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In This Issue of JAMA Internal Medicine |

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JAMA Intern Med. 2013;173(14):1273-1275. doi:10.1001/jamainternmed.2013.6303.
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Health Care Reform

Excess sodium consumption is an important cause of hypertension, a major risk factor for heart disease and stroke, and processed and restaurant foods are the source of about 80% of the sodium Americans consume. Jacobson and colleagues monitored sodium levels in 408 processed and restaurant foods in 2005, 2008, and 2011. They found that during this period, there was minimal change in sodium levels in these products. In a related Editorial, Katz discusses labeling regulations.

Health Care Reform

National recommendations emphasize self-monitoring for prevention and treatment of obesity; however, little information is available on the dietary energy contents of meals obtained from nonchain restaurants, which account for about half of all restaurants in the United States. Urban and colleagues determined gross energy of the most popular meals from randomly selected restaurants in the most common restaurant categories in Massachusetts. They found that all individual meal categories provided substantially more energy than required for weight maintenance. In a related Editorial, Katz discusses labeling regulations.

Hypoglycemia commonly occurs in diabetes and may increase risk of dementia; in turn, dementia may affect diabetes management and lead to hypoglycemia. In a biracial cohort of 783 older adults with diabetes from the Health, Aging, and Body Composition Study, Yaffe and colleagues investigated the prospective association between severe hypoglycemia and dementia. The authors present evidence supporting a bidirectional relationship between dementia and hypoglycemia among older adults with diabetes. Over 12 years, older adults who experienced a severe hypoglycemic event were almost 2 times more likely to develop dementia compared with those without a severe hypoglycemic event. Conversely, older adults who developed dementia were 3 times more likely to experience a subsequent hypoglycemic event compared with participants without dementia. Lipska and Montori provide a commentary on glucose control in older adults with diabetes mellitus.

The full spectrum of statin-associated musculoskeletal adverse events is unknown, especially in physically active individuals. Mansi and colleagues conducted a retrospective analysis of 46 249 patients from a large military health care database to evaluate the association between statin use and musculoskeletal health. In a propensity-matched analysis of 6967 statin users and 6967 nonusers, among matched pairs, statin users had a higher odds ratio for all musculoskeletal diseases, injury-related diseases, and drug-associated musculoskeletal pain. Secondary and sensitivity analyses revealed higher adjusted odds ratios in statin users compared with nonusers for all outcome groups.

Nearly 2.5 million men currently live with prostate cancer in the United States, yet little is known about diet after diagnosis and prostate cancer progression and overall mortality. Richman and colleagues conducted a prospective study among 4577 men initially diagnosed as having nonmetastatic prostate cancer to examine whether postdiagnostic intakes of saturated, monounsaturated, polyunsaturated, trans, animal, or vegetable fat were associated with risk of lethal prostate cancer (distant metastases or prostate cancer–specific death) and all-cause mortality. They found that among men with nonmetastatic prostate cancer, replacing carbohydrate and animal fat with vegetable fat after diagnosis is associated with reduced risk of all-cause mortality. In an Invited Commentary, Freedland discusses types of dietary fat and reduced prostate cancer mortality.

Red meat consumption has been consistently associated with an increased risk of type 2 diabetes mellitus; however, whether changes in red meat intake are related to subsequent diabetes risk remains unknown. Pan and colleagues evaluated the association between changes in red meat intake and diabetes risk in 26 357 men in the Health Professionals Follow-up Study (1986-2006), 48 709 women in the Nurses’ Health Study (NHS, 1986-2006), and 74 077 women in NHS II (1991-2007). The authors found that increasing red meat intake during a 4-year interval was associated with an elevated risk of type 2 diabetes over the subsequent 4 years in each cohort, and decreasing red meat intake was associated with reduced risk of type 2 diabetes over a long-term period. Evans discusses oxygen-carrying proteins in meat and risk of diabetes mellitus in an Invited Commentary.

Early diagnosis of human immunodeficiency virus (HIV), prompt linkage to and sustained care, and antiretroviral therapy are associated with reduced individual morbidity and mortality and onward transmission of the virus. Hall and colleagues analyzed national HIV surveillance data to examine differences in percentages of persons living with HIV by sex, age, race/ethnicity, and transmission category at essential steps in the continuum of care. They found that the percentage of black patients in each step of the continuum was lower than that for white patients, but care and treatment differences were not statistically significant. Younger persons with HIV were less likely to be aware of their infection, receive care, or achieve viral suppression. In an Invited Commentary, Christopolous and Havlir consider the current state of HIV treatment and prevention.

Health Care Reform

Federal quality measures for hospitals focus on a small number of medical conditions, but whether performance on these conditions accurately predicts the quality of broader hospital care is unknown. Using national Medicare data from 2322 US hospitals, McCrum and colleagues examined whether mortality rates for 3 commonly reported medical conditions (acute myocardial infarction, congestive heart failure, and pneumonia) can be used as a signal of a hospital’s overall performance on mortality. They found that hospitals in the top quartile of performance on publicly reported conditions had a 3.6% lower absolute risk-adjusted mortality rate on a composite of 9 medical and 10 surgical conditions. In an Invited Commentary, Smith and Shannon discuss the implications of the findings for quality reporting and patients.





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