially be avoided,&quot; they observed.&lt;/p&gt;
&lt;p&gt;They also suggested that even women of normal weight, but with other diabetes risk factors, could benefit from closer attention to glycemic control.&lt;/p&gt;
&lt;p&gt;A weakness of the study was the fact that detailed data on glycemic control was not available in the perinatal database, &quot;and therefore we cannot comment on the association between glycemic control and anomaly rates,&quot; the investigators wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported in part by the National Institute of Child Health and Human Development.&lt;/p&gt;&lt;p&gt;The authors did not report any potential conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_183"
                     title="Gastric Bypass Extends Life for Most Patients (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/PrimaryCare/Obesity/tb/18020?impressionId=1265800451623"
                     
      &lt;p&gt;For most patients in most categories, bariatric surgery increases life expectancy, according to a new mathematical model.&lt;/p&gt;
&lt;p&gt;Only when short-term mortality following bariatric surgery is expected to be high or the likelihood of success is low will the procedure fail to improve life expectancy, researchers reported in the January &lt;em&gt;Archives of Surgery&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Computer modeling predicted that a hypothetical &quot;base case&quot; patient  --  a 42-year-old woman with a body mass index of 45  --  would gain 2.95 years of additional survival following bariatric surgery, according to Daniel P. Schauer, MD, of the University of Cincinnati, and colleagues.&lt;/p&gt;
&lt;p&gt;Surgery failed to be beneficial in the model only when 30-day mortality reached 9.5% or the likelihood that surgery would not add life-years was 2% or less, they found.&lt;/p&gt;
&lt;p&gt;Baseline 30-day mortality in the model was 0.2%, and the baseline efficacy of surgery in extending life expectancy was 53%.&lt;/p&gt;
&lt;p&gt;&quot;While not all patients are guaranteed a good outcome, our model indicates that gastric bypass increases life expectancy for most patient subgroups,&quot; they concluded.&lt;/p&gt;
&lt;p&gt;Their analysis was based on a Markov decision model using published data to estimate 30-day mortality following bariatric surgery and the efficacy of surgery in reducing long-term death rates.&lt;/p&gt;
&lt;p&gt;The latter had two components: reduction in excess mortality associated with obesity, and research data on long-term mortality following bariatric surgery.&lt;/p&gt;
&lt;p&gt;Excess mortality estimates came from National Health Interview Survey data on some 400,000 participants from 1991 to 1996 linked to the National Death Index. Inputs on surgery efficacy were derived from a 2007 study of nearly 8,000 patients who had undergone gastric bypass and the same number of medically treated or untreated obese controls.&lt;/p&gt;
&lt;p&gt;That study found that the procedure cut death rates by half during about seven years of follow-up. (See &lt;a href=&quot;http://www.medpagetoday.com/PrimaryCare/Obesity/6480&quot; mce_href=&quot;http://www.medpagetoday.com/PrimaryCare/Obesity/6480&quot; target=&quot;_blank&quot;&gt;Missing Link Found: Bariatric Surgery Reduces Mortality&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;Schauer and colleagues obtained rates of inhospital mortality following bariatric surgery from the 2005 National Inpatient Survey, then multiplied them by three to estimate 30-day mortality.&lt;/p&gt;
&lt;p&gt;The researchers explained that according to earlier research, inhospital death rates typically underestimate 30-day mortality by a factor of two to three.&lt;/p&gt;
&lt;p&gt;Their threefold correction factor represents &quot;a conservative estimate that biases the model against gastric bypass surgery,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;Schauer and colleagues tested this correction factor and other aspects of the model in sensitivity analyses.&lt;/p&gt;
&lt;p&gt;The biggest gains in life expectancy occurred in younger women with relatively high BMI values, the model showed.&lt;/p&gt;
&lt;p&gt;The age effect was less important than BMI at the time of surgery. A 35-year-old woman with BMI of 45 would gain about 3.2 years of extra life, whereas at 55, a similarly obese woman would gain about 2.5 extra years.&lt;/p&gt;
&lt;p&gt;But a 35-year-old woman with BMI of 55 could expect to live five more years with surgery, the model indicated.&lt;/p&gt;
&lt;p&gt;Men in general derived less survival benefit from bariatric surgery, particularly with advancing age at the time of the procedure.&lt;/p&gt;
&lt;p&gt;At 35, the difference in life expectancy gained was roughly 10%, but by age 75 it had grown to about 50%.&lt;/p&gt;
&lt;p&gt;The sensitivity analyses found that relatively large changes in most parameters used in the model did not affect the overall results substantially.&lt;/p&gt;
&lt;p&gt;The effect of 30-day mortality on whether or not surgery was beneficial for long-term survival was related to BMI and gender.&lt;/p&gt;
&lt;p&gt;For women with a BMI of 40, 30-day mortality of more than 5% would mean surgery was not helpful, but short-term mortality had to exceed 15% for surgery not to be preferable for those with BMI of 55 or more. These thresholds were about 10% higher for men.&lt;/p&gt;
&lt;p&gt;The efficacy of surgery in reducing mortality was less important for older men, the analysis also showed. A 75-year-man with a BMI of 35 could expect only a very slight gain in life span  --  perhaps one or two months.&lt;/p&gt;
&lt;p&gt;&quot;Younger patients have lower surgical risk and more time over which to realize the benefits of surgery. For older patients, the gain is smaller, and for some, gastric bypass surgery will decrease life expectancy,&quot; Schauer and colleagues wrote.&lt;/p&gt;
&lt;p&gt;However, they identified several potentially serious limitations to the analysis.&lt;/p&gt;
&lt;p&gt;The study of long-term mortality following bariatric surgery was conducted at a single center and was not randomized. Additionally, long-term complications, such as need for repeat surgery, were not addressed in the model. Certain other risks that might be heightened after bariatric surgery were excluded as well, and quality of life was not modeled.&lt;/p&gt;
&lt;p&gt;&quot;The decision analysis presented here is a step forward in understanding optimal patient selection but also highlights some of the areas for which better data are needed,&quot; the researchers wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The National Institute of Diabetes and Digestive and Kidney Diseases funded the study.&lt;/p&gt;&lt;p&gt;No potential conflicts of interest were reported.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>