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    <recommendedItem id="20100101_19_413"
                     title="ICAO: In Obesity, Fat Legs Better than Fat Middles (CME/CE)"
                     score="0.012"
                     href="http://www.medpagetoday.com/PrimaryCare/Obesity/tb/18322?impressionId=1265774626432"
                     
      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="20090101_19_980"
                     title="AAHPM: Diversity of Pediatric Palliative Care Patients Documented"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/AdditionalMeetings/tb/13457?impressionId=1265774626432"
                     
      AUSTIN, Tex., March 30 -- Pediatric palliative care programs serve a diverse group of patients that defies the stereotypes that many professionals outside the discipline might have, data from six large programs suggest. 
              &lt;br&gt;&lt;br&gt;Patients with genetic and congenital conditions accounted for the largest numbers, but a substantial proportion had neuromuscular, respiratory, or gastrointestinal conditions, as well as cancer, Chris Feudtner, M.D., Ph.D., of Children&apos;s Hospital in Philadelphia, reported at the American Academy of Hospice and Palliative Medicine meeting. 
              &lt;br&gt;&lt;br&gt;Most patients&apos; care included chronic use of some form of medical technology or instrumentation with gastrostomy tubes (48.9%) being most prevalent. Cognitive impairment was the primary symptom in about half the cases, followed by pain in a third. 
              &lt;br&gt;&lt;br&gt;&quot;Outside of people who actually deliver the care . . . many people in healthcare assume that pediatric palliative care is exclusively about children with cancer or exclusively about children in the ICU,&quot; Dr. Feudtner said in an interview. &quot;They are rather taken aback to realize the diversity of patients, in terms of the conditions they have, that we are taking care of.&quot; 
              &lt;p&gt;
              &lt;p&gt;The study represented an attempt to characterize the patient population referred for pediatric palliative care. The number of programs has increased in recent years, but little information has accumulated about the types of patients referred to them, said Dr. Feudtner. 
              &lt;p&gt;
              &lt;p&gt;Investigators at six centers in North America performed a prospective observational cohort study involving each center&apos;s pediatric palliative care program. Researchers collected and evaluated records of patients referred over a three-month period in 2008. Each patient was followed for three months. 
              &lt;p&gt;
              &lt;p&gt;The analysis included 511 patients, 35.2% of whom were new to the programs and 64.8% of whom were established patients. 
              &lt;p&gt;
              &lt;p&gt;About 54% of the patients were male, 70% were white, and 57% had public insurance. Most of the patients were either 1 to 9 years old (37.2%) or 10-to-18 years (30.1%). However, patient age ranged from less than 1 month (4.7%) to 19 years or older (15.5%). 
              &lt;p&gt;
              &lt;p&gt;The most common conditions were:
              &lt;ul&gt;
              &lt;li&gt;Genetic/congenital, 40.9%
              &lt;li&gt;Neuromuscular static, 24.3%
              &lt;li&gt;Neuromuscular progressive, 18.2%
              &lt;li&gt;Respiratory, 12.9%
              &lt;li&gt;Gastrointestinal, 10%
              &lt;li&gt;Cancer, 19.7% (7% hematologic, 7% solid tumor, 5.7% brain)
              &lt;/ul&gt; 
              &lt;p&gt;Some patients had more than one condition. 
              &lt;p&gt;
              &lt;p&gt;Almost half the patients (48.9%) required gastrostomy tubes. 
              &lt;p&gt;
              &lt;p&gt;At the time of consultation, 47.2% had cognitive impairment, and 30.9% had some form of chronic pain (somatic, visceral, neuropathic, or a combination). On average, patients were taking nine medications. 
              &lt;p&gt;
              &lt;p&gt;During the three-month follow-up, 18% of patients died, and their median time from enrollment to death was 23.5 days. 
              &lt;p&gt;
              &lt;p&gt;&quot;Many of our patients are still alive three months after the consultation entry into the cohort,&quot; said Dr. Feudtner. &quot;Many of them are likely to be alive for a long time.&quot;
              &lt;p&gt; 
              &lt;p&gt;&quot;That drives home the point that we in pediatric palliative care really have many long-term relationships with our patients and families. We need to be thoughtful about how we are staffed to be able to provide enough continuity over months to address their needs longitudinally.&quot; 
              &lt;p&gt;
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; Dr. Feudtner reported no conflicts of interest.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
    <recommendedItem id="20090101_8_418"
                     title="APA: Bone-Marrow Transplantation May Slow Childhood Development"
                     score="-0.006"
                     href="