Public Release: 

Annals of Internal Medicine tip sheet for Feb. 17, 2015

American College of Physicians

1. One simple dietary change may be enough to lose weight, improve health

Dietary advice that emphasizes just one rule - consume at least 30g of fiber a day - is nearly as effective as advice to follow the more complicated American Heart Association (AHA) diet plan for inducing weight loss and improving metabolic symptoms, according to an article published in Annals of Internal Medicine.

The AHA diet is proven effective for preventing and treating metabolic syndrome, but the diet's many rules may make adherence a challenge for some. Researchers hypothesized that a more permissive diet that focused on one dietary change would be superior to the AHA intervention for weight loss, dietary quality, metabolic health, and adherence. The researchers randomly assigned 240 adults with metabolic syndrome to follow either the AHA diet plan (eat more fruits and vegetables; eat whole grain/high fiber foods; eat fish twice weekly; consume lean proteins; minimize sugar and sodium intake; limit alcohol; aim for a specific ratio of carbohydrates, proteins, and fats; and limit saturated fats, trans fats, and cholesterol) or to increase their daily fiber intake to at least 30g a day. Patients in both groups were given instructions on their diets but had no exercise requirements.

At one year, participants in both diet groups lost weight and showed improvement in blood pressure, dietary quality, and insulin resistance. While the AHA diet group lost more weight (up to 3.7 lbs), the authors conclude that a simplified approach to weight reduction may be a reasonable alternative for persons with difficulty adhering to more complicated diet regimens.

Note: The URL will be live when the embargo lifts. For a PDF please contact Megan Hanks. For an interview, please contact Lisa Larson at lisa.larson@umassmed.edu or 508-856-2689.

2. Clinical risk calculators seriously overestimate heart attack risk

Several popular standardized risk assessment algorithms used by physicians to calculate a patient's risk for having a heart attack seriously overestimate the likelihood, according to an article published in Annals of Internal Medicine .

National guidelines recommend that clinicians use objective tools, such as the Framingham risk score, to predict a patient's risk for cardiovascular disease. An accurate risk assessment is important because this information is used to determine if preventive therapies need to be prescribed. There are several such tools available, including the new American Heart Association (AHA) and American College of Cardiology (ACC) "pooled cohort" risk calculator, which is based on data from the Multi-Ethnic Study of Atherosclerosis, or MESA. Researchers compared the new AHA/ACC risk assessment score with four other commonly used "calculators" to assess their ability to correctly match predicted with observed cardiovascular events. They also sought to explore preventive therapy as a cause of the reported risk overestimation.

The researchers found that four out of the five risk scores tested, including the new AHA/ACC score, significantly overestimated the patient's risk for cardiovascular events. Medication use did not seem to explain the overestimations. Paul M. Ridker, MD, MPH and Nancy R. Cook, ScD of Brigham & Women's Hospital, Harvard Medical School in Boston, authored an accompanying editorial that analyzes the findings and addresses how the physician community might respond.

Note: The URL will be live when the embargo lifts. For a PDF please contact Megan Hanks. For an interview, please contact Ekaterina Pesheva at epeshev1@jhmi.edu or 410-502-9433 or Helen Jones at hjones49@jhmi.edu or 410-502-9422.

3. Sore throat may be a sign of serious illness in young adults

Sore throat may be a sign of a bacterial infection in young adults between the ages of 15 and 30, even if they test negative for strep, according to a paper being published in Annals of Internal Medicine.

Recent European studies suggest that Fusobacterium necrophorum (F. necrophorum) is to blame for at least 10 percent of pharyngitis cases in adolescents and adults. This is concerning because F. necrophorum may cause peritonsillar abscess and life-threatening internal jugular thrombophlebitis. The prevalence of F. necrophorum in the US is unknown and current guidelines for managing pharyngitis focus mostly on group A streptococcal infection.

Researchers studied 312 patients aged 15 to 30 presenting with a sore throat and 180 asymptomatic students at a student health clinic to estimate the prevalence of F. necrophorum compared with other agents of bacterial pharyngitis in this population. The authors developed an objective tool to calculate a Centor score based on fever history; lack of cough; swollen, tender lymph nodes and tonsils. Patients with scores of 2 to 4 were nearly two times as likely to have bacterial pathogens as patients with Centor scores of 0 or 1. F. necrophorum was detected in 20.5 percent of patients with sore throat symptoms and 9.4 percent of asymptomatic patients, and was found to be the most common bacterial agent of pharyngitis.

The author of an editorial wrote that pharyngitis guidelines do not need to be revised due to the findings of this study, but say that physicians should use the Centor scoring criteria so that they are not overcomplicating pharyngitis diagnosis and treatment.

Note: The URL will be live when the embargo lifts. For a PDF please contact Megan Hanks. For an interview, please contact Bob Shepard at bshep@uab.edu or 205-934-8934.

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