Kathleen Louden

CHICAGO — High intake of red meat has been linked to increased risk of colorectal cancer in many studies, and a new study has found a possible reason.

NAT2 genotype appears to activate carcinogenic heterocyclic amines produced in cooked red meat and in cigarette smoke, the investigators reported at the annual Digestive Disease Week.

Using data from nearly 33,000 women enrolled in the prospective Nurses' Health Study, Andrew Chan, M.D., and his coauthors examined the risk of incident colorectal cancer according to NAT2 genotypes, meat intake, and smoking. They matched 183 women with colorectal cancer to 443 controls (Int. J. Cancer 2005;115:648–52).

They found that the acetylator genotype alone did not significantly increase cancer risk. However, women with rapid acetylator genotypes had a markedly increased risk of colorectal cancer if they consumed more than half a serving a day of beef, pork, or lamb, he reported. Their risk was three times that of women who ate less red meat; if they also were longtime smokers, they had a nearly 18-fold increased risk. Among slow acetylators, meat intake did not raise the risk of colorectal cancer.

“We definitely found in a large population that women who consumed less red meat decreased their colorectal cancer risk,” Dr. Chan said.

He cautioned, however, that their sample size of 183 patients was too small.

The research does suggest that some women may be more genetically predisposed to the higher risk of colorectal cancer associated with meat and smoking, Dr. Chan said.

They plan future studies to analyze data they collected on cooking methods, to determine whether the method and temperature for cooking meat influence the risk of cancer.

The Nurses' Health Study is a set of investigations studying the risk factors of major chronic diseases in women.

Future studies will try to determine whether the method and temperature for cooking meat influence the risk of cancer. Vivian E. Lee

CHICAGO — High intake of red meat has been linked to increased risk of colorectal cancer in many studies, and a new study has found a possible reason.

NAT2 genotype appears to activate carcinogenic heterocyclic amines produced in cooked red meat and in cigarette smoke, the investigators reported at the annual Digestive Disease Week.

Using data from nearly 33,000 women enrolled in the prospective Nurses' Health Study, Andrew Chan, M.D., and his coauthors examined the risk of incident colorectal cancer according to NAT2 genotypes, meat intake, and smoking. They matched 183 women with colorectal cancer to 443 controls (Int. J. Cancer 2005;115:648–52).

They found that the acetylator genotype alone did not significantly increase cancer risk. However, women with rapid acetylator genotypes had a markedly increased risk of colorectal cancer if they consumed more than half a serving a day of beef, pork, or lamb, he reported. Their risk was three times that of women who ate less red meat; if they also were longtime smokers, they had a nearly 18-fold increased risk. Among slow acetylators, meat intake did not raise the risk of colorectal cancer.

“We definitely found in a large population that women who consumed less red meat decreased their colorectal cancer risk,” Dr. Chan said.

He cautioned, however, that their sample size of 183 patients was too small.

The research does suggest that some women may be more genetically predisposed to the higher risk of colorectal cancer associated with meat and smoking, Dr. Chan said.

They plan future studies to analyze data they collected on cooking methods, to determine whether the method and temperature for cooking meat influence the risk of cancer.

The Nurses' Health Study is a set of investigations studying the risk factors of major chronic diseases in women.

Future studies will try to determine whether the method and temperature for cooking meat influence the risk of cancer. Vivian E. Lee

CHICAGO — High intake of red meat has been linked to increased risk of colorectal cancer in many studies, and a new study has found a possible reason.

NAT2 genotype appears to activate carcinogenic heterocyclic amines produced in cooked red meat and in cigarette smoke, the investigators reported at the annual Digestive Disease Week.

Using data from nearly 33,000 women enrolled in the prospective Nurses' Health Study, Andrew Chan, M.D., and his coauthors examined the risk of incident colorectal cancer according to NAT2 genotypes, meat intake, and smoking. They matched 183 women with colorectal cancer to 443 controls (Int. J. Cancer 2005;115:648–52).

They found that the acetylator genotype alone did not significantly increase cancer risk. However, women with rapid acetylator genotypes had a markedly increased risk of colorectal cancer if they consumed more than half a serving a day of beef, pork, or lamb, he reported. Their risk was three times that of women who ate less red meat; if they also were longtime smokers, they had a nearly 18-fold increased risk. Among slow acetylators, meat intake did not raise the risk of colorectal cancer.

“We definitely found in a large population that women who consumed less red meat decreased their colorectal cancer risk,” Dr. Chan said.

He cautioned, however, that their sample size of 183 patients was too small.

The research does suggest that some women may be more genetically predisposed to the higher risk of colorectal cancer associated with meat and smoking, Dr. Chan said.

They plan future studies to analyze data they collected on cooking methods, to determine whether the method and temperature for cooking meat influence the risk of cancer.

The Nurses' Health Study is a set of investigations studying the risk factors of major chronic diseases in women.

Future studies will try to determine whether the method and temperature for cooking meat influence the risk of cancer. Vivian E. Lee

CHICAGO — A bile acid thought to decrease biliary pain and acute cholecystitis in patients with gallstones exerted no beneficial effects in Dutch patients who were awaiting cholecystectomy, Niels Venneman, M.D., reported at the annual Digestive Disease Week.

Dr. Venneman of University Medical Center Utrecht, the Netherlands, presented results of a randomized, double-blind, placebo-controlled trial of ursodeoxycholic acid, also called ursodiol.

He and his coworkers randomized 177 symptomatic gallstone patients scheduled for elective cholecystectomy to receive either ursodiol or placebo. Only 23 of 89 patients (26%) receiving ursodiol remained free of biliary colic while waiting for surgery (mean, 90 days), whereas 29 of 88 patients (33%) receiving placebo stayed colic free.

“Clearly, [ursodiol] does not protect against biliary colics,” Dr. Venneman said. The drug also had no effect on analgesic intake or episodes of nonsevere biliary pain, he added. However, patients who had fewer than three biliary colic episodes in the year before the study were significantly more likely to remain colic free while waiting for surgery than were patients with three or more preoperative colic episodes.

At baseline, 126 patients underwent ultrasonographic studies of gallbladder motility. Among those patients, the likelihood of remaining colic free was comparable in strong and weak contractors (minimal gallbladder volume less than or equal to 6 mL and greater than 6 mL, respectively).

The study may have had a selection bias, in that patients waiting to be operated on are likely sicker, one attendee commented after the presentation. Dr. Venneman agreed, saying, “We had a highly symptomatic group.”

Results of the current study contradicted a Japanese study, which found that ursodiol therapy was associated with a reduced risk of biliary pain after 10 years' follow-up of patients with gallstones (Hepatology 1999;30:6–13).

The foundation Maag Lever Darm Stichting in Nieuwegein, the Netherlands, funded Dr. Venneman's study.

CHICAGO — A bile acid thought to decrease biliary pain and acute cholecystitis in patients with gallstones exerted no beneficial effects in Dutch patients who were awaiting cholecystectomy, Niels Venneman, M.D., reported at the annual Digestive Disease Week.

Dr. Venneman of University Medical Center Utrecht, the Netherlands, presented results of a randomized, double-blind, placebo-controlled trial of ursodeoxycholic acid, also called ursodiol.

He and his coworkers randomized 177 symptomatic gallstone patients scheduled for elective cholecystectomy to receive either ursodiol or placebo. Only 23 of 89 patients (26%) receiving ursodiol remained free of biliary colic while waiting for surgery (mean, 90 days), whereas 29 of 88 patients (33%) receiving placebo stayed colic free.

“Clearly, [ursodiol] does not protect against biliary colics,” Dr. Venneman said. The drug also had no effect on analgesic intake or episodes of nonsevere biliary pain, he added. However, patients who had fewer than three biliary colic episodes in the year before the study were significantly more likely to remain colic free while waiting for surgery than were patients with three or more preoperative colic episodes.

At baseline, 126 patients underwent ultrasonographic studies of gallbladder motility. Among those patients, the likelihood of remaining colic free was comparable in strong and weak contractors (minimal gallbladder volume less than or equal to 6 mL and greater than 6 mL, respectively).

The study may have had a selection bias, in that patients waiting to be operated on are likely sicker, one attendee commented after the presentation. Dr. Venneman agreed, saying, “We had a highly symptomatic group.”

Results of the current study contradicted a Japanese study, which found that ursodiol therapy was associated with a reduced risk of biliary pain after 10 years' follow-up of patients with gallstones (Hepatology 1999;30:6–13).

The foundation Maag Lever Darm Stichting in Nieuwegein, the Netherlands, funded Dr. Venneman's study.

CHICAGO — A bile acid thought to decrease biliary pain and acute cholecystitis in patients with gallstones exerted no beneficial effects in Dutch patients who were awaiting cholecystectomy, Niels Venneman, M.D., reported at the annual Digestive Disease Week.

Dr. Venneman of University Medical Center Utrecht, the Netherlands, presented results of a randomized, double-blind, placebo-controlled trial of ursodeoxycholic acid, also called ursodiol.

He and his coworkers randomized 177 symptomatic gallstone patients scheduled for elective cholecystectomy to receive either ursodiol or placebo. Only 23 of 89 patients (26%) receiving ursodiol remained free of biliary colic while waiting for surgery (mean, 90 days), whereas 29 of 88 patients (33%) receiving placebo stayed colic free.

“Clearly, [ursodiol] does not protect against biliary colics,” Dr. Venneman said. The drug also had no effect on analgesic intake or episodes of nonsevere biliary pain, he added. However, patients who had fewer than three biliary colic episodes in the year before the study were significantly more likely to remain colic free while waiting for surgery than were patients with three or more preoperative colic episodes.

At baseline, 126 patients underwent ultrasonographic studies of gallbladder motility. Among those patients, the likelihood of remaining colic free was comparable in strong and weak contractors (minimal gallbladder volume less than or equal to 6 mL and greater than 6 mL, respectively).

The study may have had a selection bias, in that patients waiting to be operated on are likely sicker, one attendee commented after the presentation. Dr. Venneman agreed, saying, “We had a highly symptomatic group.”

Results of the current study contradicted a Japanese study, which found that ursodiol therapy was associated with a reduced risk of biliary pain after 10 years' follow-up of patients with gallstones (Hepatology 1999;30:6–13).

The foundation Maag Lever Darm Stichting in Nieuwegein, the Netherlands, funded Dr. Venneman's study.

CHICAGO — Chronic infection with the hepatitis C virus increases the risk of gallbladder disease in men, according to research presented at the annual Digestive Disease Week.

The risk of gallstones and and the risk of undergoing a cholecystectomy are highest in hepatitis C virus (HCV)-positive Hispanic patients and men aged 60 years or older, reported Luciano Kapelusznik, M.D., a resident at New York University.

Dr. Kapelusznik and senior investigator Edmund Bini, M.D., conducted the study at the Veterans Affairs New York Harbor Healthcare System.

They compared the prevalence of gallbladder disease in 564 men who had positive HCV antibody and RNA tests vs. 163 men who did not have HCV. No significant differences existed in age, race, alcohol use, smoking, or diabetes between groups, Dr. Kapelusznik reported. In the HCV-positive group, the prevalence of both gallstones and prior cholecystectomy as seen with ultrasonography was significantly higher than in the control group of noninfected men. Gallstone prevalence was 21% in men with HCV, compared with 7% in controls; cholecystectomy prevalence was 8% vs. 2% in controls. When the two parameters were combined for an end point of gallbladder disease, the prevalence was also significantly higher in HCV-positive men (29% vs. 9%).

Among HCV-positive men, the risk of gallbladder disease increased significantly with age, from 21% in those younger than 50 years to 45% at age 60 or older. Race also showed significant differences in those with chronic HCV. Hispanics had a 47% risk, non-Hispanic whites 30%, blacks 16%, and other racial groups 16.7%.

The risk of gallbladder disease also rose with increased severity of liver disease, Dr. Kapelusznik told the audience.

CHICAGO — Chronic infection with the hepatitis C virus increases the risk of gallbladder disease in men, according to research presented at the annual Digestive Disease Week.

The risk of gallstones and and the risk of undergoing a cholecystectomy are highest in hepatitis C virus (HCV)-positive Hispanic patients and men aged 60 years or older, reported Luciano Kapelusznik, M.D., a resident at New York University.

Dr. Kapelusznik and senior investigator Edmund Bini, M.D., conducted the study at the Veterans Affairs New York Harbor Healthcare System.

They compared the prevalence of gallbladder disease in 564 men who had positive HCV antibody and RNA tests vs. 163 men who did not have HCV. No significant differences existed in age, race, alcohol use, smoking, or diabetes between groups, Dr. Kapelusznik reported. In the HCV-positive group, the prevalence of both gallstones and prior cholecystectomy as seen with ultrasonography was significantly higher than in the control group of noninfected men. Gallstone prevalence was 21% in men with HCV, compared with 7% in controls; cholecystectomy prevalence was 8% vs. 2% in controls. When the two parameters were combined for an end point of gallbladder disease, the prevalence was also significantly higher in HCV-positive men (29% vs. 9%).

Among HCV-positive men, the risk of gallbladder disease increased significantly with age, from 21% in those younger than 50 years to 45% at age 60 or older. Race also showed significant differences in those with chronic HCV. Hispanics had a 47% risk, non-Hispanic whites 30%, blacks 16%, and other racial groups 16.7%.

The risk of gallbladder disease also rose with increased severity of liver disease, Dr. Kapelusznik told the audience.

CHICAGO — Chronic infection with the hepatitis C virus increases the risk of gallbladder disease in men, according to research presented at the annual Digestive Disease Week.

The risk of gallstones and and the risk of undergoing a cholecystectomy are highest in hepatitis C virus (HCV)-positive Hispanic patients and men aged 60 years or older, reported Luciano Kapelusznik, M.D., a resident at New York University.

Dr. Kapelusznik and senior investigator Edmund Bini, M.D., conducted the study at the Veterans Affairs New York Harbor Healthcare System.

They compared the prevalence of gallbladder disease in 564 men who had positive HCV antibody and RNA tests vs. 163 men who did not have HCV. No significant differences existed in age, race, alcohol use, smoking, or diabetes between groups, Dr. Kapelusznik reported. In the HCV-positive group, the prevalence of both gallstones and prior cholecystectomy as seen with ultrasonography was significantly higher than in the control group of noninfected men. Gallstone prevalence was 21% in men with HCV, compared with 7% in controls; cholecystectomy prevalence was 8% vs. 2% in controls. When the two parameters were combined for an end point of gallbladder disease, the prevalence was also significantly higher in HCV-positive men (29% vs. 9%).

Among HCV-positive men, the risk of gallbladder disease increased significantly with age, from 21% in those younger than 50 years to 45% at age 60 or older. Race also showed significant differences in those with chronic HCV. Hispanics had a 47% risk, non-Hispanic whites 30%, blacks 16%, and other racial groups 16.7%.

The risk of gallbladder disease also rose with increased severity of liver disease, Dr. Kapelusznik told the audience.

CHICAGO — Cardiologists might not be adequately protecting their coronary artery-stenting patients against the risk of upper GI bleeding due to antiplatelet therapy, according to a poster presented at the annual Digestive Disease Week.

The study, led by Steven Chang, M.D., was a chart review of 636 randomly selected patients who received cardiovascular stents at three institutions, including Chicago's Northwestern Memorial Hospital. Most patients received aspirin before (n = 459) and/or after (n = 619) stent placement, which increased their risk of peptic ulcer-related bleeding, according to Dr. Chang and his colleagues. After stenting, however, only 155 (24%) were prescribed a proton pump inhibitor (PPI); 14 (2%) were prescribed an H2-receptor antagonist; and 1 patient was prescribed sucralfate, reported Dr. Chang, who is a consultant to Santarus, a manufacturer of omeprazole.

Some of the stent recipients had risk factors for GI bleeding besides aspirin therapy. Three patients had a documented history of upper GI bleeding, 23 had a history of peptic ulcer disease, and 30 were receiving NSAID therapy that was not stopped before stenting.

“Few coronary stent patients who are started on aspirin [therapy] and other antiplatelet agents receive appropriate GI prophylaxis,” Dr. Chang wrote. But it might not be cost effective to prescribe a PPI in all patients before stent placement, he added. “We recommend that cardiologists give PPIs to patients at risk [of upper GI bleeding] before stenting.”

Outcomes data on GI bleeding were not available in the study. Dr. Chang said a randomized trial of PPI prophylaxis is needed to determine whether PPIs prevent bleeding in this at-risk population.

CHICAGO — Cardiologists might not be adequately protecting their coronary artery-stenting patients against the risk of upper GI bleeding due to antiplatelet therapy, according to a poster presented at the annual Digestive Disease Week.

The study, led by Steven Chang, M.D., was a chart review of 636 randomly selected patients who received cardiovascular stents at three institutions, including Chicago's Northwestern Memorial Hospital. Most patients received aspirin before (n = 459) and/or after (n = 619) stent placement, which increased their risk of peptic ulcer-related bleeding, according to Dr. Chang and his colleagues. After stenting, however, only 155 (24%) were prescribed a proton pump inhibitor (PPI); 14 (2%) were prescribed an H2-receptor antagonist; and 1 patient was prescribed sucralfate, reported Dr. Chang, who is a consultant to Santarus, a manufacturer of omeprazole.

Some of the stent recipients had risk factors for GI bleeding besides aspirin therapy. Three patients had a documented history of upper GI bleeding, 23 had a history of peptic ulcer disease, and 30 were receiving NSAID therapy that was not stopped before stenting.

“Few coronary stent patients who are started on aspirin [therapy] and other antiplatelet agents receive appropriate GI prophylaxis,” Dr. Chang wrote. But it might not be cost effective to prescribe a PPI in all patients before stent placement, he added. “We recommend that cardiologists give PPIs to patients at risk [of upper GI bleeding] before stenting.”

Outcomes data on GI bleeding were not available in the study. Dr. Chang said a randomized trial of PPI prophylaxis is needed to determine whether PPIs prevent bleeding in this at-risk population.

CHICAGO — Cardiologists might not be adequately protecting their coronary artery-stenting patients against the risk of upper GI bleeding due to antiplatelet therapy, according to a poster presented at the annual Digestive Disease Week.

The study, led by Steven Chang, M.D., was a chart review of 636 randomly selected patients who received cardiovascular stents at three institutions, including Chicago's Northwestern Memorial Hospital. Most patients received aspirin before (n = 459) and/or after (n = 619) stent placement, which increased their risk of peptic ulcer-related bleeding, according to Dr. Chang and his colleagues. After stenting, however, only 155 (24%) were prescribed a proton pump inhibitor (PPI); 14 (2%) were prescribed an H2-receptor antagonist; and 1 patient was prescribed sucralfate, reported Dr. Chang, who is a consultant to Santarus, a manufacturer of omeprazole.

Some of the stent recipients had risk factors for GI bleeding besides aspirin therapy. Three patients had a documented history of upper GI bleeding, 23 had a history of peptic ulcer disease, and 30 were receiving NSAID therapy that was not stopped before stenting.

“Few coronary stent patients who are started on aspirin [therapy] and other antiplatelet agents receive appropriate GI prophylaxis,” Dr. Chang wrote. But it might not be cost effective to prescribe a PPI in all patients before stent placement, he added. “We recommend that cardiologists give PPIs to patients at risk [of upper GI bleeding] before stenting.”

Outcomes data on GI bleeding were not available in the study. Dr. Chang said a randomized trial of PPI prophylaxis is needed to determine whether PPIs prevent bleeding in this at-risk population.

CHICAGO — Cholecystectomy should be performed after endoscopic removal of bile duct stones in patients older than 60 years who also have gallstones, James Lau, M.D., said at the annual Digestive Disease Week.

Surgical removal of the gallbladder, performed either traditionally or endoscopically, significantly reduces recurrent biliary events, compared with those that occur when the gallbladder is left in situ, Dr. Lau reported.

“There is a perceived high morbidity with cholecystectomy in patients older than 60,” said Dr. Lau of Prince of Wales Hospital and Chinese University of Hong Kong. However, he and his associates found that this was not the case.

The researchers randomly assigned 178 patients older than 60 who had concomitant gallstones (pigment stones) to either cholecystectomy or expectant management following endoscopic sphincterotomy and clearance of bile duct stones. Of those, 82 patients elected to have cholecystectomy, and 88 patients kept their gallbladder and were managed with watchful waiting.

During a median follow-up of 66 months, six patients (7.3%) in the cholecystectomy group returned for treatment of biliary events, primarily cholangitis, Dr. Lau reported. In the observation group, 21 patients (24%) experienced recurrent events, including bile duct stones and cholangitis, acute cholecystitis, or biliary colic. Additionally, more persons in the observation group died than did those who underwent cholecystectomy (19 vs. 11), he said.

In recommending cholecystectomy in this older patient population, Dr. Lau cautioned that the conversion rate from laparoscopic to open cholecystectomy is expected to be high. Conversion to open surgery was needed in 16 (20%) of the 82 patients.

Cholecystectomy benefited patients who had bile duct stones removed and also had gallstones, shown here by sonography. ©Elsevier 2002. Sleisenger & Fordtran's Gastrointestinal and Liver Disease 7E

CHICAGO — Cholecystectomy should be performed after endoscopic removal of bile duct stones in patients older than 60 years who also have gallstones, James Lau, M.D., said at the annual Digestive Disease Week.

Surgical removal of the gallbladder, performed either traditionally or endoscopically, significantly reduces recurrent biliary events, compared with those that occur when the gallbladder is left in situ, Dr. Lau reported.

“There is a perceived high morbidity with cholecystectomy in patients older than 60,” said Dr. Lau of Prince of Wales Hospital and Chinese University of Hong Kong. However, he and his associates found that this was not the case.

The researchers randomly assigned 178 patients older than 60 who had concomitant gallstones (pigment stones) to either cholecystectomy or expectant management following endoscopic sphincterotomy and clearance of bile duct stones. Of those, 82 patients elected to have cholecystectomy, and 88 patients kept their gallbladder and were managed with watchful waiting.

During a median follow-up of 66 months, six patients (7.3%) in the cholecystectomy group returned for treatment of biliary events, primarily cholangitis, Dr. Lau reported. In the observation group, 21 patients (24%) experienced recurrent events, including bile duct stones and cholangitis, acute cholecystitis, or biliary colic. Additionally, more persons in the observation group died than did those who underwent cholecystectomy (19 vs. 11), he said.

In recommending cholecystectomy in this older patient population, Dr. Lau cautioned that the conversion rate from laparoscopic to open cholecystectomy is expected to be high. Conversion to open surgery was needed in 16 (20%) of the 82 patients.

Cholecystectomy benefited patients who had bile duct stones removed and also had gallstones, shown here by sonography. ©Elsevier 2002. Sleisenger & Fordtran's Gastrointestinal and Liver Disease 7E

CHICAGO — Cholecystectomy should be performed after endoscopic removal of bile duct stones in patients older than 60 years who also have gallstones, James Lau, M.D., said at the annual Digestive Disease Week.

Surgical removal of the gallbladder, performed either traditionally or endoscopically, significantly reduces recurrent biliary events, compared with those that occur when the gallbladder is left in situ, Dr. Lau reported.

“There is a perceived high morbidity with cholecystectomy in patients older than 60,” said Dr. Lau of Prince of Wales Hospital and Chinese University of Hong Kong. However, he and his associates found that this was not the case.

The researchers randomly assigned 178 patients older than 60 who had concomitant gallstones (pigment stones) to either cholecystectomy or expectant management following endoscopic sphincterotomy and clearance of bile duct stones. Of those, 82 patients elected to have cholecystectomy, and 88 patients kept their gallbladder and were managed with watchful waiting.

During a median follow-up of 66 months, six patients (7.3%) in the cholecystectomy group returned for treatment of biliary events, primarily cholangitis, Dr. Lau reported. In the observation group, 21 patients (24%) experienced recurrent events, including bile duct stones and cholangitis, acute cholecystitis, or biliary colic. Additionally, more persons in the observation group died than did those who underwent cholecystectomy (19 vs. 11), he said.

In recommending cholecystectomy in this older patient population, Dr. Lau cautioned that the conversion rate from laparoscopic to open cholecystectomy is expected to be high. Conversion to open surgery was needed in 16 (20%) of the 82 patients.

Cholecystectomy benefited patients who had bile duct stones removed and also had gallstones, shown here by sonography. ©Elsevier 2002. Sleisenger & Fordtran's Gastrointestinal and Liver Disease 7E

CHICAGO — Four percent of primary care physicians and third-year medical students surveyed in a regional study reported that they made errors resulting in a patient's death but did not disclose them to their institution, Lauris C. Kaldjian, M.D., said at the combined annual meeting of the Central Society for Clinical Research and the Midwestern section of the American Federation for Medical Research.

Dr. Kaldjian surveyed faculty, residents, and third-year medical students in the departments of internal medicine, family medicine, and pediatrics at two medical schools and three hospitals in the Midwest and Northeast. The 538 responses were weighted more heavily toward residents and students than faculty members.

Of respondents, 17% did not disclose to their institution medical errors that prolonged the course of treatment or caused discomfort, and 12% did not disclose to the patient. Still, more primary care physicians and students voluntarily disclosed medical errors than those who did not, said Dr. Kaldjian, a bioethicist at the University of Iowa. Of the respondents, 27% revealed to the patient a medical error that prolonged therapy, and 18% disclosed such a mistake to their institutions.

The study was designed to develop a comprehensive taxonomy of the factors that influence voluntary disclosure of errors by physicians and to use the taxonomy in a cross-sectional survey of primary care physicians. The survey asked about factors that facilitate voluntary disclosure in four domains: a sense of responsibility to the patient, oneself, the medical profession, and the community. It also solicited reasons that impede disclosure of errors in four domains: attitudinal barriers, uncertainties, helplessness, and fears and anxiety.

These eight domains included 59 factors that either facilitate disclosure, such as the belief that telling patients about mistakes increases their trust in the physician, or hinder disclosure—for example, fear of legal liability.

“This study is trying to get at the deepest motivations and barriers that come into our minds and even our hearts when it comes to talking to patients about medical errors,” said Dr. Kaldjian, whose work was funded by the Robert Wood Johnson Foundation. “The issue of disclosure of errors has come to the fore in recent years because of the patient safety movement.”

Among fears, the most common reason survey respondents did not disclose a medical error was fear of a negative reaction from the patient or family (88%).

“You hear certain experts in the field saying the more candid we are, the less likely we'll get sued,” he said. “Among the people we surveyed, it certainly is not the consensus of what would happen.”

Women in the study were more inclined than men to disclose their errors to patients. Faculty members appeared more willing than trainees to disclose errors to their patients but not as willing to disclose to their colleagues.

Dr. Kaldjian did not break down medical errors other than those that prolonged therapy or caused discomfort and those that caused death, he told this newspaper. He is continuing to interpret the data.

The taxonomy he developed may assist in the design of systems for reporting medical errors and might be helpful for educational interventions.

CHICAGO — Four percent of primary care physicians and third-year medical students surveyed in a regional study reported that they made errors resulting in a patient's death but did not disclose them to their institution, Lauris C. Kaldjian, M.D., said at the combined annual meeting of the Central Society for Clinical Research and the Midwestern section of the American Federation for Medical Research.

Dr. Kaldjian surveyed faculty, residents, and third-year medical students in the departments of internal medicine, family medicine, and pediatrics at two medical schools and three hospitals in the Midwest and Northeast. The 538 responses were weighted more heavily toward residents and students than faculty members.

Of respondents, 17% did not disclose to their institution medical errors that prolonged the course of treatment or caused discomfort, and 12% did not disclose to the patient. Still, more primary care physicians and students voluntarily disclosed medical errors than those who did not, said Dr. Kaldjian, a bioethicist at the University of Iowa. Of the respondents, 27% revealed to the patient a medical error that prolonged therapy, and 18% disclosed such a mistake to their institutions.

The study was designed to develop a comprehensive taxonomy of the factors that influence voluntary disclosure of errors by physicians and to use the taxonomy in a cross-sectional survey of primary care physicians. The survey asked about factors that facilitate voluntary disclosure in four domains: a sense of responsibility to the patient, oneself, the medical profession, and the community. It also solicited reasons that impede disclosure of errors in four domains: attitudinal barriers, uncertainties, helplessness, and fears and anxiety.

These eight domains included 59 factors that either facilitate disclosure, such as the belief that telling patients about mistakes increases their trust in the physician, or hinder disclosure—for example, fear of legal liability.

“This study is trying to get at the deepest motivations and barriers that come into our minds and even our hearts when it comes to talking to patients about medical errors,” said Dr. Kaldjian, whose work was funded by the Robert Wood Johnson Foundation. “The issue of disclosure of errors has come to the fore in recent years because of the patient safety movement.”

Among fears, the most common reason survey respondents did not disclose a medical error was fear of a negative reaction from the patient or family (88%).

“You hear certain experts in the field saying the more candid we are, the less likely we'll get sued,” he said. “Among the people we surveyed, it certainly is not the consensus of what would happen.”

Women in the study were more inclined than men to disclose their errors to patients. Faculty members appeared more willing than trainees to disclose errors to their patients but not as willing to disclose to their colleagues.

Dr. Kaldjian did not break down medical errors other than those that prolonged therapy or caused discomfort and those that caused death, he told this newspaper. He is continuing to interpret the data.

The taxonomy he developed may assist in the design of systems for reporting medical errors and might be helpful for educational interventions.

CHICAGO — Four percent of primary care physicians and third-year medical students surveyed in a regional study reported that they made errors resulting in a patient's death but did not disclose them to their institution, Lauris C. Kaldjian, M.D., said at the combined annual meeting of the Central Society for Clinical Research and the Midwestern section of the American Federation for Medical Research.

Dr. Kaldjian surveyed faculty, residents, and third-year medical students in the departments of internal medicine, family medicine, and pediatrics at two medical schools and three hospitals in the Midwest and Northeast. The 538 responses were weighted more heavily toward residents and students than faculty members.

Of respondents, 17% did not disclose to their institution medical errors that prolonged the course of treatment or caused discomfort, and 12% did not disclose to the patient. Still, more primary care physicians and students voluntarily disclosed medical errors than those who did not, said Dr. Kaldjian, a bioethicist at the University of Iowa. Of the respondents, 27% revealed to the patient a medical error that prolonged therapy, and 18% disclosed such a mistake to their institutions.

The study was designed to develop a comprehensive taxonomy of the factors that influence voluntary disclosure of errors by physicians and to use the taxonomy in a cross-sectional survey of primary care physicians. The survey asked about factors that facilitate voluntary disclosure in four domains: a sense of responsibility to the patient, oneself, the medical profession, and the community. It also solicited reasons that impede disclosure of errors in four domains: attitudinal barriers, uncertainties, helplessness, and fears and anxiety.

These eight domains included 59 factors that either facilitate disclosure, such as the belief that telling patients about mistakes increases their trust in the physician, or hinder disclosure—for example, fear of legal liability.

“This study is trying to get at the deepest motivations and barriers that come into our minds and even our hearts when it comes to talking to patients about medical errors,” said Dr. Kaldjian, whose work was funded by the Robert Wood Johnson Foundation. “The issue of disclosure of errors has come to the fore in recent years because of the patient safety movement.”

Among fears, the most common reason survey respondents did not disclose a medical error was fear of a negative reaction from the patient or family (88%).

“You hear certain experts in the field saying the more candid we are, the less likely we'll get sued,” he said. “Among the people we surveyed, it certainly is not the consensus of what would happen.”

Women in the study were more inclined than men to disclose their errors to patients. Faculty members appeared more willing than trainees to disclose errors to their patients but not as willing to disclose to their colleagues.

Dr. Kaldjian did not break down medical errors other than those that prolonged therapy or caused discomfort and those that caused death, he told this newspaper. He is continuing to interpret the data.

The taxonomy he developed may assist in the design of systems for reporting medical errors and might be helpful for educational interventions.

CHICAGO — High intake of red meat has been linked to increased risk of colorectal cancer in many studies, and a new study has found a possible reason.

NAT2 genotype appears to activate carcinogenic heterocyclic amines produced in cooked red meat and in cigarette smoke, the investigators reported at the annual Digestive Disease Week.

Using data from nearly 33,000 women enrolled in the prospective Nurses' Health Study, Andrew Chan, M.D., and his coauthors examined the risk of incident colorectal cancer according to NAT2 genotypes, meat intake, and smoking. They matched 183 women with colorectal cancer to 443 controls (Int. J. Cancer 2005;115:648–52). They found that the acetylator genotype alone did not significantly increase cancer risk.

However, women with rapid acetylator genotypes had a markedly increased risk of colorectal cancer if they consumed more than half a serving a day of beef, pork, or lamb, he reported. Their risk was three times that of women who ate less red meat; if they also were longtime smokers, they had a nearly 18-fold increased risk. Among slow acetylators, meat intake did not raise the risk of colorectal cancer.

“We definitely found in a large population that women who consumed less red meat decreased their colorectal cancer risk,” Dr. Chan said.

He cautioned, however, that their sample size of 183 patients was too small. The research does suggest that some women may be more genetically predisposed to the higher risk of colorectal cancer associated with meat and smoking, he said.

They plan future studies to analyze data they collected on cooking methods, to determine whether the method and temperature for cooking meat influence the risk of cancer. The Nurses' Health Study is an ongoing set of investigations studying the risk factors of major chronic diseases in women.

High intake of red meat activates the NAT2 genotype, which increases a patient's risk for colorectal cancer. Vivian E. Lee

CHICAGO — High intake of red meat has been linked to increased risk of colorectal cancer in many studies, and a new study has found a possible reason.

NAT2 genotype appears to activate carcinogenic heterocyclic amines produced in cooked red meat and in cigarette smoke, the investigators reported at the annual Digestive Disease Week.

Using data from nearly 33,000 women enrolled in the prospective Nurses' Health Study, Andrew Chan, M.D., and his coauthors examined the risk of incident colorectal cancer according to NAT2 genotypes, meat intake, and smoking. They matched 183 women with colorectal cancer to 443 controls (Int. J. Cancer 2005;115:648–52). They found that the acetylator genotype alone did not significantly increase cancer risk.

However, women with rapid acetylator genotypes had a markedly increased risk of colorectal cancer if they consumed more than half a serving a day of beef, pork, or lamb, he reported. Their risk was three times that of women who ate less red meat; if they also were longtime smokers, they had a nearly 18-fold increased risk. Among slow acetylators, meat intake did not raise the risk of colorectal cancer.

“We definitely found in a large population that women who consumed less red meat decreased their colorectal cancer risk,” Dr. Chan said.

He cautioned, however, that their sample size of 183 patients was too small. The research does suggest that some women may be more genetically predisposed to the higher risk of colorectal cancer associated with meat and smoking, he said.

They plan future studies to analyze data they collected on cooking methods, to determine whether the method and temperature for cooking meat influence the risk of cancer. The Nurses' Health Study is an ongoing set of investigations studying the risk factors of major chronic diseases in women.

High intake of red meat activates the NAT2 genotype, which increases a patient's risk for colorectal cancer. Vivian E. Lee

CHICAGO — High intake of red meat has been linked to increased risk of colorectal cancer in many studies, and a new study has found a possible reason.

NAT2 genotype appears to activate carcinogenic heterocyclic amines produced in cooked red meat and in cigarette smoke, the investigators reported at the annual Digestive Disease Week.

Using data from nearly 33,000 women enrolled in the prospective Nurses' Health Study, Andrew Chan, M.D., and his coauthors examined the risk of incident colorectal cancer according to NAT2 genotypes, meat intake, and smoking. They matched 183 women with colorectal cancer to 443 controls (Int. J. Cancer 2005;115:648–52). They found that the acetylator genotype alone did not significantly increase cancer risk.

However, women with rapid acetylator genotypes had a markedly increased risk of colorectal cancer if they consumed more than half a serving a day of beef, pork, or lamb, he reported. Their risk was three times that of women who ate less red meat; if they also were longtime smokers, they had a nearly 18-fold increased risk. Among slow acetylators, meat intake did not raise the risk of colorectal cancer.

“We definitely found in a large population that women who consumed less red meat decreased their colorectal cancer risk,” Dr. Chan said.

He cautioned, however, that their sample size of 183 patients was too small. The research does suggest that some women may be more genetically predisposed to the higher risk of colorectal cancer associated with meat and smoking, he said.

They plan future studies to analyze data they collected on cooking methods, to determine whether the method and temperature for cooking meat influence the risk of cancer. The Nurses' Health Study is an ongoing set of investigations studying the risk factors of major chronic diseases in women.

High intake of red meat activates the NAT2 genotype, which increases a patient's risk for colorectal cancer. Vivian E. Lee

CHICAGO — Patients with acute bleeding of the lower intestinal tract have a shorter hospitalization if they undergo colonoscopy on the first day of admission, according to a nationwide study by Harvard Medical School researchers.

Early colonoscopy also was associated with decreased hospital charges, Lisa Strate, M.D., reported at the annual Digestive Disease Week.

The study was based on a 20% sample of a nationally representative cohort called the Healthcare Cost and Utilization Project's 2002 National Inpatient Sample. This database contains discharge data from 995 U.S. community hospitals in 35 states, according to its sponsor, the Agency for Healthcare Research and Quality.

Among more than 255,000 discharged patients who had a principal diagnosis of acute lower intestinal bleeding, 28% had colonoscopy on hospital day 1, called early colonoscopy. Another 22% of the total cohort underwent colonoscopy after day 1.

Patients who underwent early colonoscopy had a mean stay of 5 days vs. 7 days for patients who did not have the procedure or had it after the first hospital day, Dr. Strate said.

Reduced stay did not appear to result from therapeutic interventions, because colonoscopy with endoscopic hemostasis was not associated with shorter length of stay, she reported. This finding confirmed the results of two single-institution studies (Am. J. Gastroenterol. 2003;98:317–22; Gastrointest. Endosc. 2003;58:841–6).

“We hypothesize that doing an early colonoscopy and finding no source of active or ongoing bleeding offered reassurance and led to an earlier discharge,” Dr. Strate said in an interview. “Patients with high-risk stigmata were observed for longer periods.”

In a separate presentation, Don Rockey, M.D., professor of gastroenterology at Duke University and an author of one of the previous studies (Gastrointest. Endosc. 2003;58:841–6), commented on early colonoscopy in this patient population. “Urgent colonoscopy translates to decreased hospital stay and costs,” he said.

Longer hospital stay for patients with acute lower intestinal bleeding is associated with higher mortality, Dr. Strate reported in another study at the meeting that used the National Inpatient Sample.

CHICAGO — Patients with acute bleeding of the lower intestinal tract have a shorter hospitalization if they undergo colonoscopy on the first day of admission, according to a nationwide study by Harvard Medical School researchers.

Early colonoscopy also was associated with decreased hospital charges, Lisa Strate, M.D., reported at the annual Digestive Disease Week.

The study was based on a 20% sample of a nationally representative cohort called the Healthcare Cost and Utilization Project's 2002 National Inpatient Sample. This database contains discharge data from 995 U.S. community hospitals in 35 states, according to its sponsor, the Agency for Healthcare Research and Quality.

Among more than 255,000 discharged patients who had a principal diagnosis of acute lower intestinal bleeding, 28% had colonoscopy on hospital day 1, called early colonoscopy. Another 22% of the total cohort underwent colonoscopy after day 1.

Patients who underwent early colonoscopy had a mean stay of 5 days vs. 7 days for patients who did not have the procedure or had it after the first hospital day, Dr. Strate said.

Reduced stay did not appear to result from therapeutic interventions, because colonoscopy with endoscopic hemostasis was not associated with shorter length of stay, she reported. This finding confirmed the results of two single-institution studies (Am. J. Gastroenterol. 2003;98:317–22; Gastrointest. Endosc. 2003;58:841–6).

“We hypothesize that doing an early colonoscopy and finding no source of active or ongoing bleeding offered reassurance and led to an earlier discharge,” Dr. Strate said in an interview. “Patients with high-risk stigmata were observed for longer periods.”

In a separate presentation, Don Rockey, M.D., professor of gastroenterology at Duke University and an author of one of the previous studies (Gastrointest. Endosc. 2003;58:841–6), commented on early colonoscopy in this patient population. “Urgent colonoscopy translates to decreased hospital stay and costs,” he said.

Longer hospital stay for patients with acute lower intestinal bleeding is associated with higher mortality, Dr. Strate reported in another study at the meeting that used the National Inpatient Sample.

CHICAGO — Patients with acute bleeding of the lower intestinal tract have a shorter hospitalization if they undergo colonoscopy on the first day of admission, according to a nationwide study by Harvard Medical School researchers.

Early colonoscopy also was associated with decreased hospital charges, Lisa Strate, M.D., reported at the annual Digestive Disease Week.

The study was based on a 20% sample of a nationally representative cohort called the Healthcare Cost and Utilization Project's 2002 National Inpatient Sample. This database contains discharge data from 995 U.S. community hospitals in 35 states, according to its sponsor, the Agency for Healthcare Research and Quality.

Among more than 255,000 discharged patients who had a principal diagnosis of acute lower intestinal bleeding, 28% had colonoscopy on hospital day 1, called early colonoscopy. Another 22% of the total cohort underwent colonoscopy after day 1.

Patients who underwent early colonoscopy had a mean stay of 5 days vs. 7 days for patients who did not have the procedure or had it after the first hospital day, Dr. Strate said.

Reduced stay did not appear to result from therapeutic interventions, because colonoscopy with endoscopic hemostasis was not associated with shorter length of stay, she reported. This finding confirmed the results of two single-institution studies (Am. J. Gastroenterol. 2003;98:317–22; Gastrointest. Endosc. 2003;58:841–6).

“We hypothesize that doing an early colonoscopy and finding no source of active or ongoing bleeding offered reassurance and led to an earlier discharge,” Dr. Strate said in an interview. “Patients with high-risk stigmata were observed for longer periods.”

In a separate presentation, Don Rockey, M.D., professor of gastroenterology at Duke University and an author of one of the previous studies (Gastrointest. Endosc. 2003;58:841–6), commented on early colonoscopy in this patient population. “Urgent colonoscopy translates to decreased hospital stay and costs,” he said.

Longer hospital stay for patients with acute lower intestinal bleeding is associated with higher mortality, Dr. Strate reported in another study at the meeting that used the National Inpatient Sample.

CHICAGO — In premenopausal women with breast cancer, a higher number of pregnancies may predict estrogen-receptor status, a small preliminary study suggests.

Presented at a poster session during the combined annual meeting of the Central Society for Clinical Research and the Midwestern section of the American Federation for Medical Research, the study is one of the few to analyze hormonal risk factors in premenopausal women, according to Jacqueline Ogutha, the study's lead investigator and a second-year medical student at the University of Chicago. She and her associates reported results from 100 women with breast cancer diagnosed before age 50 years (64 African Americans and 36 whites) and 67 healthy, age-matched controls (39 African Americans and 28 whites).

A logistical regression analysis of this hospital-based cohort detected a near-significant predictive effect of the number of pregnancies for estrogen-receptor status. African American women were significantly more likely than were white women to have estrogen-receptor-negative tumors and a higher mean number of pregnancies.

By omitting postmenopausal women from their study, the researchers found surprising information, said coinvestigator Olufunmilayo Olopade, M.D., professor of medicine at the university. “What we thought was protective may not be protective at young ages,” she said in an interview. “Our preliminary finding suggests that it is not the case that the more pregnancies you have, the higher the protective effect.”

The small size of the patient population may have affected the results, Dr. Olopade said. Although racial differences in breast cancer incidence and mortality are well recognized, the differences remain largely unexplained, Ms. Ogutha said.

The researchers found striking differences in hormonal risk factors between races in their young population, she said. African American women were significantly more likely than whites to have a higher body mass index and younger age at first live birth and were less likely to breast feed.

Other hormonal factors, including age at first menstrual period and oral contraceptive use, as well as tumor size and grade, appeared to have no statistically significant effect across racial groups.

CHICAGO — In premenopausal women with breast cancer, a higher number of pregnancies may predict estrogen-receptor status, a small preliminary study suggests.

Presented at a poster session during the combined annual meeting of the Central Society for Clinical Research and the Midwestern section of the American Federation for Medical Research, the study is one of the few to analyze hormonal risk factors in premenopausal women, according to Jacqueline Ogutha, the study's lead investigator and a second-year medical student at the University of Chicago. She and her associates reported results from 100 women with breast cancer diagnosed before age 50 years (64 African Americans and 36 whites) and 67 healthy, age-matched controls (39 African Americans and 28 whites).

A logistical regression analysis of this hospital-based cohort detected a near-significant predictive effect of the number of pregnancies for estrogen-receptor status. African American women were significantly more likely than were white women to have estrogen-receptor-negative tumors and a higher mean number of pregnancies.

By omitting postmenopausal women from their study, the researchers found surprising information, said coinvestigator Olufunmilayo Olopade, M.D., professor of medicine at the university. “What we thought was protective may not be protective at young ages,” she said in an interview. “Our preliminary finding suggests that it is not the case that the more pregnancies you have, the higher the protective effect.”

The small size of the patient population may have affected the results, Dr. Olopade said. Although racial differences in breast cancer incidence and mortality are well recognized, the differences remain largely unexplained, Ms. Ogutha said.

The researchers found striking differences in hormonal risk factors between races in their young population, she said. African American women were significantly more likely than whites to have a higher body mass index and younger age at first live birth and were less likely to breast feed.

Other hormonal factors, including age at first menstrual period and oral contraceptive use, as well as tumor size and grade, appeared to have no statistically significant effect across racial groups.

CHICAGO — In premenopausal women with breast cancer, a higher number of pregnancies may predict estrogen-receptor status, a small preliminary study suggests.

Presented at a poster session during the combined annual meeting of the Central Society for Clinical Research and the Midwestern section of the American Federation for Medical Research, the study is one of the few to analyze hormonal risk factors in premenopausal women, according to Jacqueline Ogutha, the study's lead investigator and a second-year medical student at the University of Chicago. She and her associates reported results from 100 women with breast cancer diagnosed before age 50 years (64 African Americans and 36 whites) and 67 healthy, age-matched controls (39 African Americans and 28 whites).

A logistical regression analysis of this hospital-based cohort detected a near-significant predictive effect of the number of pregnancies for estrogen-receptor status. African American women were significantly more likely than were white women to have estrogen-receptor-negative tumors and a higher mean number of pregnancies.

By omitting postmenopausal women from their study, the researchers found surprising information, said coinvestigator Olufunmilayo Olopade, M.D., professor of medicine at the university. “What we thought was protective may not be protective at young ages,” she said in an interview. “Our preliminary finding suggests that it is not the case that the more pregnancies you have, the higher the protective effect.”

The small size of the patient population may have affected the results, Dr. Olopade said. Although racial differences in breast cancer incidence and mortality are well recognized, the differences remain largely unexplained, Ms. Ogutha said.

The researchers found striking differences in hormonal risk factors between races in their young population, she said. African American women were significantly more likely than whites to have a higher body mass index and younger age at first live birth and were less likely to breast feed.

Other hormonal factors, including age at first menstrual period and oral contraceptive use, as well as tumor size and grade, appeared to have no statistically significant effect across racial groups.

CHICAGO — Health care costs for morbidly obese adults are nearly double those of normal-weight adults, according to a study presented at the combined annual meeting of the Central Society for Clinical Research and the Midwestern section of the American Federation for Medical Research.

Morbidly obese individuals make up less than 3% of the U.S. adult population, but they account for more than 10% of all health care spending in this country, reported the study's lead investigator, David E. Arterburn, M.D., of the University of Cincinnati.

The study defined morbid obesity as a body mass index of 40 or greater (Int. J. Obes. Relat. Metab. Disord. 2005;29:334–9).

Of U.S. health care expenditures, $56 billion were linked to excess body weight in the year 2000, up from a previously published estimate of $51.5 billion in 1998 (Obes. Res. 2004;12:18–24). Health care expenses for morbidly obese adults totaled more than $11 billion, Dr. Arterburn and his colleagues reported.

The researchers calculated this total by analyzing data from a nationally representative sample of 16,262 adults from the 2000 Medical Expenditure Panel Survey.

Adults who are morbidly obese had elevated costs in all health care categories, Dr. Arterburn said. Compared with adults considered to be of normal weight, morbidly obese persons had higher per capita annual expenditures for office visits, outpatient hospital care, inpatient hospitalizations, and prescription drugs.

Dr. Arterburn and his associates did not study the effect of age on health care expenditures. However, he said, “it's known there's a delay in onset of obesity-associated morbidities, so one would expect expenditures to go up with age.” The mean age of their sample was 45.4 years.

The researchers adjusted the odds of incurring health care expenses for sociodemographic variables, type of health insurance, and smoking status.

Nearly 5 million U.S. adults were morbidly obese in 2000, according to this study, supported by a grant from the Department of Veterans Affairs. Because weight and height were self-reported in the survey data, Dr. Arterburn said he believes the study underestimated the prevalence of morbid obesity.

CHICAGO — Health care costs for morbidly obese adults are nearly double those of normal-weight adults, according to a study presented at the combined annual meeting of the Central Society for Clinical Research and the Midwestern section of the American Federation for Medical Research.

Morbidly obese individuals make up less than 3% of the U.S. adult population, but they account for more than 10% of all health care spending in this country, reported the study's lead investigator, David E. Arterburn, M.D., of the University of Cincinnati.

The study defined morbid obesity as a body mass index of 40 or greater (Int. J. Obes. Relat. Metab. Disord. 2005;29:334–9).

Of U.S. health care expenditures, $56 billion were linked to excess body weight in the year 2000, up from a previously published estimate of $51.5 billion in 1998 (Obes. Res. 2004;12:18–24). Health care expenses for morbidly obese adults totaled more than $11 billion, Dr. Arterburn and his colleagues reported.

The researchers calculated this total by analyzing data from a nationally representative sample of 16,262 adults from the 2000 Medical Expenditure Panel Survey.

Adults who are morbidly obese had elevated costs in all health care categories, Dr. Arterburn said. Compared with adults considered to be of normal weight, morbidly obese persons had higher per capita annual expenditures for office visits, outpatient hospital care, inpatient hospitalizations, and prescription drugs.

Dr. Arterburn and his associates did not study the effect of age on health care expenditures. However, he said, “it's known there's a delay in onset of obesity-associated morbidities, so one would expect expenditures to go up with age.” The mean age of their sample was 45.4 years.

The researchers adjusted the odds of incurring health care expenses for sociodemographic variables, type of health insurance, and smoking status.

Nearly 5 million U.S. adults were morbidly obese in 2000, according to this study, supported by a grant from the Department of Veterans Affairs. Because weight and height were self-reported in the survey data, Dr. Arterburn said he believes the study underestimated the prevalence of morbid obesity.

CHICAGO — Health care costs for morbidly obese adults are nearly double those of normal-weight adults, according to a study presented at the combined annual meeting of the Central Society for Clinical Research and the Midwestern section of the American Federation for Medical Research.

Morbidly obese individuals make up less than 3% of the U.S. adult population, but they account for more than 10% of all health care spending in this country, reported the study's lead investigator, David E. Arterburn, M.D., of the University of Cincinnati.

The study defined morbid obesity as a body mass index of 40 or greater (Int. J. Obes. Relat. Metab. Disord. 2005;29:334–9).

Of U.S. health care expenditures, $56 billion were linked to excess body weight in the year 2000, up from a previously published estimate of $51.5 billion in 1998 (Obes. Res. 2004;12:18–24). Health care expenses for morbidly obese adults totaled more than $11 billion, Dr. Arterburn and his colleagues reported.

The researchers calculated this total by analyzing data from a nationally representative sample of 16,262 adults from the 2000 Medical Expenditure Panel Survey.

Adults who are morbidly obese had elevated costs in all health care categories, Dr. Arterburn said. Compared with adults considered to be of normal weight, morbidly obese persons had higher per capita annual expenditures for office visits, outpatient hospital care, inpatient hospitalizations, and prescription drugs.

Dr. Arterburn and his associates did not study the effect of age on health care expenditures. However, he said, “it's known there's a delay in onset of obesity-associated morbidities, so one would expect expenditures to go up with age.” The mean age of their sample was 45.4 years.

The researchers adjusted the odds of incurring health care expenses for sociodemographic variables, type of health insurance, and smoking status.

Nearly 5 million U.S. adults were morbidly obese in 2000, according to this study, supported by a grant from the Department of Veterans Affairs. Because weight and height were self-reported in the survey data, Dr. Arterburn said he believes the study underestimated the prevalence of morbid obesity.