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    <recommendedItem id="20100101_19_352"
                     title="ICAO: Future Chronic Disease Risk Goes Beyond BMI (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/Endocrinology/Diabetes/tb/18233?impressionId=1265762871623"
                     
      When it comes to predicting chronic disease, body mass index doesn&apos;t tell the whole story, according to a population-based study that found elevated risk with obesity and other metabolic risk factors independently.&lt;br&gt;
&lt;br&gt;Metabolically-healthy obese people tended toward being at least twice as likely to develop multiple metabolic risk factors and diabetes as healthy, normal weight individuals over the subsequent 3.5 years of a study led by Sarah Appleton, a postgraduate student at the University of Adelaide, Australia.&lt;br&gt;
&lt;br&gt;However, normal weight individuals with metabolic risk factors  --  a group the researchers called &quot;metabolically obese&quot;  --  were at greater risk, she told attendees at the International Congress on Abdominal Obesity in Hong Kong, a conference sponsored by the International Chair on Cardiometabolic Risk.&lt;br&gt;
&lt;br&gt;Overall, just 4.1% of the 3,743 adults in the population-based, North West Adelaide Health Study were in the normal body mass index range at baseline but had at least two of the following metabolic risk factors:&lt;ul&gt; &lt;li&gt;Triglyceride levels of 1.7 mmol/L or greater&lt;/li&gt; &lt;li&gt;HDL cholesterol under 1.0mmol/L for men or 1.3 mmol/L for women&lt;/li&gt; &lt;li&gt;Blood pressure of 130/85 mm Hg or higher&lt;/li&gt; &lt;li&gt;A fasting plasma glucose of at least 5.6mmol/L or self-reported diabetes&lt;/li&gt; &lt;li&gt;Treatment for any of these disorders &lt;/li&gt; &lt;/ul&gt;
&lt;p&gt;Although free of cardiovascular disease when they entered the study through a random population sample of the northwest region of Adelaide, after a mean of 3.5 years of follow-up, this group was 2.48 times at risk of incident cardiovascular disease or stroke events (95% CI 1.1 to 5.4).&lt;/p&gt;
&lt;p&gt;Compared with metabolically-healthy, normal weight individuals, those with metabolic risk factors tended to be&lt;strong&gt; &lt;/strong&gt;3.27 times as likely to develop diabetes (&lt;em&gt;P&lt;/em&gt;=0.07).&lt;/p&gt;
&lt;p&gt;Identifying these individuals for prevention efforts may require less emphasis on BMI and increased surveillance of central obesity in primary care, the researchers told the congress.&lt;/p&gt;
&lt;p&gt;&quot;The problem with BMI is it doesn&apos;t tell you where the fat is,&quot; Appleton added in an interview. &quot;Visceral fat is really bad for you.&quot;&lt;/p&gt;
&lt;p&gt;Obese individuals without multiple metabolic risk factors at baseline comprised a larger group (12.1%).&lt;/p&gt;
&lt;p&gt;They were more likely to be middle age, live in a disadvantaged neighborhood, have smoked at some point, and get less exercise than their metabolically similar, but slimmer peers.&lt;/p&gt;
&lt;p&gt;Over the subsequent 3.5 years, they were 2.82 times more likely to develop more than one metabolic risk factor than metabolically-healthy, normal weight individuals (95% CI 2.0 to 4.0).&lt;/p&gt;
&lt;p&gt;The metabolically-normal obese also tended to be 2.36 times more likely to develop diabetes (95% CI 0.8 to 7.1). On the other hand, their risk of cardiovascular disease wasn&apos;t elevated, &quot;which likely related to the younger age of that group,&quot; Appleton told &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Notably, abdominal obesity as determined by a waist circumference of 80 cm and over for men or 95 cm and greater for women was 6.1 times more likely among metabolically healthy individuals if their BMI was in the obese versus normal range.&lt;/p&gt;
&lt;p&gt;But those who were in the normal BMI range were 2.2-fold more likely to be overweight or obese according to waist circumference if they had metabolic risk factors, which was statistically significant as well and likely contributed to the health risks they faced over the short-term future, Appleton said.&lt;/p&gt;
&lt;p&gt;Maintenance of metabolic health in the obese population was more likely for younger individuals (OR 2.83 for age 40 or younger, 95% CI 1.1 to 7.6) and those who were at least moderately physically active (OR 2.04, 95% CI 1.01 to 4.1).&lt;/p&gt;
&lt;p&gt;Appleton noted that these findings generally fit with data from the U.S. National Health Assessment Survey and Examination.&lt;/p&gt;
&lt;p&gt;Regardless of whether patients have abdominal obesity, BMI obesity, or other metabolic risk factors, the solution is likely similar  --  improved diet and exercise, she said.&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 by the University of Adelaide and the South Australian Department of Health.&lt;/p&gt;&lt;p&gt;Appleton 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_229"
                     title="Abnormal Lipid Levels Common in Teens"
                     score="0"
                     href="http://www.medpagetoday.com/Cardiology/Dyslipidemia/tb/18084?impressionId=1265762871623"
                     
      &lt;p&gt;One in five American adolescents has unhealthy cholesterol and triglyceride levels, suggesting that targeted screening of youths would be a good idea, CDC researchers said.&lt;/p&gt;
&lt;p&gt;Data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2006 indicated that 20.3% (95% CI 18.0% to 22.8%) of participants 12 to 19 years old had higher-than-normal levels of LDL cholesterol or triglycerides, or low levels of HDL cholesterol, according to Ashleigh L. May and colleagues at the CDC&apos;s National Center for Chronic Disease Prevention and Health Promotion.&lt;/p&gt;
&lt;p&gt;They also found that about a third of American youths would be candidates for lipid screening on the basis of body mass index (BMI) value, under guidelines from the American Academy of Pediatrics.&lt;/p&gt;
&lt;p&gt;Their findings, based on blood tests in 3,125 young NHANES participants, were published in the Jan. 22 issue of &lt;em&gt;Morbidity and Mortality Weekly Report&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;High LDL cholesterol was defined as at least 130 mg/dL. High triglyceride levels were 150 mg/dL or above. HDL cholesterol of 35 mg/dL or below was considered low. These applied equally across age groups.&lt;/p&gt;
&lt;p&gt;Here is the overall prevalence of each individual lipid abnormality: &lt;ul&gt; &lt;li&gt;High LDL: 7.6% (95% CI 6.2% to 9.3%)&lt;/li&gt; &lt;li&gt;Low HDL: 7.6% (95% CI 6.3% to 9.2%)&lt;/li&gt; &lt;li&gt;High triglycerides: 10.2% (95% CI 8.4% to 12.2%)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Those 18 to 19 years old were much more likely to have these abnormalities than younger adolescents: some 28.8% of participants in this age group had at least one, compared with 16.5% to 18.4% of those 17 and younger (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05).&lt;/p&gt;
&lt;p&gt;Prevalence of lipid abnormalities was also more common among white youths (22.4%) than among black (14.6%) and Hispanic (18.6%) participants (&lt;em&gt;P&lt;/em&gt;&amp;#8804;0.05 for both groups versus whites). Girls were somewhat less likely than boys to have one or more abnormalities (prevalence ratio 0.7, 95% CI 0.5 to 0.9).&lt;/p&gt;
&lt;p&gt;Not surprisingly, overweight and obese youths were much more likely than those of normal weight to have unhealthy lipid levels.&lt;/p&gt;
&lt;p&gt;Some 43% of obese adolescents had at least one abnormality, as did 22% of those considered overweight for their age and height. Both were significantly higher than the 14.2% of normal-weight participants with abnormal lipid levels.&lt;/p&gt;
&lt;p&gt;&quot;Based solely on their BMI, 32% of all youths would be candidates for lipid screening,&quot; May and colleagues wrote.&lt;/p&gt;
&lt;p&gt;An unsigned commentary by &lt;em&gt;MMWR&lt;/em&gt;&apos;s editors noted that &quot;untreated abnormal lipid levels in childhood and adolescence are linked to increased risk for cardiovascular disease in adulthood,&quot; but they stopped short of endorsing routine lipid testing for adolescents.&lt;/p&gt;
&lt;p&gt;The American Academy of Pediatrics recommends screening youths with specific risk factors such as overweight and family history. The U.S. Preventive Services Task Force looked at the screening issue in 2007 and decided not to recommend for or against routine screening.&lt;/p&gt;
&lt;p&gt;The &lt;em&gt;MMWR&lt;/em&gt; editors suggested a strategy in line with the pediatrics group&apos;s recommendation. &quot;Targeted screening of youths for abnormal lipid levels can identify those youths who might benefit from interventions that reduce the risk for CVD,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;&quot;Based on the findings in this study, clinicians should be aware of lipid screening guidelines and recommended interventions for children and youths who are overweight or obese,&quot; the editors added.&lt;/p&gt;
&lt;p&gt;Such interventions include behavior and nutrition counseling and, if lipid levels remain abnormal, drug treatment.&lt;/p&gt;
&lt;p&gt;But the editors pointed out that fewer than 1% of NHANES participants included in the current study &quot;had lipid levels high enough to warrant drug therapy according to AAP guidelines.&quot;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_3_334"
                     title="AHA: Women Receive Less Cardiovascular Secondary Prevention"
                     score="-0.005"
                     href="