Abdominal obesity may increase risk of death in women

Women who carry excess fat around their waists were at greater risk of dying early from cancer or heart disease than women with smaller waistlines, even if they were of normal weight, reported researchers from Harvard and the US National Institutes of Health.

Previous studies have shown that the tendency to deposit fat around the waist increases the risk for health problems.

The current study is the largest, most comprehensive of its kind undertaken to show that accumulation of abdominal fat can increase the risk of death.

To conduct the study, the researchers analysed data from more than 44,000 women in the Nurses' Health study, which followed the health history of thousands of registered nurses in 11 US states.

The study was published online in Circulation.

All the women included in the study were registered nurses. At the beginning of the study the women were asked to measure their waists and hips. Every two years, the women completed questionnaires about their health, providing information about their age, activity level, smoking status, diet, blood pressure and cholesterol levels.

The researchers examined the cause of death for all women who died over the course of the study. In total, 3,507 deaths occurred – of these, 1,748 were due to cancer and 751 were due to heart disease.

The researchers discovered that women with greater waist circumferences were more likely to die prematurely, particularly from heart disease, when compared to women with smaller waists. For example, women with waist size equal to or greater than 35 inches were approximately twice as likely to die of heart disease as were women with a waist size less than 28 inches, regardless of their body mass index. Similarly, women with a waist size equal to or greater than 35 inches also were twice as likely to die of cancer as were women with a waist size less than 28 inches.

According to the “Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults” published by NHLBI in cooperation with NIDDK in 1998, a healthy waist limit for women is 35 inches and, for men, 40 inches. Waist circumference is determined by measuring around the waist at the navel line.

The researchers also studied waist-to-hip ratio – a measure of the narrowest part of the waist compared to the circumference at the broadest part of the hip – as a potential determinant of mortality risk. Waist-to-hip ratio was found to be as strongly associated with risk of early death as the measurement of waist size alone.

The study authors wrote that results from previous studies have been inconsistent because of the relatively small number of people who took part and the short duration of the studies. The current study provides the strongest evidence so far regarding the adverse effects of abdominal obesity on the risk of death in women. The authors called for future studies to investigate abdominal obesity and the risk of death in men

Call for new ECG standards for elderly

Researchers at the Mayo Clinic suggest that the established “normal” ranges for evaluating electrocardiograms for persons over 80 years old should be "revisited." The recommendation comes in a study published 14 March 2008 in the American Journal of Geriatric Cardiology.

After analysing readings from more than 700 patients 80 or older, the researchers discovered that the average cut-offs (beginning and end points) for measuring all three ECG intervals – PR, QRS and QT – were greater than the current established norms. The findings also showed that the intervals, while greater in general, were significantly higher in men.

Hormone therapy risk for women highlighted

New results from the Women's Health Initiative (WHI) confirm that the health risks of long-term use of combination (estrogen plus progestin) hormone therapy in healthy, postmenopausal women persist even a few years after stopping the drugs and clearly outweigh the benefits. Researchers report that about three years after women stopped taking combination hormone therapy, many of the health effects of hormones such as increased risk of heart disease are diminished, but overall risks, including risks of stroke, blood clots, and cancer, remain high. The WHI is sponsored by the National Heart, Lung, and Blood Institute (NHLBI) of the US National Institutes of Health (NIH).

Results of the WHI threeyear follow-up study of the estrogen plus progestin clinical trial are published in the 5 March 2008, issue of the Journal of the American Medical Association.

“After being on combination hormone therapy for several years, the women's risk of cardiovascular disease was significantly higher - from a 29 percent increase in heart attacks to a 41 percent increase in strokes and nearly twice the risk of serious blood clots - compared to the women who did not take hormones,” said Michael S. Lauer, MD, director of the NHLBI Division of Prevention and Population Sciences.

“While it is reassuring that heart attack risk decreased and that the risks for stroke and blood clots did not grow after the women stopped taking hormones, this study provides further evidence that five years of combination hormone therapy is harmful. All the accumulated risks do not simply disappear.”

“The hormones’ effects on breast cancer appear to linger,” noted Leslie Ford, MD, associate director for clinical research in the Division of Cancer Prevention of the NIH’s National Cancer Institute. “These findings reinforce the importance of women getting regular breast exams and mammograms, even after they stop hormone therapy.”

Paediatric pneumonia can be treated in 3 days

Most children up to the age of 5 who are prescribed antibiotics for non-severe community acquired pneumonia will be treated for between 7 and 14 days. But, a Cochrane Systematic Review of available research showed that treating for just three days was effective.

“This short duration treatment is cheaper to give, is more likely to be taken by the child and is less likely to trigger antimicrobial resistance than longer-duration regimens,” says lead researcher Professor Zulfiqar Bhutta who heads the department of Paediatrics and Child Health at the Aga Khan University in Karachi, Pakistan.

The findings are important for the world as a whole, but will probably be of greatest benefit in resource-poor societies, where a shorter dose would be much easier for people to afford, acquire and comply with.

The systematic review identified three studies that included 5,763 children younger than 5. In these trials, some of children were treated for 3 days and the rest were given the same antibiotics for 5 days. The researchers ensured that any other differences between the children were kept to a minimum.

“Pneumonia accounts for the highest number of deaths in children under five in low income countries, so it is important to find the most efficient way of treating it,” says coresearcher Dr Batool Haider.

This review restricted itself to research that had compared 3 days of antibiotics against 5 days. The researchers are now keen to see more wellcontrolled randomised studies of different durations. This would make their conclusions stronger and would also allow more severe forms of pneumonia to be studied for optimal treatment strategies.

● Haider BA, Saeed MA, Bhutta ZA. Short-course versus long-course antibiotic therapy for non-severe community-acquired pneumonia in children aged 2 months to 59 months. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD005976. DOI: 10.1002/14651858.CD005976. pub2.

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