Low Vitamin D Linked to Forearm Fracture Risk in Children

August 27, 2012 — Low vitamin D levels and bone mineral density may be risk factors for forearm fracture, according to results of a case-control study of 150 African American children, published online August 27 and in the September issue of Pediatrics.

"Because suboptimal childhood bone health also negatively impacts adult bone health, interventions to increase bone mineral density and correct vitamin D deficiency are indicated in this population to provide short-term and long-term benefits," write Leticia Manning Ryan, MD, MPH, from the Children's National Medical Center in Washington, DC, and colleagues.

Forearm fractures are on the rise among children. The authors note they are unique injuries that have been associated with low bone mineral density in both adults and white children, but the links between bone mineral density, serum vitamin D status (25-hydroxvitamin D), and risk for forearm fracture have not been studied in African-American children.

Factors associated with risks for forearm fracture, such as poor dietary intake of calcium and dairy products, are more common in African American children than in white children, the authors note. African-American children are also more likely than white children to be obese — another demonstrated risk factor for forearm fractures.

"Although African American children may be a vulnerable subset of the pediatric population, the relationship between forearm fracture risk and bone health has not been investigated in this group," the authors write.

From December 2005 to May 2011, the authors recruited 150 African American children aged 5 to 9 years. About half (n = 76) had sustained forearm fractures; the other half (n = 74) had not.

The researchers measured height and weight, bone mineral density, and 25-hydroxvitamin D status in both groups of children. They interviewed the children and their parents to find out about the children's diets and to get sociodemographic data and medical history. They also asked about how much outdoor play time the children engaged in each week, using that quantified measure as a proxy for exposure to the sun.

The authors report that the 2 groups were the same in terms of age, sex, parental education levels, season of enrollment, and the amount of time they spent playing outdoors.

Children with fractures had lower whole-body z scores for bone mineral density (0.62 ± 0.96 vs 0.98 ± 1.09; adjusted odds ratio, 0.38; 95% confidence interval [CI], 0.20 - 0.72) than children without fractures. Children with fractures also were more likely to be overweight (49.3% vs 31.4%; P = .03).

Compared with the control patients, children with fractures were also more likely to be vitamin D deficient (47.1% vs 40.8%; adjusted odds ratio, 3.46; 95% CI, 1.09 - 10.94), the authors report.

Another statistically significant difference in the 2 groups was that the children with fractures consumed more dietary calcium than children in the control group. However, the authors say, that probably reflects higher overall caloric intake in that group. In fact, the authors state, "when the daily calcium intake was expressed as a proportion of daily kilocalorie intake (as calcium nutrient density), there was no longer a significant difference present between the groups."

"To our knowledge," the authors write, "this is the first study in which the association between lower [bone mineral density] and increased odds of forearm fracture risk has been shown in African American children, a pediatric population that may be at higher risk for bone health deficiencies and fractures."

They say their results add to the growing body of literature suggesting that forearm fractures during childhood may be a marker of deficient bone health. Limitations of the current study include single site design, lack of non–English speaking participants, potential recall and reporting bias, a greater number of subjects with asthma in the control group, and no measurement of pubertal status.

"Because forearm fracture rates in children are increasing and bone health status in childhood may directly impact adult bone health, opportunities to intervene during childhood should be pursued," they conclude.

This study is funded in part by the National Institutes of Health National Center for Research Resources, the Children’s National Medical Center General Clinical Research Center, the Children’s National Medical Center Board of Visitors, and the DC-Baltimore Research Center on Child Health Disparities. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online August 27, 2012.

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Antibiotic Use in Early Infancy Linked to Childhood Obesity

August 22, 2012 — Infants who receive antibiotics before 6 months of age may be at increased risk for obesity during childhood, according to data from a cohort of 10,000 children in the United Kingdom.

A study based on analysis of those data was published online August 21 in the International Journal of Obesity.

Lead author Leonardo Trasande, MD, MPP, associate professor of pediatrics and environmental medicine at New York University School of Medicine in New York City, and colleagues note that in recent years, researchers have gained new understanding about the human microbiome — the myriad bacterial flora that reside in the body and aid in metabolism, cell differentiation, and immune response.

"Knowledge of the importance of the microbiome in human development raises new issues about antibiotic use in children, since such exposures may disrupt the microbial ecology," the authors write.

They say that even though populations of bacterial flora in adults are relatively stable, that might not be the case with young children, whose bacterial flora may be more variable and susceptible to negative effects from antibiotics and other factors.

To look further into how antibiotic exposure in early life might affect body weight later on, the researchers evaluated longitudinal birth cohort data from 11,532 children who were included in the Avon Longitudinal Study of Parents and Children (ALSPAC). ALSPAC is a population-based study of children born in Avon, United Kingdom, during 1991 and 1992. All of the children included in this analysis weighed at least 2500 g at birth.

Over time, data on the children were collected via hospital records, surveys, clinical visits, and laboratory tests. The researchers especially focused on exposure to antibiotics during 3 periods: before 6 months of age, at 6 to 14 months of age, and at 15 to 23 months of age. They also checked data on the children's weight up through their seventh year of life.

The researchers found that on average, children exposed to antibiotics early on weighed more. "This longitudinal study found that early life antibiotic exposure was associated with subsequent increases in body mass," the authors write.

However, they say that of the 3 periods studied, only exposure during the first 6 months of life was consistently linked to increased body mass.

"At 38 months, children who had been exposed to antibiotics during this earliest period had significantly higher standardized [body mass index (BMI)] scores, and were 22% more likely to be overweight than children who had not been exposed," they write.

However, exposure to antibiotics after 6 months of age was not consistently associated with an increased BMI, the researchers say. Children exposed to antibiotics during their first 6 to 14 months of life showed no association, whereas children exposed at age 15 to 23 months showed significant associations, with higher BMIs at 7 years of age but not when they were assessed in the years leading up to that time.

All the assessments were based on statistical models that took a variety of potential factors into account, including diet, physical activity, and the weight of the children's parents.

The authors emphasize that their findings, although showing an association between early antibiotic exposure and childhood obesity, do not prove a causal link. Other limitations include potential recall bias, possible confounding factors not accounted for in multivariable analysis, and limited generalizability.

In addition, the ALSPAC sample is from the early 1990s; antibiotic exposure was significantly less frequent at that time than it is today, explain the authors. Average use, the researchers say, has increased 4.3% annually since 2000 in the United Kingdom.

"While effects of early exposures are modest at the individual level, they could have substantial consequences for population health," the authors note. "Given the prevalence of antibiotic exposures in infants, and in light of growing concerns about childhood obesity, further studies are needed to isolate effects and define life-course implications for body mass and cardiovascular health," they conclude.

The UK Medical Research Council, the Wellcome Trust, and the University of Bristol provide core support for ALSPAC. Support for preliminary work with the ALPSAC database was provided through a pilot grant from the NYU Global Public Health Research Challenge Fund and by grants from the National Institutes of Health. The authors have disclosed no relevant financial relationships.

Int J Obes. Published online August 21, 2012. Abstract

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Debate Over Dangers of Egg-Yolk Consumption Continues With New Study

August 20, 2012 (London, Ontario) — Researchers who have long argued that egg-yolk consumption contributes to cardiovascular disease have now published a study showing that lifelong consumption of egg yolks is correlated to development of carotid artery plaques and therefore should be avoided by anyone at risk for cardiovascular disease [1].

Dr J David Spence (Robarts Research Institute, London, ON) publish the results of a study of 1262 consecutive patients attending vascular prevention clinics in Canada online August 1, 2012 in Atherosclerosis. All of the subjects had baseline measurement of total carotid plaque area by ultrasound and filled out questionnaires about their diet and lifestyle, including medications they take, smoking, and the number of egg yolks they've eaten per week times the number of years they've kept that dietary pattern (egg-yolk years).

The results show that carotid plaque area increased linearly with age after age 40 and increased exponentially with both pack-years of smoking and egg-yolk years. The average plaque area in subjects claiming to consume fewer than two eggs a week (n=388) was 125 mm² vs 132 mm² in subjects eating three or more egg yolks per week (n=603) (p<0.0001 after adjustment for age). Multiple regression analysis found that egg-yolk years were a significant predictor of disease after adjustment for other coronary risk factors.

Spence is a long-time critic of the egg industry and believes the industry's lobbyists have confused the public by convincing government dietary guideline writers to downplay the dangers of dietary cholesterol. He often points out that a single egg yolk contains approximately 215 mg to 275 mg of cholesterol, more than the 200-mg daily limit recommended by the American Heart Association (AHA) and National Cholesterol Education Program.

"We've known that [dietary cholesterol is a cardiovascular risk factor] for 50 years, but the egg marketing people have been so successful with their propaganda that in Canada there are no longer recommendations against consuming dietary cholesterol," he told heartwire .

He argues that the defense of eggs as part of a healthy diet depends largely on a study in the 1990s based on theHealth Professionals Follow-up Study and Nurse's Health Study [2]. Together, these studies found that consumption of up to one egg per day had little or no impact on cardiovascular risk. But Spence maintains that "the reason they failed to show harm in the people who remained healthy was that they were too young and they weren't followed long enough."

That study found a link between cardiovascular risk and egg consumption in diabetics, and a 2006 study in Greece found that increased consumption of eggs and saturated fat was associated with a significant increase in mortality among diabetics [3], Spence stresses. Also, a 2009 study of data the Women's Health Study and Physicians' Health Study showed that high levels of egg consumption are associated with an increased risk of type 2 diabetes [4].

Bad Diet vs Bad Foods

In an interview with heartwire , nutritionist Dr Susan Racette (Washington University School of Medicine, St Louis) pointed out that cholesterol is certainly not the only dietary factor that can contribute to the development of cardiovascular disease, yet the study by Spence et al provides no other dietary information. "Cholesterol itself may not be the biggest player, but cholesterol is included in foods with saturated fats," she said.

"If people are consuming more eggs, then people might be consuming more saturated fat from other sources as well," she suggested. She pointed out that the preparation of eggs--fried vs boiled--makes a difference, but that wasn't specifically addressed in the study. Also, the subjects in the study were consuming a lot of eggs despite the professional recommendations to cut back because of their disease risk. "That implies that perhaps they weren't following other dietary recommendations, either. It might not just be the cholesterol, but part of a whole dietary pattern that may not be optimal, although that doesn't mean the cholesterol doesn't have potentially an important role."

Racette says she supports the AHA's recommendation that individuals concerned about their cardiovascular risk limit their egg-yolk intake "within the constellation of limiting saturated fats, trans fats, and cholesterol." She also pointed out that some dietary choices can offset the consumption of cholesterol. Plant sterols (phytosterols) have been shown to reduce the body's absorption of cholesterol. "But people who eat a lot of cholesterol are probably consuming fewer plant products," she said.

Egg Industry Is Not Impressed

Researchers aligned with egg producers are not persuaded by the study by Spence et al. Dr Mitch Kanter, executive director of the Egg Nutrition Center (ENC), in Park Ridge, IL told heartwire that the study "is just not that well done." He pointed out that the study included mostly older at-risk patients and relied entirely on their self-reports of egg consumption. "There are so many confounders just in a question like that," he said. "The people who were oldest were the people in the highest quintile, and that makes sense because if a guy is 75, even if he ate only one and half eggs per week, 75 times one-and-a-half per week is going to give you a high number. If these are the premises upon which these data were collected, then how do you put a lot of faith in the results that you get?"

The Egg Nutrition Center is funded by the American Egg Board, which is supported by egg farmers as a so-called "check-off" program overseen by the US Department of Agriculture.

As further evidence that eggs can be part of a heart-healthy diet, the ENC cites a study published in Risk Analysis that found that modifiable lifestyle risk factors account for less than 40% of coronary heart disease mortality and that for most adults, consuming one egg a day accounts for less than 1% of coronary disease risk [5]. The group also highlights a small randomized study in England that found that increased intake of dietary cholesterol from two eggs a day did not increase total plasma or LDL cholesterol when accompanied by moderate weight loss [6].

Dr Maria Luz-Fernandez (University of Connecticut, Storrs), who has received research funding from the ENC and has criticized Spence's position on eggs in the past, told heartwire in an email that the conclusions of Spence et al are "really overstated based on the data."

She points out that "the subjects under study were already sick and came to the clinic with high blood pressure, hyperlipidemia, and excess body weight, [and because] this is a cross-sectional study it is not possible to reach a causal conclusion."

She also questions the usefulness of measuring consumption in egg-years. "It is not surprising that the individuals with more egg-years (older) had higher plaque area. So a big problem is that they did not control their data with age, which as we all know is highly associated with heart disease and high lipid levels." Also, she argues that the questionnaire used in the study was biased because it only asked about egg intake and smoking and not other potentially relevant dietary factors such as saturated fat and high sugar intake.

Spence, however, anticipated this reaction in his interview with heartwire . "Every time a paper like this comes out the media come and . . . they ask what my study shows, and then they go ask what the egg marketers think and give equal weight to three of Canada's leading experts on stroke prevention nutrition and cholesterol and to the egg marketers," Spence said. "No wonder the public is confused."

This research was supported by the Stroke Prevention & Atherosclerosis Research Centre and the Heart & Stroke Foundation of Ontario. Disclosures for the authors were not provided. Luz-Fernandez has received research funding from the American Egg Board, the Egg Nutrition Center, and the National Dairy Council. Racette reports no potential conflicts.

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J&J First to Promise Toxin-Free Products

August 15, 2012 — Johnson & Johnson, maker of brands including Aveeno, Neutrogena, and Johnson's Baby Shampoo, says it will remove controversial chemicals from all its baby and adult products by 2015.

The company is one of the world's largest producers of cosmetics. J&J says its products have been shown to be safe by FDA standards and its own internal tests. But safety concerns have been raised about several kinds of chemicals commonly used in cosmetics, including some probable carcinogens.

J&J announced today that by 2015 it will reformulate hundreds of cosmetic and personal care products sold worldwide. The announcement confirms commitments the company made last winter in a letter to a consumer group.

That group, the Campaign for Safe Cosmetics, co-founded by the Environmental Working Group and about 175 other nonprofit organizations, has been lobbying cosmetics companies to stop using ingredients suspected of toxic effects.

In today's announcement, J&J said it would:

• Reduce traces of 1,4-dioxane to the lowest measurable level in baby products and reduce the chemical below 10 parts per million in adult products. The chemical is a suspected carcinogen. PEG compounds, sodium myreth sulfate, and chemicals including the phrases "xynol," "ceteareth," and "oleth" may contain the chemical.
• Phase out formaldehyde-releasing preservatives. J&J does not add formaldehyde to products, but over a product's shelf life, preservatives emit the alcohol form of formaldehyde. Ingredients that release formaldehyde, which is also suspected to cause cancer, include quaternium 15, DMDM hydantoin, imidazolidinyl urea, diazolidinyl urea, sodium hydroxymethylglycinate, and 2-bromo-2-nitropropane-1,3 diol (Bronopol).
• Remove parabens from baby products and use only the three safest forms in adult products. Parabens are the most widely used preservatives in cosmetics. The Campaign for Safe Cosmetics says they can be absorbed through the skin and may alter the way hormones work in the body. One study found parabens in breast cancers.
• Phase out triclosan from all products. Triclosan protects products from bacteria. It's been suspected of, but not proven to have, toxic effects.
• Phase out the phthalate DEP from all products. DEP is the only phthalate used in J&J products. Phthalates have been linked to developmental delay and lack of muscular coordination in children and may also affect the body’s hormones.
• Phase out polycyclic musks, animal-derived ingredients, tagetes, rose crystal, and diacetyl from fragrances. These substances are often used in fragrances.

"Every beauty and baby care product from the Johnson & Johnson Family of Consumer Companies is safe and effective when used as directed," the company says on its web site. "We’ve held ourselves to the very highest standards for more than one hundred years."

Lisa Archer, director of the Campaign for Safe Cosmetics, praised the company’s action in a news release and asked for other companies to follow its lead. "We call on other cosmetic giants ... to meet or beat J&J's commitments and signal they take consumer safety as seriously as their competitor."

SOURCES:

News release, Campaign for Safe Cosmetics

Johnson & Johnson web site.

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Cocoa Can Boost Cognitive Function

August 14, 2012 — A new study hints that regular consumption of cocoa flavanol might improve cognitive function in older adults with mild cognitive impairment (MCI), perhaps by improving glucose-insulin metabolism.

"Given the global rise in cognitive disorders due to the 'graying' of populations in Western countries, our findings provide encouraging evidence that consuming cocoa flavanols could represent a fascinating new tool for preserving/improving cognitive function during senescence," first author Giovambattista Desideri, MD, director of the Geriatric Division, Department of Life, Health and Environmental Sciences, University of L'Aquila in Italy, told Medscape Medical News.

The study was published online August 14 in Hypertension. It was funded by Mars Inc, a maker of chocolate products; the company also provided the standardized cocoa drinks used in the trial.

Findings "Intriguing"

"There is great interest in identifying nutritional factors that could potentially delay or prevent conversion of MCI to dementia," Mary Ann Johnson, PhD, national spokesperson for the American Society of Nutrition (ASN), who was not involved in the study, toldMedscape Medical News.

What makes this study novel, she said, is that it is a randomized controlled trial in people with MCI, it employed well-known cognitive tests, and it used 3 levels of cocoa flavanols: low, medium, and high.

"Both the medium and high levels conferred some benefits to cognition, insulin resistance, and blood pressure. Poor cognition, poor insulin resistance, high blood pressure, and other cardiovascular risk factors have all been linked to dementia," Dr. Johnson said.

"These are intriguing findings that should be followed up with additional research studies to confirm these findings for cocoa," added Dr. Johnson, who is from the Department of Foods and Nutrition, College of Family and Consumer Sciences at the University of Georgia in Athens.

More Is Better?

Based on prior studies, intake of flavonoids may be associated with a decreased risk for incident dementia, a lower prevalence of cognitive impairment, and better cognitive evolution over 10 years in aging adults, the authors note.

To investigate further, Dr. Desideri and colleagues recruited 90 elderly individuals with MCI into the Cocoa, Cognition and Aging (CoCoA) Study. They were randomly assigned to consume once daily for 8 weeks a drink containing 1 of 3 levels of cocoa flavanols: 990 mg, the high flavanol (HF) group; 520 mg, the intermediate flavanol (IF) group; or 45 mg, the low flavanol (LF) group.

Overall compliance was good — 99.6% at week 4 and 99.4% at week 8, with no between-group differences.

The team assessed cognitive function using the Mini–Mental State Examination (MMSE), the Trail Making Test A (TMT A) and B (TMT B), and a verbal fluency test. Baseline performances on these 3 tests were similar.

During the study period, the researchers did not see any significant changes in MMSE scores in relation to group assignment.

However, the time needed to complete the TMT A did change significantly during the study period (P < .0001), with significant reductions observed in participants in the HF group (-14.3 seconds; P < .0001) and IF group (-8.8 seconds; P < .0001) but not in those in the LF group (+1.1 seconds; P = .65).

The results were similar for the TMT B test, with significant reductions in the time needed to complete the test seen in the HF and IF groups (-29.2 and -22.8 seconds, respectively; for both, P < .0001) but not in the LF group (+3.8 seconds; P = .21).

As a result, TMT A and B scores at the end of follow-up were significantly (P < .05) better in the HF and IF groups than in the LF group, the authors note.

Additionally, they say verbal fluency test scores significantly improved (P < .0001) during the study, with improvements seen in the HF group (+8.0 words per 60 seconds; P < .0001) and IF group (+5.1 words per 60 seconds; P < .0001) and, to a lesser extent, in the LF group (+1.2 words per 60 seconds; P < .014).

The improvement of verbal fluency test score was significantly greater in HF participants than in those assigned to the LF group (P < .05).

Baseline blood pressure and metabolic parameters were similar in the 3 groups, but with treatment, HF and IF groups experienced a decrease in insulin resistance, blood pressure, and lipid peroxidation.

Insulin Resistance

Dr. Desideri and colleagues report that changes in homeostasis model assessment–insulin resistance (HOMA-IR) were the main determinants of change in cognitive function, accounting for roughly 40% of composite z score variability throughout the study period (P < .0001).

Changes in systolic blood pressure levels and plasma isoprostane concentrations accounted for only 2% and 7% of cognitive improvement, respectively, throughout the study period.

"Our data suggest that regular cocoa flavanol consumption, in the context of a calorie-controlled and nutritionally balanced diet, might represent an effective strategy in preserving brain and cardiovascular health and function," Dr. Desideri concluded. "Obviously, larger studies are needed to validate our findings."

The researchers caution that the intervention lasted only 2 months; therefore, the extent of the cognitive benefits and their duration, as well as their impact on a clinical course of MCI, remain to be established.

It is also unclear whether the observed benefits in neurocognition are a direct consequence of cocoa flavanols themselves or a secondary effect related to general improvements in cardiovascular function or health.

Finally, the study team points out that the participants in the study were generally in good health and were free of cardiovascular disease and therefore may not be completely representative of all individuals with MCI.

The study was supported by a grant from Mars Inc, which also supplied the standardized powdered cocoa drinks used in the study. One author is an employee of Mars Inc. A complete list of author disclosures is given in the original article.

Hypertension. Published online August 14, 2012. Abstract

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Weight Gain Slower Where School-Food Laws Are Strong

By Frederik Joelving

NEW YORK (Reuters Health) Aug 13 - Regulating the foods and beverages sold outside of federal meal programs at schools may help curb the child obesity epidemic, suggests a U.S. study released August 13.

Researchers found that fifth graders in states with strong competitive food laws gained less weight than did kids in states with no such legislation.

"I definitely see this as encouraging evidence that the laws can have a positive impact," said Dr. Daniel R. Taber of the University of Illinois at Chicago, who worked on the study. "But we need to recognize that it is not going to influence all students."

The new findings come as the U.S. Department of Agriculture is updating its standards for competitive foods sold at schools across the nation as required by the Healthy, Hunger-Free Kids Act of 2010.

A host of programs are geared toward stemming the obesity tide by providing healthier school foods. Just last week, one study showed half as many adolescent students as in 2006 can still buy high-calorie sodas at school.

But so far there's little evidence that such programs work, Dr. Taber said.

So he and his colleagues tapped into an earlier study following 6,300 students in 40 states from 2003 to 2006 (fifth to eighth grade). They compared the children's body mass index (BMI) with the competitive food laws in each state.

Students whose states had consistent, strong laws throughout the study period gained 0.44 BMI points less than children whose states did not regulate the foods sold at schools, according to findings published in Pediatrics.

The researchers also found that states with strong laws in 2003 saw 5% fewer students remain overweight and 8% fewer remain obese in eighth grade than did states without competitive food laws.

The researchers classified laws as strong or weak based on a scoring system from the National Cancer Institute.

To be as effective as possible, Dr. Taber said the rules should be consistent throughout high school, have strong language, and be as specific as possible.

"The key is really in the details," he told Reuters Health.

SOURCE: http://bit.ly/NvnsjE

Pediatrics, 2012.

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An Aspirin a Day Lowers Cancer Mortality, New Data Confirm

August 10, 2012 — Results from a new study support the daily use aspirin to help prevent death from cancer.

However, questions remain about the size of the potential benefit, lead author Eric J. Jacobs, MD, from the American Cancer Society (ACS) in Atlanta, Georgia, told Medscape Medical News.

"We were prompted to do the study because a recent analysis pooling results from existing randomized trials of daily aspirin for the prevention of vascular events found an estimated 37% reduction in cancer mortality among those using aspirin for 5 years or more [Lancet. 2012;379:1602–1612]," Dr. Jacobs said.

"But uncertainty remains about how much daily aspirin use may lower cancer mortality. The size of this pooled analysis was limited, and 2 very large randomized trials of aspirin taken every other day found no effect on overall cancer mortality," he explained.

To clarify how much daily aspirin use might lower the risk for fatal cancer, Dr. Jacobs and his colleagues analyzed information from 100,139 predominantly elderly participants in the Cancer Prevention Study II Nutrition Cohort who reported using aspirin on questionnaires.

The study was published online August 10 in the Journal of the National Cancer Institute.

The participants, who did not have cancer at the start of the study, were followed for up to 11 years.

The researchers found that daily aspirin use was associated with an estimated 16% lower overall risk for cancer mortality, both among people who reported taking aspirin daily for at least 5 years and among those who reported shorter-term daily use.

The reduction in overall cancer mortality was driven by a decrease of about 40% for cancers of the gastrointestinal tract (such as esophageal, stomach, and colorectal cancer) and a decrease of about 12% for cancers outside the gastrointestinal tract.

Too Soon to Recommend Aspirin to Prevent Cancer

"Although recent evidence about aspirin use and cancer is encouraging, it is still premature to recommend that people start taking aspirin specifically to prevent cancer," Dr. Jacobs said.

"Even low-dose aspirin can substantially increase the risk of serious gastrointestinal bleeding. Decisions about aspirin use should be made by balancing the risks against the benefits in the context of each individual's medical history, and any decision should be made only in consultation with a healthcare professional," he explained.

He added that expert committees developing clinical guidelines will consider the totality of the evidence on risks and benefits when guidelines for aspirin use are updated.

"I hope this study and other recent promising research about aspirin will lead to studies that look very carefully at daily aspirin use over long periods of time to more clearly understand aspirin's effects on specific cancers," Dr. Jacobs said.

Big Picture Is Positive

In an accompanying editorial, John A. Baron, MD, from the University of North Carolina School of Medicine in Chapel Hill, writes that "overall, the well-conducted ACS study is an echo of other data on aspirin and cancer mortality, not a resounding confirmation."

The "big picture" on aspirin use and cancer is "very positive," he noted. "The drug clearly reduces the incidence and mortality from luminal gastrointestinal cancers, and it may similarly affect other cancers. This is exciting: simply taking a pill can prevent cancer incidence and cancer death."

However, like Dr. Jacobs, Dr. Baron urges caution with regard to the widespread recommendation to use aspirin to prevent cancer.

Just because aspirin is effective "does not mean it necessarily should be used. Aspirin is a real drug, with definite toxicity. As for any preventive intervention, the benefits must be balanced against the risks, particularly when the benefits are delayed whereas the risks are not," he writes.

Dr. Jacobs has disclosed no relevant financial relationships. Dr. Baron reports being a consultant to Bayer, and holding a use patent for the chemopreventative use of aspirin, currently not licensed.

J Natl Cancer Inst. Published online August 10, 2012. Abstract, Editorial

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Serious Mental Illness Can Double Cancer Risk

August 10, 2012 — Adults with schizophrenia or bipolar disorder have a greater than 2-fold increased risk for cancer, particularly lung cancer, a new study suggests.

This study adds to a growing body of research suggesting a higher risk for cancer in patients with serious mental illness.

These latest results suggest that extra efforts should be made to improve cancer prevention and early detection in patients with schizophrenia, Gail L. Daumit, MD, MHS, from Johns Hopkins University School of Medicine, Baltimore, Maryland, and colleagues note.

"Clinicians and mental health system administrators, together with primary care providers, should promote appropriate cancer screening and work to reduce modifiable risk factors, such as smoking, among persons with serious mental illness," they advise.

The study is published in the July issue of Psychiatric Services.

Lifestyle to Blame?

Dr. Daumit and colleagues determined cancer incidence in a cohort of 3317 adult Medicaid beneficiaries with schizophrenia (n = 2315) and bipolar disorder (n = 1002) who were followed from 1994 through 2004.

Compared with the general US population (data from the Surveillance Epidemiology and End Results [SEER] program), the standardized incidence ratio (SIR) for any cancer was 2.6 (95% confidence interval [CI], 2.2 - 3.0) in adults with schizophrenia or bipolar disorder.

By cancer site, the risk was greatest for lung cancer — SIR of 4.7 (95% CI, 3.1 - 6.8) in adults with schizophrenia and 4.1 (95% CI, 2.2 - 7.2) in those with bipolar disorder.

The next greatest risk was for colorectal cancer — SIR, 3.5 (95% CI, 2.1 - 5.5) for schizophrenia and 4.0 (95% CI, 2.0 - 7.2) for bipolar disorder.

Women with schizophrenia or bipolar disorder had a heightened risk of developing breast cancer — SIR, 2.9 (95% CI, 2.1 - 3.9) and 1.9 (95% CI, 1.1 - 3.0), respectively.

"High rates of smoking in the population with serious mental illness likely contribute to lung cancer incidence, and research suggests a possible but inconclusive elevated risk of breast cancer due to low rates of childbearing and increased prolactin levels caused by use of particular psychotropic medications," the investigators write.

"The risk factors contributing to high risk of colon cancer are less understood but may be related to smoking, a sedentary lifestyle, or a diet high in fat and low in fruits and vegetables," they note.

The investigators found no difference in risk for black vs white Medicaid beneficiaries.

The researchers note a "better understanding of how behavioral and pharmacological factors increase cancer risk among persons with serious mental illness, and more information on the extent to which the population receives appropriate cancer screening and treatment, are important in order to improve health in this vulnerable group."

As reported by Medscape Medical News, a recent study showed that malignancies, especially of the breast and lung, are the second most common cause of death in people with schizophrenia, whose risk for cancer death is 50% higher than that of the general population (Limosin et al, Cancer 2009:15;3555-62).

Funding for the study was provided by the National Institute of Mental Health. The authors have disclosed no relevant financial relationships.

Psychiatr Serv. 2012:63:714-7. Abstract

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