1. A high-fat Mediterranean diet may protect against breast cancer, diabetes, and cardiovascular events

Author: A healthy diet can include a lot of fat

Video Soundbites: HD video soundbites of Dr. Hanna Bloomfield discussing the findings are available to download at http://www.dssimon.com/MM/ACP-mediteranian-diet

Abstract: http://www.annals.org/article.aspx?doi=10.7326/M16-0361

URL goes live when the embargo lifts

According to researchers, a healthy diet can include "a lot of fat." A review of available evidence suggests that a Mediterranean diet with no restrictions on fat intake may reduce a person's risk for breast cancer diabetes, and cardiovascular events compared to other diets. The findings are published in Annals of Internal Medicine.

Despite advances in diagnosis and treatment, cardiovascular disease, diabetes, and cancer continue to be among the leading causes of morbidity and mortality in developed countries. Typical Western diets, which are high in saturated fats, sugar, and refined grains, have been linked to the development of these chronic diseases. Limited evidence has suggested that a Mediterranean diet, which is essentially plant-based, may be a healthier option.

Researchers reviewed available evidence to summarize the effect of a Mediterranean diet on health outcomes and to assess whether North American populations would be likely to adhere to such a diet. Since not everyone defines the Mediterranean diet in the same way, the researchers defined it as a diet that placed no restriction on total fat intake and included two or more of seven components: high monounsaturated-to-saturated fat ratio (for example, using olive oil as a main cooking ingredient), high fruit and vegetable intake, high consumption of legumes, high grain and cereal intake, moderate red wine consumption, moderate consumption of dairy products, and low consumption of meat and meat products with increased intake of fish. Few randomized, controlled trials compared this type of diet to all others, but the few that did suggest that a Mediterranean diet with no restriction on fat intake may be associated with reduced incidence of cardiovascular events, breast cancer, and type 2 diabetes but does not affect all-cause mortality. The researchers found no studies that met their inclusion criteria to assess adherence outcomes, however, observational data reveal that total cancer incidence and mortality and colorectal and lung cancer incidence were lower in persons with the highest adherence to the Mediterranean diet compared to those with the lowest but show no association between Mediterranean diet adherence and breast cancer risk.

Note: For an embargoed PDF, please contact Cara Graeff. To reach the lead author, Dr. Hanna Bloomfield, please contact Ralph Heussner at [email protected] or 612-467-3012.

2. "Dense breasts" diagnosis varies widely among radiologists

Free content: http://www.annals.org/article.aspx?doi=10.7326/M15-2934

URL goes live when the embargo lifts

The likelihood of a woman being told she has dense breasts varies substantially according to which radiologist interprets her mammogram. These findings, published in Annals of Internal Medicine, have policy implications with regard to supplemental screening strategies.

Having dense breasts makes it more difficult to interpret mammography results and is also an independent risk factor for developing breast cancer. To ensure that women with dense breasts are aware of the limitations of mammography and their increased risk for cancer, about half of U.S. states currently have breast density notification laws and some of those states require that women are advised to talk to their health care providers about supplemental screening. Such laws are controversial because of the large number of women affected and because the lack of consensus in the medical community regarding supplemental screening strategies. An additional concern is the subjective nature of breast density assessment, which is based on the Breast Imaging Reporting and Data System (BI-RADS) that provides four possible categories for breast density.

Using data from 30 radiology facilities within the three breast cancer screening research centers of the Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium, researchers sought to examine variations in the distribution of breast density assessment across radiologists as recorded in clinical practice. They also accounted for factors known to be associated with breast density. The researchers found a wide variation among radiologists in the percentage of mammograms rated as showing dense breasts (ranging from 6.3 percent to 84.5 percent), which persisted after adjustment for patient factors. In addition, more than 1 in 6 women with consecutive mammograms interpreted by different radiologists during a short period were reclassified into dense versus nondense categories. According to the researchers, this variation has important implications for debates about mandatory notification laws.

Note: For an embargoed PDF, please contact Cara Graeff. Interviews with Dr. Brian Sprague are being coordinated by Sarah Keblin at [email protected] or 802-656-3099.

3. Women on osteoporosis treatment should have repeat DXA screenings to assess response to treatment

Nearly 1 in 5 women experienced a decrease in total hip BMD during treatment, substantially increasing their risk for fracture

Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-2937

URL goes live when the embargo lifts

Treatment-related changes in bone mineral density (BMD) are associated with fracture risk and decreases in BMD during treatment are not uncommon. As such, women taking osteoporosis treatment should have their BMD monitored to determine if their treatment is working. The findings are published in Annals of Internal Medicine.

Osteoporosis, a common cause of fracture, is typically diagnosed based a finding of low bone mineral density (BMD) from dual-energy x-ray absorptiometry (DXA). Screening with DXA is recommended for women aged 65 years or older and in younger women at increased risk for fracture, but there is no consensus on the role of repeated BMD testing after initial evaluation. The practice of repeated BMD testing during pharmacotherapy also remains controversial. Group-level clinical trial data suggest that greater increases in BMD are associated with greater fracture risk reduction, but this may be more difficult to show in clinical practice.

Using data from a comprehensive Canadian registry of more than 6,600 women initiating osteoporosis treatment with two consecutive DXA scans, researchers sought to evaluate repeated BMD testing as an indicator of treatment-related fracture risk reduction. The authors assessed BMD between the first and second scan for each patient. They found that change in total hip BMD after initiation of treatment was an indicator of fracture risk reduction. Most important, the greater the increase in total hip BMD, the lower the fracture risk. In contrast, a decrease in total hip BMD during treatment was not uncommon and occurred in almost 1 in 5 women, which was associated with a substantially increased fracture risk. According to the authors, these data support the use of serial BMD monitoring in clinical practice to determine response to osteoporosis therapy.

Note: For an embargoed PDF, please contact Cara Graeff. The lead author, Dr. William Leslie, is taking interview requests directly at [email protected]

4. Annals of Internal Medicine introduces new Annals for Hospitalists feature

Hospitalists site: http://go.annals.org/hospitalist

Hospitalists feature: http://www.annals.org/article.aspx?doi=10.7326/M16-1367

Editorial: http://www.annals.org/article.aspx?doi=10.7326/M16-1400

URLs go live when the embargo lifts

Annals of Internal Medicine announced today that it will partner with the University of Michigan Hospitalist Program to produce a new monthly feature called Annals for Hospitalists. Editors from the University of Michigan program will review Annals articles and ACP Journal Club summaries to identify those that will be most applicable to the practice of hospital medicine. Links to content and important takeaway points will be collated into a monthly alert.

Annals for Hospitalists will also include a monthly commentary titled Inpatient Notes. Authored by thought leaders in hospital medicine, Inpatient Notes is considered the "crown jewel" of Annals for Hospitalists and is intended to bring unique perspectives to the issues that affect hospital medicine. The first feature, Inpatient Notes: Hospitalists and Digital Medicine – Overcoming the Productivity Paradox (http://www.annals.org/article.aspx?doi=10.7326/M16-1367) is authored by Dr. Robert Wachter, one of the founders of hospital medicine. Dr. Wachter will discuss electronic health systems and why hospitalists will be crucial in bringing about the unrealized potential of this new technology.

Note: For an embargoed PDF or an interview about this new feature with Dr. Christine Laine, Annals' editor-in-chief, please contact Cara Graeff. For an interview with Drs. Dr. David Wesorick or Dr. Vineet Chopra from the University of Michigan, please contact Kara Gavin at [email protected] or 734-764-2220.

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Also new in this issue:

The Philadelphia Story: Attacking Behavioral and Social Determinants of Health

Cheryl Bettigole, MD MPH; Thomas A. Farley, MD MPH

Ideas and Opinions

Abstract: http://www.annals.org/article.aspx?doi=10.7326/M16-1570

Media Contact

Cara Graeff

[email protected]

215-351-2513

@ACPinternists

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