<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_413"
                     title="ICAO: In Obesity, Fat Legs Better than Fat Middles (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/PrimaryCare/Obesity/tb/18322?impressionId=1265753984763"
                     
      Having less abdominal fat but more leg fat may play a role in maintaining metabolic health in obese women, but not in heavy men, researchers found.&lt;br&gt;
&lt;br&gt;Metabolically healthy obese women had significantly more leg fat compared with metabolically unfit women, and smaller waist circumference (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05), Sarah Appleton, a postgraduate student at the University of Adelaide in Australia, and colleagues reported at the International Congress on Abdominal Obesity in Hong Kong.&lt;br&gt;
&lt;br&gt;When there&apos;s no significant differences in total body fat, the high levels of leg fat but low levels of central fat &quot;makes you think this is a protective factor against developing metabolic complications of their obesity, including diabetes,&quot; Appleton told &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Smaller studies have shown that metabolically healthy obese patients have less visceral fat compared with insulin-resistant obese patients, suggesting these may be protective factors that limit the development of metabolic disease.&lt;/p&gt;
&lt;p&gt;On the other hand, normal-weight patients with cardiometabolic risk factors, who are labeled as &quot;metabolically obese,&quot; have higher abdominal adiposity compared with metabolically healthy normal-weight patients. They&apos;re also at increased risk for diabetes and heart disease.&lt;/p&gt;
&lt;p&gt;To examine the relationship, the researchers conducted dual energy X-ray absorptiometry (DEXA) scans of body composition in 1,604 patients who were over age 50 and participated in the North West Adelaide Health Study. They were stratified in four categories: metabolically obese normal-weight, metabolically healthy normal weight, metabolically healthy obese, and metabolically unfit obese.&lt;/p&gt;
&lt;p&gt;Metabolic obesity was defined by having two or more metabolic risk factors including high triglycerides, low HDL cholesterol, high blood pressure, high fasting plasma glucose, or diabetes.&lt;/p&gt;
&lt;p&gt;The researchers also measured waist circumference.&lt;/p&gt;
&lt;p&gt;They found that among normal-weight women, the metabolically obese had significantly more total fat and more trunk fat compared with those who were metabolically healthy (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05). There were no differences in waist circumference or lean mass.&lt;/p&gt;
&lt;p&gt;Among obese women, the metabolically healthy had no significant differences in total body fat, compared with the metabolically unfit. But they had significantly more leg fat, a smaller waist circumference, and the same amounts of lean mass.&lt;/p&gt;
&lt;p&gt;&quot;We would have expected to see that metabolically healthy obese ladies would have more leg fat, but also more lean mass and less central fat, since this combination is protective against developing diabetes,&quot; Appleton said, &quot;but we didn&apos;t see that related to lean mass, which was surprising.&quot;&lt;/p&gt;
&lt;p&gt;Normal-weight men who had metabolic problems had significantly more total fat and trunk (chest and abdominal) fat than metabolically healthy ones, but no differences in lean mass.&lt;/p&gt;
&lt;p&gt;And for obese men, there were no significant differences between the metabolically fit and unfit, which &quot;was a surprise,&quot; Appleton said.&lt;/p&gt;
&lt;p&gt;&quot;Men generally have much less fat and more lean mass,&quot; she added. &quot;Women are the other way around, so maybe it&apos;s not so surprising to see these effects specifically in women.&quot;&lt;/p&gt;
&lt;p&gt;The researchers did find that among all overweight patients, both male and female, metabolic health was associated with significantly lower waist circumference.&lt;/p&gt;
&lt;p&gt;&quot;We know specifically that fat around the abdomen is dangerous because it can drain into your blood very easily and have direct effects on organs including the liver and pancreas,&quot; Appleton said. &quot;The theory is that distribution of fat and maybe an alternative inflammatory profile protects obese ladies from developing the metabolic consequences you&apos;d expect to see in people who are obese.&quot;&lt;/p&gt;
&lt;p&gt;Appleton said the study may have implications for clinical practice, adding that physicians should assess both BMI and waist circumference to determine disease risk. Moreover, physicians &quot;need to focus on healthy weight loss in a way that protects lean mass but also reduces dangerous fat deposits including central adiposity.&quot;&lt;/p&gt;
&lt;p&gt;It also goes to show that &quot;just because somebody looks thin,&quot; Appleton added, &quot;doesn&apos;t mean they&apos;re healthy.&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 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_226"
                     title="ASCO GI: Blood Test Detects Colorectal Cancer"
                     score="-0.003"
                     href="http://www.medpagetoday.com/MeetingCoverage/ASCOGI/tb/18079?impressionId=1265753984763"
                     
      &lt;p&gt;ORLANDO  --  A novel blood test that measures CD24 protein levels may detect early colorectal cancer and precancerous adenomas, researchers found.&lt;/p&gt;
&lt;p&gt;The investigational assay had 78.4%% sensitivity and 86.8% specificity for distinguishing patients with colorectal adenoma or cancer from healthy controls in a study led by Sarah Kraus, PhD, of Tel Aviv Souraski Medical Center in Israel.&lt;/p&gt;
&lt;p&gt;Further validation for the biomarker would be needed before considering clinical use in surveillance, they cautioned here at the ASCO Gastrointestinal Cancers Symposium.&lt;/p&gt;
&lt;p&gt;But the results were exciting and could represent &quot;a very significant advance,&quot; commented Robert P. Sticca, MD, of the University of North Dakota in Grand Forks.&lt;/p&gt;
&lt;p&gt;&quot;It looks like it may be a very reliable marker for not only the early detection of colon cancer and even precancerous conditions, but also could be used for follow-up for patients who previously had cancer for recurrence,&quot; he said as moderator of a press briefing at which the results were discussed.&lt;/p&gt;
&lt;p&gt;Colorectal cancer screening is effective, with early detection and treatment shown to improve survival.&lt;/p&gt;
&lt;p&gt;However, colorectal cancer is often diagnosed at a late stage with poor prognosis, in part because of &lt;a href=&quot;http://www.medpagetoday.com/Gastroenterology/ColonCancer/10115&quot; mce_href=&quot;http://www.medpagetoday.com/Gastroenterology/ColonCancer/10115&quot; target=&quot;_blank&quot;&gt;poor uptake of colonoscopy&lt;/a&gt;, Kraus said at the press briefing.&lt;/p&gt;
&lt;p&gt;Unfortunately, there are no sufficiently accurate blood-based screening tests, he noted, although there have been &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/ECCO-ESMO/16057&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/ECCO-ESMO/16057&quot; target=&quot;_blank&quot;&gt;attempts&lt;/a&gt; to develop them.&lt;/p&gt;
&lt;p&gt;Her group had previously found that the CD24 protein  --  expressed on the cell surface, where it plays a role in cell adhesion and metastasis  --  was associated with development of colorectal cancer in a gene expression study.&lt;/p&gt;
&lt;p&gt;So, with two independent cohorts, they tested whether CD24 could be a good biomarker for colorectal cancer.&lt;/p&gt;
&lt;p&gt;The first cohort included 63 patients with colorectal cancer, 19 with adenoma, and 68 controls with a clean bill of health on colonoscopy. Of these 150 individuals, 143 were externally evaluated by a blinded investigator.&lt;/p&gt;
&lt;p&gt;CD24 expression was nearly six-fold higher among adenoma and colorectal cancer cases than among controls, a significant difference. Levels were similar between the cancer and adenoma groups.&lt;/p&gt;
&lt;p&gt;The second cohort included 73 subjects: 38 normal controls, 24 with colorectal adenoma, and 11 with colorectal cancer.&lt;/p&gt;
&lt;p&gt;The test could distinguish colorectal cancer cases from controls with &quot;relatively high&quot; sensitivity and specificity (92.3% and 83.8%, respectively), Kraus said.&lt;/p&gt;
&lt;p&gt;Its performance in detecting adenoma versus normal colonoscopy results was lower, 75.0% sensitivity and 89.2% specificity.&lt;/p&gt;
&lt;p&gt;Kraus said her group is now testing this CD24 approach in a larger sample and developing an enzyme-linked immunosorbent assay (ELISA) that could be more widely used.&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_207"
                     title="ISET: Women Fare Better in Small Leg Vessel Procedures (CME/CE)"
                     score="-0.004"
                     href="http://www.medpagetoday.com/Cardiology/PeripheralArteryDisease/tb/18051?impressionId=1265753984763"
                     
      &lt;p&gt;HOLLYWOOD, Fla.  --  Contrary to expectations, women who undergo last-ditch, minimally-invasive procedures to open small blood vessels in the leg  --  and forestall amputation  --  generally have better outcomes than men, researchers reported here.&lt;/p&gt;
&lt;p&gt;Overall, 87.5% of women who underwent the infragenicular endoscopic angioplasty avoided amputation for at least two years, compared with 82.9% of the men who were similarly treated (&lt;em&gt;P&lt;/em&gt;=0.041), according to Tejas Shah, MD, of Mount Sinai Medical Center in New York City.&lt;/p&gt;
&lt;p&gt;&quot;This study is the first to compare the outcomes of men and women being treated for blocked lower-leg arteries with endovascular therapy,&quot; Shah said at the International Symposium on Endovascular Therapy (ISET). &quot;The results suggest endovascular therapy should be strongly considered in women with blocked arteries below the knee.&quot;&lt;/p&gt;
&lt;p&gt;In many endovascular procedures, women tend to do worse then men, generally because they tend to have smaller blood vessels. But in this study, involving the smallest leg blood vessels, the opposite occurred. &quot;We really don&apos;t have any good reason why there should be this gender difference,&quot; Shah said.&lt;/p&gt;
&lt;p&gt;&quot;What made this difference significant,&quot; Shah told &lt;em&gt;MedPage Today&lt;/em&gt;, &quot;was that the women in the study, overall, were at significantly greater risk of amputation than the male patients.&quot; He said that about 22.3% of men underwent treatment for claudication, compared with 12.3% of the women, but 77.7% of men were being treated for limb-threatening conditions compared with 87.7% of women.&lt;/p&gt;
&lt;p&gt;The retrospective study involved review of angioplasties, stenting, and atherectomies performed on 152 men and 125 women at Mount Sinai between July 1999 and November 2009.&lt;/p&gt;
&lt;p&gt;When adjusted for comorbidities, women treated for tibial lesions with concurrent proximal disease had higher 24-month primary patency rates compared with men.&lt;/p&gt;
&lt;p&gt;Some 46% of treated leg arteries in women remained open, compared with 30% (&lt;em&gt;P&lt;/em&gt;=0.016) in men. Shah said that a subanalysis of isolated tibial lesions indicated that 50% of women achieved 24-month primary patency rates, compared with 28.8% of men (&lt;em&gt;P&lt;/em&gt; =0.002).&lt;/p&gt;
&lt;p&gt;On the downside, women experienced higher rates of blood clots forming at the access site of the treatment (9% versus 0.6%, &lt;em&gt;P&lt;/em&gt;&amp;lt;.0001). Clotting, typically treated with blood thinners, may require a longer stay in the hospital (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001).&lt;/p&gt;
&lt;p&gt;&quot;In both men and women it is hard to keep these smaller leg blood vessels open,&quot; said Constantino Pe&amp;#241;a, MD, medical director of vascular imaging at Baptist Cardiac &amp;amp; Vascular Institute, Miami.&lt;/p&gt;
&lt;p&gt;&quot;It might be possible that women do better because of their hormone status. But we need to do prospective clinical trials to see if we can determine what factor is involved in making the procedure work better for women.&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;Shah listed no relevant disclosures.  Pe&amp;#241;a reported financial relationships with Bard and Medtronic.&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=1265753984763"
                     
      &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>
    <recommendedItem id="20090101_3_483"
                     title="ACG: Carb-Heavy Diet Linked to Esophageal Cancer"
                     score="-0.006"
                     href="