In This Issue of Archives of Internal Medicine FREE

Alcohol consumption may potentially contribute to the development of obesity. Wang et al conducted a prospective cohort study among 19 220 US women who reported a normal body mass index of 18.5 to less than 25.0 kg/m² at baseline and assessed the association of alcohol intake with body weight gain and the risk of becoming overweight or obese during follow-up. The majority of women consumed light to moderate alcohol as reported on food frequency questionnaires. The authors found an inverse association between amount of alcohol consumed at baseline and weight gained over 12.9 years of follow-up. After multivariate adjustment, the risks of becoming overweight and/or obese significantly decreased across increasing total alcohol intake. These study results suggest that women who have normal body weight and consume light to moderate alcohol could maintain their drinking habits without gaining excessive weight.

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The mechanism that confers adverse cardiovascular prognosis in patients with the metabolic syndrome remains unclear. Bayturan et al performed a systematic review of 3459 patients participating in 7 clinical trials that monitored coronary atheroma progression with intravascular ultrasonography. While a greater progression of coronary atherosclerosis was observed in patients with the metabolic syndrome, this was no longer evident after controlling for the presence of its individual defining factors. These findings underscore the importance of risk factors associated with abdominal obesity.

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This study by Givens et al used a national sample of 98 258 Medicare beneficiaries 66 years and older on January 1, 2001, with a diagnosis of heart failure, to determine the effect of race/ethnicity on hospice entry for heart failure in 2001. In unadjusted analysis, blacks (odds ratio [OR], 0.52) and Hispanics (OR, 0.43) used hospice for heart failure less than whites. Racial/ethnic differences in hospice use for heart failure persisted after adjusting for markers of income, urbanicity, severity of illness, local density of hospice use, and medical comorbidity (adjusted OR [95% confidence interval], 0.59 [0.47-0.73] for blacks and 0.49 [0.37-0.66] for Hispanics compared with whites). This work extends the findings of racial and ethnic differences in hospice utilization to the leading noncancer diagnosis.

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In this observational cohort study of 85 088 men with clinically localized prostate cancer diagnosed between 1994 and 2002, Jang et al used data from the Surveillance, Epidemiology and End Results–Medicare linked database to examine how the types of physicians men visit relate to ultimate treatment choice. Overall, 50% of men were seen exclusively by urologists, 44% by urologists and radiation oncologists, 3% by urologists and medical oncologists, and 3% by all 3 specialists. Men were categorized by primary treatment received: radical prostatectomy (21%), radiotherapy (42%), androgen deprivation (17%), or expectant management (20%). There was a strong association between the type of specialist seen and primary therapy received. Primary care physician visits were infrequent between diagnosis and receipt of therapy and were not associated with a greater likelihood of specialist visits. Irrespective of age, comorbidities, or visits to specialists, men seen by primary care physicians were more likely to be managed expectantly. The authors conclude that men should have access to balanced information before choosing a particular therapy for prostate cancer.

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There is growing interest in taxation as a policy to address poor food choice in the United States. Duffey et al used longitudinal data from the Coronary Artery Risk Development in Young Adults Study to examine the associations between food price and intake of soda, whole milk, away-from-home pizza and hamburgers, overall energy intake, weight, and homeostatic model assessment insulin resistance (HOMA-IR) scores over 20 years. The authors found that the price of soda and pizza decreased over time, while the price of whole milk increased. Increased prices for soda or pizza were associated with a decrease in consumption of these foods, as well as declines in total energy intake, lower weight, and lower HOMA-IR scores. Declines in energy intake, weight, and HOMA-IR were greater when the price of both soda and pizza was increased.

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