Robert Finn

Major Finding: Women with type 2 diabetes in the highest quintile of bran consumption had a 28% lower risk of all-cause mortality and 35% lower risk of cardiovascular disease–specific mortality than did women in the lowest quintile.

Data Source: The Nurses' Health Study.

Disclosures: The study was funded by the National Institutes of Health, the American Heart Association, and the Boston Obesity Nutrition Research Center. The investigators reported that they had no other disclosures.

Consumption of whole grains, especially the bran component of whole grains, was associated with a significant decrease in the risk of allcause mortality and cardiovascular disease–specific mortality in women with type 2 diabetes who were followed as part of the Nurses' Health Study.

After adjustment for age, women in the highest quintile of whole grain, cereal fiber, bran, and germ consumption had 16%-31% lower all-cause mortality than did women in the lowest quintile, Dr. Meian He of the Harvard School of Public Health, Boston, and colleagues reported.

After further adjustment for lifestyle and dietary risk factors, only bran consumption remained significantly associated with mortality.

Compared with women in the lowest quintile of bran consumption, those in the highest quintile had a 28% decrease in the risk of all-cause mortality and a 35% increase in the risk of mortality associated with cardiovascular disease.

“To my knowledge, this is the first study of whole grain and its components and risk of death in diabetic patients,” Dr. Lu Qi, also of the Harvard School of Public Health and the study's senior author, said in a statement.

“These findings suggest a potential benefit of whole grain, and particularly bran, in reducing death and cardiovascular risk in diabetic patients,” Dr. Qi added.

The Nurses' Health Study began in 1976 with 121,700 female registered nurses aged 30-55 years. Data on participants' medical history, lifestyle, and medical diagnoses have been updated every 2 years.

For this study, the investigators focused on 7,822 women who were diagnosed with type 2 diabetes between 1976 and 2006. They excluded women who were diagnosed with diabetes before age 30 years and those with a history of cardiovascular disease or cancer reported on the 1980 questionnaire, when diet was first assessed (Circulation 2010 May 25 [doi:10.1161/CIRCULATIONAHA.109.907360]).

Women completed semi-quantitative food frequency questionnaires every 2 or 4 years between 1980 and 2002. Investigators used data on how often they consumed certain foods and beverages to estimate each woman's average intake of whole grains, as well as her intake of bran and cereal fiber.

Investigators followed the women for 26 years, for a total of 70,102 person-years. During that time, 852 women died, 295 of cardiovascular disease.

The researchers adjusted for age, smoking status, body mass index, alcohol intake, physical activity, parental history of myocardial infarction, menopausal status, use of hormone therapy, duration of diabetes, and various dietary factors including total energy intake, and intake of polyunsaturated fat, saturated fat, trans fat, magnesium, and folate.

Several different mechanisms could explain the association between bran consumption and mortality in women with diabetes, Dr. He and colleagues wrote. Their earlier research suggested that consumption of whole grains might protect against systemic inflammation and endothelial dysfunction.

“Diabetes is thought to be a chronic state of inflammation characterized by moderately increased levels of chemical markers for inflammation and endothelial dysfunction,” Dr. Qi said in the statement, which was issued by the American Heart Association, one of the study's sponsors.

“Those markers have been found to be related to increased risk of [cardiovascular disease] in both diabetic and nondiabetic populations,” Dr. Qi said.

Major Finding: Women with type 2 diabetes in the highest quintile of bran consumption had a 28% lower risk of all-cause mortality and 35% lower risk of cardiovascular disease–specific mortality than did women in the lowest quintile.

Data Source: The Nurses' Health Study.

Disclosures: The study was funded by the National Institutes of Health, the American Heart Association, and the Boston Obesity Nutrition Research Center. The investigators reported that they had no other disclosures.

Consumption of whole grains, especially the bran component of whole grains, was associated with a significant decrease in the risk of allcause mortality and cardiovascular disease–specific mortality in women with type 2 diabetes who were followed as part of the Nurses' Health Study.

After adjustment for age, women in the highest quintile of whole grain, cereal fiber, bran, and germ consumption had 16%-31% lower all-cause mortality than did women in the lowest quintile, Dr. Meian He of the Harvard School of Public Health, Boston, and colleagues reported.

After further adjustment for lifestyle and dietary risk factors, only bran consumption remained significantly associated with mortality.

Compared with women in the lowest quintile of bran consumption, those in the highest quintile had a 28% decrease in the risk of all-cause mortality and a 35% increase in the risk of mortality associated with cardiovascular disease.

“To my knowledge, this is the first study of whole grain and its components and risk of death in diabetic patients,” Dr. Lu Qi, also of the Harvard School of Public Health and the study's senior author, said in a statement.

“These findings suggest a potential benefit of whole grain, and particularly bran, in reducing death and cardiovascular risk in diabetic patients,” Dr. Qi added.

The Nurses' Health Study began in 1976 with 121,700 female registered nurses aged 30-55 years. Data on participants' medical history, lifestyle, and medical diagnoses have been updated every 2 years.

For this study, the investigators focused on 7,822 women who were diagnosed with type 2 diabetes between 1976 and 2006. They excluded women who were diagnosed with diabetes before age 30 years and those with a history of cardiovascular disease or cancer reported on the 1980 questionnaire, when diet was first assessed (Circulation 2010 May 25 [doi:10.1161/CIRCULATIONAHA.109.907360]).

Women completed semi-quantitative food frequency questionnaires every 2 or 4 years between 1980 and 2002. Investigators used data on how often they consumed certain foods and beverages to estimate each woman's average intake of whole grains, as well as her intake of bran and cereal fiber.

Investigators followed the women for 26 years, for a total of 70,102 person-years. During that time, 852 women died, 295 of cardiovascular disease.

The researchers adjusted for age, smoking status, body mass index, alcohol intake, physical activity, parental history of myocardial infarction, menopausal status, use of hormone therapy, duration of diabetes, and various dietary factors including total energy intake, and intake of polyunsaturated fat, saturated fat, trans fat, magnesium, and folate.

Several different mechanisms could explain the association between bran consumption and mortality in women with diabetes, Dr. He and colleagues wrote. Their earlier research suggested that consumption of whole grains might protect against systemic inflammation and endothelial dysfunction.

“Diabetes is thought to be a chronic state of inflammation characterized by moderately increased levels of chemical markers for inflammation and endothelial dysfunction,” Dr. Qi said in the statement, which was issued by the American Heart Association, one of the study's sponsors.

“Those markers have been found to be related to increased risk of [cardiovascular disease] in both diabetic and nondiabetic populations,” Dr. Qi said.

Major Finding: Women with type 2 diabetes in the highest quintile of bran consumption had a 28% lower risk of all-cause mortality and 35% lower risk of cardiovascular disease–specific mortality than did women in the lowest quintile.

Data Source: The Nurses' Health Study.

Disclosures: The study was funded by the National Institutes of Health, the American Heart Association, and the Boston Obesity Nutrition Research Center. The investigators reported that they had no other disclosures.

Consumption of whole grains, especially the bran component of whole grains, was associated with a significant decrease in the risk of allcause mortality and cardiovascular disease–specific mortality in women with type 2 diabetes who were followed as part of the Nurses' Health Study.

After adjustment for age, women in the highest quintile of whole grain, cereal fiber, bran, and germ consumption had 16%-31% lower all-cause mortality than did women in the lowest quintile, Dr. Meian He of the Harvard School of Public Health, Boston, and colleagues reported.

After further adjustment for lifestyle and dietary risk factors, only bran consumption remained significantly associated with mortality.

Compared with women in the lowest quintile of bran consumption, those in the highest quintile had a 28% decrease in the risk of all-cause mortality and a 35% increase in the risk of mortality associated with cardiovascular disease.

“To my knowledge, this is the first study of whole grain and its components and risk of death in diabetic patients,” Dr. Lu Qi, also of the Harvard School of Public Health and the study's senior author, said in a statement.

“These findings suggest a potential benefit of whole grain, and particularly bran, in reducing death and cardiovascular risk in diabetic patients,” Dr. Qi added.

The Nurses' Health Study began in 1976 with 121,700 female registered nurses aged 30-55 years. Data on participants' medical history, lifestyle, and medical diagnoses have been updated every 2 years.

For this study, the investigators focused on 7,822 women who were diagnosed with type 2 diabetes between 1976 and 2006. They excluded women who were diagnosed with diabetes before age 30 years and those with a history of cardiovascular disease or cancer reported on the 1980 questionnaire, when diet was first assessed (Circulation 2010 May 25 [doi:10.1161/CIRCULATIONAHA.109.907360]).

Women completed semi-quantitative food frequency questionnaires every 2 or 4 years between 1980 and 2002. Investigators used data on how often they consumed certain foods and beverages to estimate each woman's average intake of whole grains, as well as her intake of bran and cereal fiber.

Investigators followed the women for 26 years, for a total of 70,102 person-years. During that time, 852 women died, 295 of cardiovascular disease.

The researchers adjusted for age, smoking status, body mass index, alcohol intake, physical activity, parental history of myocardial infarction, menopausal status, use of hormone therapy, duration of diabetes, and various dietary factors including total energy intake, and intake of polyunsaturated fat, saturated fat, trans fat, magnesium, and folate.

Several different mechanisms could explain the association between bran consumption and mortality in women with diabetes, Dr. He and colleagues wrote. Their earlier research suggested that consumption of whole grains might protect against systemic inflammation and endothelial dysfunction.

“Diabetes is thought to be a chronic state of inflammation characterized by moderately increased levels of chemical markers for inflammation and endothelial dysfunction,” Dr. Qi said in the statement, which was issued by the American Heart Association, one of the study's sponsors.

“Those markers have been found to be related to increased risk of [cardiovascular disease] in both diabetic and nondiabetic populations,” Dr. Qi said.

SAN FRANCISCO — The era of personalized genetic medicine has arrived, but this is not an unalloyed blessing, especially in the area of breast cancer, according to Dr. Mary S. Beattie.

More women are asking their physicians about whether they should undergo genetic testing for mutations in one of the two BRCA genes, and some physicians are approaching such questions with trepidation. But Dr. Beattie, director of clinical research in the cancer risk program at the University of California, San Francisco, said that there's not that much difference between genetic testing and standard lab tests.

“I envision genomics and genetics as a tool in our armamentarium. We can be intimidated by it, or we can practice medicine using the same principles we've always used, personalizing test results and helping patients to improve their general health and lower their risk of disease,” she said at the meeing sponsored by UCSF.

Still, it's important to understand not only the benefits of BRCA testing, but also the risks and limitations, she said at the meeting. For example, although BRCA testing can detect certain known mutations and certain high-risk individuals, not every dangerous mutation is known. And of course, breast cancer often arises sporadically, even in women with no BRCA mutations.

Dr. Beattie offered the following suggestions to help respond to questions about BRCA testing:

Don't just order a test. Ask the patient about her family history, and be especially alert for a pedigree that includes deaths from breast cancer in premenopausal women. If the patient has only a vague notion of her family history, send her home with an assignment to learn as much as she can.

This is where it can be valuable to enlist the aid of a genetics counselor. “They do a better job and they have more time” than physicians do, Dr. Beattie said at the meeting. “They're trained to take very thorough three-generation pedigrees, sometimes even four or five generations.” Genetics counselors will typically verify the causes of death and the age and diagnosis at death, and they will collect documents to make sure they're all correct.

Let's say that the patient has a paternal aunt who died of breast cancer at 40 years of age, as well as a father who was diagnosed with prostate cancer (whose risk can also be increased by BRCA mutations) at 55 years, Dr. Beattie posited. And let's add that the aunt's daughter has just been diagnosed with breast cancer at 33 years of age. This is a fairly concerning family history, and it seems clear that testing the patient for BRCA is indicated.

But don't jump to this conclusion, she advised. “It might seem a little counterintuitive, but in the genetics world, we typically think about testing the person who has the highest probability of testing positive,” Dr. Beattie said. “So the next step, if we were going to go ahead and test, would not be to test [the patient]; it would be to test someone in her family who's had cancer, the person who has the highest probability and who's still alive and available for testing.”

Make sure testing is informed by ethnic history. Hundreds of different BRCA mutations are now known, and a comprehensive analysis can cost $3,800. But these mutations are not evenly distributed in populations.

In the Ashkenazi Jewish population, for example, three BRCA alterations account for 90% of the mutations; testing for those three specific alterations costs only about $400.

Such founder mutations are not unique to Ashkenazi Jews. French Canadians, for example, typically have one of four mutations in each of the two BRCA genes, and Icelanders typically have one of two mutations in each of the genes.

Once a family's specific BRCA alteration has been identified, the patient will need only single-site testing, reducing the cost even further.

Consider a patient's psychosocial situation before ordering genetic testing. A positive test can have far-reaching consequences, both psychologically and economically. Dr. Beattie advised. For example, “never do BRCA testing with someone who's going through an episode of depression or anxiety.”

Fortunately, the economic consequences of a positive BRCA test are not as dire as they once were. In 2008, Congress passed—and President George W. Bush signed—the Genetic Information Nondiscrimination Act (GINA). The section of the law that prohibits health insurance plans from increasing premiums or dropping coverage based on the results of genetic testing went into effect on May 22, 2009, for individual health insurers, and must be in effect by May 21, 2010, for group plans.

Disclosures: None was reported.

SAN FRANCISCO — The era of personalized genetic medicine has arrived, but this is not an unalloyed blessing, especially in the area of breast cancer, according to Dr. Mary S. Beattie.

More women are asking their physicians about whether they should undergo genetic testing for mutations in one of the two BRCA genes, and some physicians are approaching such questions with trepidation. But Dr. Beattie, director of clinical research in the cancer risk program at the University of California, San Francisco, said that there's not that much difference between genetic testing and standard lab tests.

“I envision genomics and genetics as a tool in our armamentarium. We can be intimidated by it, or we can practice medicine using the same principles we've always used, personalizing test results and helping patients to improve their general health and lower their risk of disease,” she said at the meeing sponsored by UCSF.

Still, it's important to understand not only the benefits of BRCA testing, but also the risks and limitations, she said at the meeting. For example, although BRCA testing can detect certain known mutations and certain high-risk individuals, not every dangerous mutation is known. And of course, breast cancer often arises sporadically, even in women with no BRCA mutations.

Dr. Beattie offered the following suggestions to help respond to questions about BRCA testing:

Don't just order a test. Ask the patient about her family history, and be especially alert for a pedigree that includes deaths from breast cancer in premenopausal women. If the patient has only a vague notion of her family history, send her home with an assignment to learn as much as she can.

This is where it can be valuable to enlist the aid of a genetics counselor. “They do a better job and they have more time” than physicians do, Dr. Beattie said at the meeting. “They're trained to take very thorough three-generation pedigrees, sometimes even four or five generations.” Genetics counselors will typically verify the causes of death and the age and diagnosis at death, and they will collect documents to make sure they're all correct.

Let's say that the patient has a paternal aunt who died of breast cancer at 40 years of age, as well as a father who was diagnosed with prostate cancer (whose risk can also be increased by BRCA mutations) at 55 years, Dr. Beattie posited. And let's add that the aunt's daughter has just been diagnosed with breast cancer at 33 years of age. This is a fairly concerning family history, and it seems clear that testing the patient for BRCA is indicated.

But don't jump to this conclusion, she advised. “It might seem a little counterintuitive, but in the genetics world, we typically think about testing the person who has the highest probability of testing positive,” Dr. Beattie said. “So the next step, if we were going to go ahead and test, would not be to test [the patient]; it would be to test someone in her family who's had cancer, the person who has the highest probability and who's still alive and available for testing.”

Make sure testing is informed by ethnic history. Hundreds of different BRCA mutations are now known, and a comprehensive analysis can cost $3,800. But these mutations are not evenly distributed in populations.

In the Ashkenazi Jewish population, for example, three BRCA alterations account for 90% of the mutations; testing for those three specific alterations costs only about $400.

Such founder mutations are not unique to Ashkenazi Jews. French Canadians, for example, typically have one of four mutations in each of the two BRCA genes, and Icelanders typically have one of two mutations in each of the genes.

Once a family's specific BRCA alteration has been identified, the patient will need only single-site testing, reducing the cost even further.

Consider a patient's psychosocial situation before ordering genetic testing. A positive test can have far-reaching consequences, both psychologically and economically. Dr. Beattie advised. For example, “never do BRCA testing with someone who's going through an episode of depression or anxiety.”

Fortunately, the economic consequences of a positive BRCA test are not as dire as they once were. In 2008, Congress passed—and President George W. Bush signed—the Genetic Information Nondiscrimination Act (GINA). The section of the law that prohibits health insurance plans from increasing premiums or dropping coverage based on the results of genetic testing went into effect on May 22, 2009, for individual health insurers, and must be in effect by May 21, 2010, for group plans.

Disclosures: None was reported.

SAN FRANCISCO — The era of personalized genetic medicine has arrived, but this is not an unalloyed blessing, especially in the area of breast cancer, according to Dr. Mary S. Beattie.

More women are asking their physicians about whether they should undergo genetic testing for mutations in one of the two BRCA genes, and some physicians are approaching such questions with trepidation. But Dr. Beattie, director of clinical research in the cancer risk program at the University of California, San Francisco, said that there's not that much difference between genetic testing and standard lab tests.

“I envision genomics and genetics as a tool in our armamentarium. We can be intimidated by it, or we can practice medicine using the same principles we've always used, personalizing test results and helping patients to improve their general health and lower their risk of disease,” she said at the meeing sponsored by UCSF.

Still, it's important to understand not only the benefits of BRCA testing, but also the risks and limitations, she said at the meeting. For example, although BRCA testing can detect certain known mutations and certain high-risk individuals, not every dangerous mutation is known. And of course, breast cancer often arises sporadically, even in women with no BRCA mutations.

Dr. Beattie offered the following suggestions to help respond to questions about BRCA testing:

Don't just order a test. Ask the patient about her family history, and be especially alert for a pedigree that includes deaths from breast cancer in premenopausal women. If the patient has only a vague notion of her family history, send her home with an assignment to learn as much as she can.

This is where it can be valuable to enlist the aid of a genetics counselor. “They do a better job and they have more time” than physicians do, Dr. Beattie said at the meeting. “They're trained to take very thorough three-generation pedigrees, sometimes even four or five generations.” Genetics counselors will typically verify the causes of death and the age and diagnosis at death, and they will collect documents to make sure they're all correct.

Let's say that the patient has a paternal aunt who died of breast cancer at 40 years of age, as well as a father who was diagnosed with prostate cancer (whose risk can also be increased by BRCA mutations) at 55 years, Dr. Beattie posited. And let's add that the aunt's daughter has just been diagnosed with breast cancer at 33 years of age. This is a fairly concerning family history, and it seems clear that testing the patient for BRCA is indicated.

But don't jump to this conclusion, she advised. “It might seem a little counterintuitive, but in the genetics world, we typically think about testing the person who has the highest probability of testing positive,” Dr. Beattie said. “So the next step, if we were going to go ahead and test, would not be to test [the patient]; it would be to test someone in her family who's had cancer, the person who has the highest probability and who's still alive and available for testing.”

Make sure testing is informed by ethnic history. Hundreds of different BRCA mutations are now known, and a comprehensive analysis can cost $3,800. But these mutations are not evenly distributed in populations.

In the Ashkenazi Jewish population, for example, three BRCA alterations account for 90% of the mutations; testing for those three specific alterations costs only about $400.

Such founder mutations are not unique to Ashkenazi Jews. French Canadians, for example, typically have one of four mutations in each of the two BRCA genes, and Icelanders typically have one of two mutations in each of the genes.

Once a family's specific BRCA alteration has been identified, the patient will need only single-site testing, reducing the cost even further.

Consider a patient's psychosocial situation before ordering genetic testing. A positive test can have far-reaching consequences, both psychologically and economically. Dr. Beattie advised. For example, “never do BRCA testing with someone who's going through an episode of depression or anxiety.”

Fortunately, the economic consequences of a positive BRCA test are not as dire as they once were. In 2008, Congress passed—and President George W. Bush signed—the Genetic Information Nondiscrimination Act (GINA). The section of the law that prohibits health insurance plans from increasing premiums or dropping coverage based on the results of genetic testing went into effect on May 22, 2009, for individual health insurers, and must be in effect by May 21, 2010, for group plans.

Disclosures: None was reported.

Major Finding: No significant differences were found in physical or sexual side effects in adolescents taking DMPA-IM and DMPA-SC.

Data Source: Randomized crossover trial of 55 adolescents.

Disclosures: The study was supported by the National Institutes of Health, the Health Resources and Services Administration, and the Indiana Clinical and Translational Sciences Institute. Dr. Williams said she had no conflicts of interest.

LAS VEGAS — The intramuscular and subcutaneous formulations of depot medroxyprogesterone acetate seem to have similar side effect profiles in adolescents, according to a randomized crossover study.

Although the side effects of the two formulations (DMPA-IM and DMPA-SC) have been studied in adult women, this is the first study among adolescents, Dr. Rebekah L. Williams said at the meeting.

The randomized crossover study involved 55 young women aged 14-20 years, with a mean of 16.5 years. All participants were either initiating or restarting DMPA therapy.

Among the young women, 85% were African American and 20% said they had never had sex.

At baseline the participants completed surveys about their expectations regarding the side effects, and they were randomized to receive one of the two formulations.

At the end of 3 months, participants answered questions about side effects, and then they were given the other formulation.

At the end of another 3 months, the participants were again surveyed, after which they were permitted to choose which formulation they preferred for a third injection. Thirty-eight of the women completed surveys at all three visits.

The investigators found no significant differences between the two formulations in participants' expectations or experience of physical or sexual side effects.

In addition, the experience of side effects was not significantly related to expectations of side effects, participants' level of general worry, or their level of general concern about birth control side effects.

Furthermore, with two exceptions, there was no difference in the expectation or experience of side effects between the participants' first and second injections, no matter in which order they received them.

The two exceptions were amenorrhea and irregular bleeding. During the first dose, 10.5% of the participants had amenorrhea, and this increased significantly to 31.6% at the second dose. In contrast, the proportion of women reporting irregular bleeding declined significantly from 26.3% at dose one to 7.9% at dose two.

Dr. Williams of Indiana University, Indianapolis, noticed a mismatch between expectations and experience for sexual side effects.

“Over one-third of our sample experienced some change in sexual interest, and one-quarter experienced changes in lubrication during sex,” she said.

“The striking difference between expectations between physical and sexual side effects may reflect our clinical practice, in that physical side effects are emphasized during contraceptive counseling but sexual side effects may be relatively neglected.

“Clinical counseling should include both physical and sexual side effects, both of which have the potential to significantly impact young women's contraceptive use in the long run.”

One difference between the intramuscular and subcutaneous formulations emerged when the women were allowed to choose which one they would receive at the third visit. Of the 38 women who made it to that visit, 26 chose a subcutaneous injection, 9 chose an intramuscular injection, and 3 chose to discontinue DMPA.

“I'm not 100% sure why we [saw] such a striking preference,” Dr. Williams said, noting that there were no reported differences in injection pain during the injection, immediately after the injection, or 7 days later.

“I'm not sure if we're using the wrong pain measures, the wrong side effect measures, or if those just aren't the things that influence it,” she said.

“All of our [intramuscular injections] were gluteal, and all of our [subcutaneous injections] were abdominal. Maybe there was a preference for just lifting your shirt up a little bit and getting your shot instead of yanking your pants down a little bit and getting your shot.

My research assistant is now probing our exit interviews at two different points in the study to see if we can pick up something more concrete,” Dr. Williams said.

Major Finding: No significant differences were found in physical or sexual side effects in adolescents taking DMPA-IM and DMPA-SC.

Data Source: Randomized crossover trial of 55 adolescents.

Disclosures: The study was supported by the National Institutes of Health, the Health Resources and Services Administration, and the Indiana Clinical and Translational Sciences Institute. Dr. Williams said she had no conflicts of interest.

LAS VEGAS — The intramuscular and subcutaneous formulations of depot medroxyprogesterone acetate seem to have similar side effect profiles in adolescents, according to a randomized crossover study.

Although the side effects of the two formulations (DMPA-IM and DMPA-SC) have been studied in adult women, this is the first study among adolescents, Dr. Rebekah L. Williams said at the meeting.

The randomized crossover study involved 55 young women aged 14-20 years, with a mean of 16.5 years. All participants were either initiating or restarting DMPA therapy.

Among the young women, 85% were African American and 20% said they had never had sex.

At baseline the participants completed surveys about their expectations regarding the side effects, and they were randomized to receive one of the two formulations.

At the end of 3 months, participants answered questions about side effects, and then they were given the other formulation.

At the end of another 3 months, the participants were again surveyed, after which they were permitted to choose which formulation they preferred for a third injection. Thirty-eight of the women completed surveys at all three visits.

The investigators found no significant differences between the two formulations in participants' expectations or experience of physical or sexual side effects.

In addition, the experience of side effects was not significantly related to expectations of side effects, participants' level of general worry, or their level of general concern about birth control side effects.

Furthermore, with two exceptions, there was no difference in the expectation or experience of side effects between the participants' first and second injections, no matter in which order they received them.

The two exceptions were amenorrhea and irregular bleeding. During the first dose, 10.5% of the participants had amenorrhea, and this increased significantly to 31.6% at the second dose. In contrast, the proportion of women reporting irregular bleeding declined significantly from 26.3% at dose one to 7.9% at dose two.

Dr. Williams of Indiana University, Indianapolis, noticed a mismatch between expectations and experience for sexual side effects.

“Over one-third of our sample experienced some change in sexual interest, and one-quarter experienced changes in lubrication during sex,” she said.

“The striking difference between expectations between physical and sexual side effects may reflect our clinical practice, in that physical side effects are emphasized during contraceptive counseling but sexual side effects may be relatively neglected.

“Clinical counseling should include both physical and sexual side effects, both of which have the potential to significantly impact young women's contraceptive use in the long run.”

One difference between the intramuscular and subcutaneous formulations emerged when the women were allowed to choose which one they would receive at the third visit. Of the 38 women who made it to that visit, 26 chose a subcutaneous injection, 9 chose an intramuscular injection, and 3 chose to discontinue DMPA.

“I'm not 100% sure why we [saw] such a striking preference,” Dr. Williams said, noting that there were no reported differences in injection pain during the injection, immediately after the injection, or 7 days later.

“I'm not sure if we're using the wrong pain measures, the wrong side effect measures, or if those just aren't the things that influence it,” she said.

“All of our [intramuscular injections] were gluteal, and all of our [subcutaneous injections] were abdominal. Maybe there was a preference for just lifting your shirt up a little bit and getting your shot instead of yanking your pants down a little bit and getting your shot.

My research assistant is now probing our exit interviews at two different points in the study to see if we can pick up something more concrete,” Dr. Williams said.

Major Finding: No significant differences were found in physical or sexual side effects in adolescents taking DMPA-IM and DMPA-SC.

Data Source: Randomized crossover trial of 55 adolescents.

Disclosures: The study was supported by the National Institutes of Health, the Health Resources and Services Administration, and the Indiana Clinical and Translational Sciences Institute. Dr. Williams said she had no conflicts of interest.

LAS VEGAS — The intramuscular and subcutaneous formulations of depot medroxyprogesterone acetate seem to have similar side effect profiles in adolescents, according to a randomized crossover study.

Although the side effects of the two formulations (DMPA-IM and DMPA-SC) have been studied in adult women, this is the first study among adolescents, Dr. Rebekah L. Williams said at the meeting.

The randomized crossover study involved 55 young women aged 14-20 years, with a mean of 16.5 years. All participants were either initiating or restarting DMPA therapy.

Among the young women, 85% were African American and 20% said they had never had sex.

At baseline the participants completed surveys about their expectations regarding the side effects, and they were randomized to receive one of the two formulations.

At the end of 3 months, participants answered questions about side effects, and then they were given the other formulation.

At the end of another 3 months, the participants were again surveyed, after which they were permitted to choose which formulation they preferred for a third injection. Thirty-eight of the women completed surveys at all three visits.

The investigators found no significant differences between the two formulations in participants' expectations or experience of physical or sexual side effects.

In addition, the experience of side effects was not significantly related to expectations of side effects, participants' level of general worry, or their level of general concern about birth control side effects.

Furthermore, with two exceptions, there was no difference in the expectation or experience of side effects between the participants' first and second injections, no matter in which order they received them.

The two exceptions were amenorrhea and irregular bleeding. During the first dose, 10.5% of the participants had amenorrhea, and this increased significantly to 31.6% at the second dose. In contrast, the proportion of women reporting irregular bleeding declined significantly from 26.3% at dose one to 7.9% at dose two.

Dr. Williams of Indiana University, Indianapolis, noticed a mismatch between expectations and experience for sexual side effects.

“Over one-third of our sample experienced some change in sexual interest, and one-quarter experienced changes in lubrication during sex,” she said.

“The striking difference between expectations between physical and sexual side effects may reflect our clinical practice, in that physical side effects are emphasized during contraceptive counseling but sexual side effects may be relatively neglected.

“Clinical counseling should include both physical and sexual side effects, both of which have the potential to significantly impact young women's contraceptive use in the long run.”

One difference between the intramuscular and subcutaneous formulations emerged when the women were allowed to choose which one they would receive at the third visit. Of the 38 women who made it to that visit, 26 chose a subcutaneous injection, 9 chose an intramuscular injection, and 3 chose to discontinue DMPA.

“I'm not 100% sure why we [saw] such a striking preference,” Dr. Williams said, noting that there were no reported differences in injection pain during the injection, immediately after the injection, or 7 days later.

“I'm not sure if we're using the wrong pain measures, the wrong side effect measures, or if those just aren't the things that influence it,” she said.

“All of our [intramuscular injections] were gluteal, and all of our [subcutaneous injections] were abdominal. Maybe there was a preference for just lifting your shirt up a little bit and getting your shot instead of yanking your pants down a little bit and getting your shot.

My research assistant is now probing our exit interviews at two different points in the study to see if we can pick up something more concrete,” Dr. Williams said.

Major Finding: In adolescents, ovarian cysts on the left side are 116 times less likely to resolve spontaneously than those on the right.

Data Source: Retrospective analysis of data from 151 patients aged 13-18 years.

Disclosures: None was reported.

LAS VEGAS — It's well known that most ovarian cysts in adolescents resolve spontaneously, but for some unknown reason, those on the right side are far more likely to resolve than those on the left, a retrospective study of 151 teenaged girls showed.

Investigators at the University of Missouri–Kansas City determined that after adjusting for potential confounders, cysts on the left side were 116 times less likely to resolve without surgery than those on the right.

“It was kind of a surprising finding,” coauthor Dr. Jeffrey Wall said in an interview. “You'd think that a right- or left-sided cyst wouldn't matter. It would spontaneously regress independently [of side]. But we found that a right-sided cyst was a predictor of cyst resolution.”

Dr. Wall and lead author Dr. Timothy Chad McCormick conducted the study by reviewing charts from 2000 to 2008 of all adolescent females with a diagnostic ICD-9 code consistent with an ovarian cyst or mass. There were 342 such patients. For the purposes of the study, the investigators included only 151 of those patients—those who had been followed until documented resolution or who underwent surgical intervention for nonresolution.

Of those patients, 91 (60%) had their cysts resolve spontaneously, while the others required surgery.

The investigators conducted a multivariate regression analysis that adjusted for age at diagnosis, race, cyst size, cyst volume, cyst side, and cyst complexity. Only two factors emerged as statistically significant independent predictors of resolution: cyst side and cyst size. The odds ratio for left-sided cysts was 116.39, indicating a far greater risk for left-sided cysts than for those on the right. The odds ratio for right cyst size was 0.42, indicating that right-sided cysts under 7 cm in size were 58% more likely to resolve spontaneously than larger right-sided cysts.

Dr. Wall said that the investigators have no explanation for their unusual findings, and that they intended to take a closer look at patient charts to see if they can identify any hypotheses.

Asked whether he would treat patients with left-sided cysts any differently as a result of this study, Dr. Wall said that he would not, at least not yet. “This was a new finding for us. It was unexpected,” he said. “I would say [that physicians should] continue to manage them as they normally would. I would still observe them for a period of time. But if it is on the right side, it's certainly something you can tell the family: It's right sided, so there's a better chance. It's a reassuring thing if nothing else right now.”

Also reassuring, he said, was that the study confirmed that most ovarian cysts in adolescents do resolve spontaneously.

Major Finding: In adolescents, ovarian cysts on the left side are 116 times less likely to resolve spontaneously than those on the right.

Data Source: Retrospective analysis of data from 151 patients aged 13-18 years.

Disclosures: None was reported.

LAS VEGAS — It's well known that most ovarian cysts in adolescents resolve spontaneously, but for some unknown reason, those on the right side are far more likely to resolve than those on the left, a retrospective study of 151 teenaged girls showed.

Investigators at the University of Missouri–Kansas City determined that after adjusting for potential confounders, cysts on the left side were 116 times less likely to resolve without surgery than those on the right.

“It was kind of a surprising finding,” coauthor Dr. Jeffrey Wall said in an interview. “You'd think that a right- or left-sided cyst wouldn't matter. It would spontaneously regress independently [of side]. But we found that a right-sided cyst was a predictor of cyst resolution.”

Dr. Wall and lead author Dr. Timothy Chad McCormick conducted the study by reviewing charts from 2000 to 2008 of all adolescent females with a diagnostic ICD-9 code consistent with an ovarian cyst or mass. There were 342 such patients. For the purposes of the study, the investigators included only 151 of those patients—those who had been followed until documented resolution or who underwent surgical intervention for nonresolution.

Of those patients, 91 (60%) had their cysts resolve spontaneously, while the others required surgery.

The investigators conducted a multivariate regression analysis that adjusted for age at diagnosis, race, cyst size, cyst volume, cyst side, and cyst complexity. Only two factors emerged as statistically significant independent predictors of resolution: cyst side and cyst size. The odds ratio for left-sided cysts was 116.39, indicating a far greater risk for left-sided cysts than for those on the right. The odds ratio for right cyst size was 0.42, indicating that right-sided cysts under 7 cm in size were 58% more likely to resolve spontaneously than larger right-sided cysts.

Dr. Wall said that the investigators have no explanation for their unusual findings, and that they intended to take a closer look at patient charts to see if they can identify any hypotheses.

Asked whether he would treat patients with left-sided cysts any differently as a result of this study, Dr. Wall said that he would not, at least not yet. “This was a new finding for us. It was unexpected,” he said. “I would say [that physicians should] continue to manage them as they normally would. I would still observe them for a period of time. But if it is on the right side, it's certainly something you can tell the family: It's right sided, so there's a better chance. It's a reassuring thing if nothing else right now.”

Also reassuring, he said, was that the study confirmed that most ovarian cysts in adolescents do resolve spontaneously.

Major Finding: In adolescents, ovarian cysts on the left side are 116 times less likely to resolve spontaneously than those on the right.

Data Source: Retrospective analysis of data from 151 patients aged 13-18 years.

Disclosures: None was reported.

LAS VEGAS — It's well known that most ovarian cysts in adolescents resolve spontaneously, but for some unknown reason, those on the right side are far more likely to resolve than those on the left, a retrospective study of 151 teenaged girls showed.

Investigators at the University of Missouri–Kansas City determined that after adjusting for potential confounders, cysts on the left side were 116 times less likely to resolve without surgery than those on the right.

“It was kind of a surprising finding,” coauthor Dr. Jeffrey Wall said in an interview. “You'd think that a right- or left-sided cyst wouldn't matter. It would spontaneously regress independently [of side]. But we found that a right-sided cyst was a predictor of cyst resolution.”

Dr. Wall and lead author Dr. Timothy Chad McCormick conducted the study by reviewing charts from 2000 to 2008 of all adolescent females with a diagnostic ICD-9 code consistent with an ovarian cyst or mass. There were 342 such patients. For the purposes of the study, the investigators included only 151 of those patients—those who had been followed until documented resolution or who underwent surgical intervention for nonresolution.

Of those patients, 91 (60%) had their cysts resolve spontaneously, while the others required surgery.

The investigators conducted a multivariate regression analysis that adjusted for age at diagnosis, race, cyst size, cyst volume, cyst side, and cyst complexity. Only two factors emerged as statistically significant independent predictors of resolution: cyst side and cyst size. The odds ratio for left-sided cysts was 116.39, indicating a far greater risk for left-sided cysts than for those on the right. The odds ratio for right cyst size was 0.42, indicating that right-sided cysts under 7 cm in size were 58% more likely to resolve spontaneously than larger right-sided cysts.

Dr. Wall said that the investigators have no explanation for their unusual findings, and that they intended to take a closer look at patient charts to see if they can identify any hypotheses.

Asked whether he would treat patients with left-sided cysts any differently as a result of this study, Dr. Wall said that he would not, at least not yet. “This was a new finding for us. It was unexpected,” he said. “I would say [that physicians should] continue to manage them as they normally would. I would still observe them for a period of time. But if it is on the right side, it's certainly something you can tell the family: It's right sided, so there's a better chance. It's a reassuring thing if nothing else right now.”

Also reassuring, he said, was that the study confirmed that most ovarian cysts in adolescents do resolve spontaneously.

Major Finding: No significant differences were found in physical or sexual side effects in adolescents taking DMPA-IM and DMPA-SC.

Data Source: Randomized crossover trial of 55 adolescents.

Disclosures: The study was supported by the National Institutes of Health, the Health Resources and Services Administration, and the Indiana Clinical and Translational Sciences Institute. Dr. Williams said he had no conflicts of interest.

LAS VEGAS — The intramuscular and subcutaneous formulations of depot medroxyprogesterone acetate seem to have similar side effect profiles in adolescents, according to a randomized crossover study.

Although the side effects of the two formulations (DMPA-IM and DMPA-SC) have been studied in adult women, this is the first study in adolescents, Dr. Rebekah L. Williams said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

The randomized crossover study involved 55 young women aged 14–20 years, with a mean of 16.5 years. All participants were either initiating or restarting DMPA therapy. Among the young women, 85% were African American and 20% said they had never had sex.

At baseline the participants completed surveys about their expectations regarding the side effects, and they were randomized to receive one of the two formulations. At the end of 3 months, participants answered questions about side effects, and then they were given the other formulation. At the end of another 3 months, the participants were again surveyed, after which they were permitted to choose which formulation they preferred for a third injection. Thirty-eight of the women completed surveys at all three visits.

The investigators found no significant differences between the two formulations in participants' expectations or experience of physical or sexual side effects. In addition, the experience of side effects was not significantly related to expectations of side effects, participants' level of general worry, or their level of general concern about birth control side effects.

Furthermore, with two exceptions, there was no difference in the expectation or experience of side effects between the participants' first and second injections, no matter in which order they received them.

The two exceptions were amenorrhea and irregular bleeding. During the first dose, 10.5% of the participants had amenorrhea, and this increased significantly to 31.6% at the second dose. In contrast, the proportion of women reporting irregular bleeding declined significantly from 26.3% at dose one to 7.9% at dose two.

Dr. Williams of Indiana University, Indianapolis, noticed a mismatch between expectations and experience for sexual side effects. “Over one-third of our sample experienced some change in sexual interest, and one-quarter experienced changes in lubrication during sex,” she said. “The striking difference between expectations between physical and sexual side effects may reflect our clinical practice, in that physical side effects are emphasized during contraceptive counseling but sexual side effects may be relatively neglected.

“Clinical counseling should include both physical and sexual side effects, both of which have the potential to significantly impact young women's contraceptive use in the long run.”

One difference between the intramuscular and subcutaneous formulations emerged when the women were allowed to choose which one they would receive at the third visit. Of the 38 women who made it to that visit, 26 chose a subcutaneous injection, 9 chose an intramuscular injection, and 3 chose to discontinue DMPA.

Major Finding: No significant differences were found in physical or sexual side effects in adolescents taking DMPA-IM and DMPA-SC.

Data Source: Randomized crossover trial of 55 adolescents.

Disclosures: The study was supported by the National Institutes of Health, the Health Resources and Services Administration, and the Indiana Clinical and Translational Sciences Institute. Dr. Williams said he had no conflicts of interest.

LAS VEGAS — The intramuscular and subcutaneous formulations of depot medroxyprogesterone acetate seem to have similar side effect profiles in adolescents, according to a randomized crossover study.

Although the side effects of the two formulations (DMPA-IM and DMPA-SC) have been studied in adult women, this is the first study in adolescents, Dr. Rebekah L. Williams said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

The randomized crossover study involved 55 young women aged 14–20 years, with a mean of 16.5 years. All participants were either initiating or restarting DMPA therapy. Among the young women, 85% were African American and 20% said they had never had sex.

At baseline the participants completed surveys about their expectations regarding the side effects, and they were randomized to receive one of the two formulations. At the end of 3 months, participants answered questions about side effects, and then they were given the other formulation. At the end of another 3 months, the participants were again surveyed, after which they were permitted to choose which formulation they preferred for a third injection. Thirty-eight of the women completed surveys at all three visits.

The investigators found no significant differences between the two formulations in participants' expectations or experience of physical or sexual side effects. In addition, the experience of side effects was not significantly related to expectations of side effects, participants' level of general worry, or their level of general concern about birth control side effects.

Furthermore, with two exceptions, there was no difference in the expectation or experience of side effects between the participants' first and second injections, no matter in which order they received them.

The two exceptions were amenorrhea and irregular bleeding. During the first dose, 10.5% of the participants had amenorrhea, and this increased significantly to 31.6% at the second dose. In contrast, the proportion of women reporting irregular bleeding declined significantly from 26.3% at dose one to 7.9% at dose two.

Dr. Williams of Indiana University, Indianapolis, noticed a mismatch between expectations and experience for sexual side effects. “Over one-third of our sample experienced some change in sexual interest, and one-quarter experienced changes in lubrication during sex,” she said. “The striking difference between expectations between physical and sexual side effects may reflect our clinical practice, in that physical side effects are emphasized during contraceptive counseling but sexual side effects may be relatively neglected.

“Clinical counseling should include both physical and sexual side effects, both of which have the potential to significantly impact young women's contraceptive use in the long run.”

One difference between the intramuscular and subcutaneous formulations emerged when the women were allowed to choose which one they would receive at the third visit. Of the 38 women who made it to that visit, 26 chose a subcutaneous injection, 9 chose an intramuscular injection, and 3 chose to discontinue DMPA.

Major Finding: No significant differences were found in physical or sexual side effects in adolescents taking DMPA-IM and DMPA-SC.

Data Source: Randomized crossover trial of 55 adolescents.

Disclosures: The study was supported by the National Institutes of Health, the Health Resources and Services Administration, and the Indiana Clinical and Translational Sciences Institute. Dr. Williams said he had no conflicts of interest.

LAS VEGAS — The intramuscular and subcutaneous formulations of depot medroxyprogesterone acetate seem to have similar side effect profiles in adolescents, according to a randomized crossover study.

Although the side effects of the two formulations (DMPA-IM and DMPA-SC) have been studied in adult women, this is the first study in adolescents, Dr. Rebekah L. Williams said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

The randomized crossover study involved 55 young women aged 14–20 years, with a mean of 16.5 years. All participants were either initiating or restarting DMPA therapy. Among the young women, 85% were African American and 20% said they had never had sex.

At baseline the participants completed surveys about their expectations regarding the side effects, and they were randomized to receive one of the two formulations. At the end of 3 months, participants answered questions about side effects, and then they were given the other formulation. At the end of another 3 months, the participants were again surveyed, after which they were permitted to choose which formulation they preferred for a third injection. Thirty-eight of the women completed surveys at all three visits.

The investigators found no significant differences between the two formulations in participants' expectations or experience of physical or sexual side effects. In addition, the experience of side effects was not significantly related to expectations of side effects, participants' level of general worry, or their level of general concern about birth control side effects.

Furthermore, with two exceptions, there was no difference in the expectation or experience of side effects between the participants' first and second injections, no matter in which order they received them.

The two exceptions were amenorrhea and irregular bleeding. During the first dose, 10.5% of the participants had amenorrhea, and this increased significantly to 31.6% at the second dose. In contrast, the proportion of women reporting irregular bleeding declined significantly from 26.3% at dose one to 7.9% at dose two.

Dr. Williams of Indiana University, Indianapolis, noticed a mismatch between expectations and experience for sexual side effects. “Over one-third of our sample experienced some change in sexual interest, and one-quarter experienced changes in lubrication during sex,” she said. “The striking difference between expectations between physical and sexual side effects may reflect our clinical practice, in that physical side effects are emphasized during contraceptive counseling but sexual side effects may be relatively neglected.

“Clinical counseling should include both physical and sexual side effects, both of which have the potential to significantly impact young women's contraceptive use in the long run.”

One difference between the intramuscular and subcutaneous formulations emerged when the women were allowed to choose which one they would receive at the third visit. Of the 38 women who made it to that visit, 26 chose a subcutaneous injection, 9 chose an intramuscular injection, and 3 chose to discontinue DMPA.

Major Finding: In adolescents, ovarian cysts on the left side are 116 times less likely to resolve spontaneously than those on the right.

Data Source: Retrospective analysis of data from 151 patients, aged 13-18 years.

Disclosures: None was reported.

LAS VEGAS — It's well known that most ovarian cysts in adolescents resolve spontaneously, but for some unknown reason, those on the right side are far more likely to resolve than those on the left, a retrospective study of 151 teenaged girls showed.

Investigators at the University of Missouri–Kansas City determined that after adjustment for potential confounders, cysts on the left side were 116 times less likely to resolve without surgery than those on the right.

“You'd think that a right- or left-sided cyst wouldn't matter. It would spontaneously regress independently [of side]. But we found that a right-sided cyst was a predictor of cyst resolution.” said coauthor Dr. Jeffrey Wall.

Dr. Wall and lead author Dr. Timothy Chad McCormick conducted the study by reviewing charts from 2000 to 2008 of all adolescent females with a diagnostic ICD-9 code consistent with an ovarian cyst or mass. There were 342 such patients. For the purposes of the study, the investigators included only 151 of those patients—those who had been followed until documented resolution or who underwent surgical intervention for nonresolution.

Of those patients, 91 (60%) had their cysts resolve spontaneously, while the others required surgery.

The researchers conducted a multivariate regression analysis that adjusted for age at diagnosis, race, cyst size, cyst volume, cyst side, and cyst complexity. Only two factors emerged as statistically significant independent predictors of resolution: cyst side and cyst size. The odds ratio for left-sided cysts was 116.39, indicating a far greater risk for left-sided cysts than for those on the right. The odds ratio for right cyst size was 0.42, indicating that right-sided cysts under 7 cm in size were 58% more likely to resolve spontaneously than larger right-sided cysts.

Dr. Wall had no explanation for their unusual findings, and that they intended to take a look at patient charts to see if they can identify any hypotheses.

Asked whether he would treat patients with left-sided cysts any differently as a result of this study, Dr. Wall said that he would not, at least not yet. “This was a new finding for us. It was unexpected,” he said. “I would say [that physicians should] continue to manage them as they normally would. I would still observe them for a period of time. But if it is on the right side, it's certainly something you can tell the family: It's right sided, so there's a better chance. It's a reassuring thing if nothing else.”

Major Finding: In adolescents, ovarian cysts on the left side are 116 times less likely to resolve spontaneously than those on the right.

Data Source: Retrospective analysis of data from 151 patients, aged 13-18 years.

Disclosures: None was reported.

LAS VEGAS — It's well known that most ovarian cysts in adolescents resolve spontaneously, but for some unknown reason, those on the right side are far more likely to resolve than those on the left, a retrospective study of 151 teenaged girls showed.

Investigators at the University of Missouri–Kansas City determined that after adjustment for potential confounders, cysts on the left side were 116 times less likely to resolve without surgery than those on the right.

“You'd think that a right- or left-sided cyst wouldn't matter. It would spontaneously regress independently [of side]. But we found that a right-sided cyst was a predictor of cyst resolution.” said coauthor Dr. Jeffrey Wall.

Dr. Wall and lead author Dr. Timothy Chad McCormick conducted the study by reviewing charts from 2000 to 2008 of all adolescent females with a diagnostic ICD-9 code consistent with an ovarian cyst or mass. There were 342 such patients. For the purposes of the study, the investigators included only 151 of those patients—those who had been followed until documented resolution or who underwent surgical intervention for nonresolution.

Of those patients, 91 (60%) had their cysts resolve spontaneously, while the others required surgery.

The researchers conducted a multivariate regression analysis that adjusted for age at diagnosis, race, cyst size, cyst volume, cyst side, and cyst complexity. Only two factors emerged as statistically significant independent predictors of resolution: cyst side and cyst size. The odds ratio for left-sided cysts was 116.39, indicating a far greater risk for left-sided cysts than for those on the right. The odds ratio for right cyst size was 0.42, indicating that right-sided cysts under 7 cm in size were 58% more likely to resolve spontaneously than larger right-sided cysts.

Dr. Wall had no explanation for their unusual findings, and that they intended to take a look at patient charts to see if they can identify any hypotheses.

Asked whether he would treat patients with left-sided cysts any differently as a result of this study, Dr. Wall said that he would not, at least not yet. “This was a new finding for us. It was unexpected,” he said. “I would say [that physicians should] continue to manage them as they normally would. I would still observe them for a period of time. But if it is on the right side, it's certainly something you can tell the family: It's right sided, so there's a better chance. It's a reassuring thing if nothing else.”

Major Finding: In adolescents, ovarian cysts on the left side are 116 times less likely to resolve spontaneously than those on the right.

Data Source: Retrospective analysis of data from 151 patients, aged 13-18 years.

Disclosures: None was reported.

LAS VEGAS — It's well known that most ovarian cysts in adolescents resolve spontaneously, but for some unknown reason, those on the right side are far more likely to resolve than those on the left, a retrospective study of 151 teenaged girls showed.

Investigators at the University of Missouri–Kansas City determined that after adjustment for potential confounders, cysts on the left side were 116 times less likely to resolve without surgery than those on the right.

“You'd think that a right- or left-sided cyst wouldn't matter. It would spontaneously regress independently [of side]. But we found that a right-sided cyst was a predictor of cyst resolution.” said coauthor Dr. Jeffrey Wall.

Dr. Wall and lead author Dr. Timothy Chad McCormick conducted the study by reviewing charts from 2000 to 2008 of all adolescent females with a diagnostic ICD-9 code consistent with an ovarian cyst or mass. There were 342 such patients. For the purposes of the study, the investigators included only 151 of those patients—those who had been followed until documented resolution or who underwent surgical intervention for nonresolution.

Of those patients, 91 (60%) had their cysts resolve spontaneously, while the others required surgery.

The researchers conducted a multivariate regression analysis that adjusted for age at diagnosis, race, cyst size, cyst volume, cyst side, and cyst complexity. Only two factors emerged as statistically significant independent predictors of resolution: cyst side and cyst size. The odds ratio for left-sided cysts was 116.39, indicating a far greater risk for left-sided cysts than for those on the right. The odds ratio for right cyst size was 0.42, indicating that right-sided cysts under 7 cm in size were 58% more likely to resolve spontaneously than larger right-sided cysts.

Dr. Wall had no explanation for their unusual findings, and that they intended to take a look at patient charts to see if they can identify any hypotheses.

Asked whether he would treat patients with left-sided cysts any differently as a result of this study, Dr. Wall said that he would not, at least not yet. “This was a new finding for us. It was unexpected,” he said. “I would say [that physicians should] continue to manage them as they normally would. I would still observe them for a period of time. But if it is on the right side, it's certainly something you can tell the family: It's right sided, so there's a better chance. It's a reassuring thing if nothing else.”

Major Finding: Women with type 2 diabetes in the highest quintile of bran consumption had a 28% lower risk of all-cause mortality and 35% lower risk of cardiovascular disease–specific mortality than women in the lowest quintile.

Data Source: The Nurses' Health Study.

Disclosures: The study was funded by the National Institutes of Health, the American Heart Association, and the Boston Obesity Nutrition Research Center. The investigators reported that they had no other disclosures.

Consumption of whole grains, especially the bran component of whole grains, was associated with a significant decrease in the risk of all-cause mortality and cardiovascular disease–specific mortality in women with type 2 diabetes who were followed as part of the Nurses' Health Study.

After adjustment for age, women in the highest quintile of whole grain, cereal fiber, bran, and germ consumption had 16%-31% lower all-cause mortality than women in the lowest quintile, Dr. Meian He of the Harvard School of Public Health, Boston, and colleagues reported.

After further adjustment for lifestyle and dietary risk factors, only bran consumption remained significantly associated with mortality.

Compared to women in the lowest quintile of bran consumption, those in the highest quintile had a 28% decrease in the risk of all-cause mortality and a 35% increase in the risk of mortality associated with cardiovascular disease.

“To my knowledge, this is the first study of whole grain and its components and risk of death in diabetic patients,” Dr. Lu Qi, also of the Harvard School of Public Health and the study's senior author, said in a statement.

“These findings suggest a potential benefit of whole grain, and particularly bran, in reducing death and cardiovascular risk in diabetic patients,” Dr. Qi said.

The Nurses' Health Study began in 1976 with 121,700 female registered nurses aged 30–55 years.

Data on participants' medical history, lifestyle, and medical diagnoses have been updated every 2 years.

For this study, the investigators focused on 7,822 women diagnosed with type 2 diabetes between 1976 and 2006.

They excluded women diagnosed with diabetes before age 30 years and those with a history of cardiovascular disease or cancer reported on the 1980 questionnaire, when diet was first assessed [doi:10.1161/CIRCULATIONAHA.109.907360]).

Women completed semi-quantitative food frequency questionnaires every 2 or 4 years between 1980 and 2002.

Investigators used data on how often they consumed certain foods and beverages to estimate each woman's average intake of whole grains, as well as her intake of bran and cereal fiber.

Investigators followed the women for 26 years, for a total of 70,102 person-years.

During that time, 852 women died, 295 of cardiovascular disease.

They adjusted for age, smoking status, body mass index, alcohol intake, physical activity, parental history of myocardial infarction, menopausal status, use of hormone therapy, duration of diabetes, and various dietary factors including total energy intake, and intake of polyunsaturated fat, saturated fat, trans fat, magnesium, and folate.

Several different mechanisms could explain the association between bran consumption and mortality in women with diabetes, Dr. He and colleagues wrote. Their earlier research suggested that consumption of whole grains might protect against systemic inflammation and endothelial dysfunction.

“Diabetes is thought to be a chronic state of inflammation characterized by moderately increased levels of chemical markers for inflammation and endothelial dysfunction,” Dr. Qi said in the prepared statement, which was issued by the American Heart Association, one of the study's sponsors.

“Those markers have been found to be related to increased risk of CVD in both diabetic and nondiabetic populations,” Dr. Qi said.

After adjustment for lifestyle and dietary risk factors, only bran consumption remained significantly associated with mortality reduction.

Source ©Mark Herreid/iStockphoto.com

Major Finding: Women with type 2 diabetes in the highest quintile of bran consumption had a 28% lower risk of all-cause mortality and 35% lower risk of cardiovascular disease–specific mortality than women in the lowest quintile.

Data Source: The Nurses' Health Study.

Disclosures: The study was funded by the National Institutes of Health, the American Heart Association, and the Boston Obesity Nutrition Research Center. The investigators reported that they had no other disclosures.

Consumption of whole grains, especially the bran component of whole grains, was associated with a significant decrease in the risk of all-cause mortality and cardiovascular disease–specific mortality in women with type 2 diabetes who were followed as part of the Nurses' Health Study.

After adjustment for age, women in the highest quintile of whole grain, cereal fiber, bran, and germ consumption had 16%-31% lower all-cause mortality than women in the lowest quintile, Dr. Meian He of the Harvard School of Public Health, Boston, and colleagues reported.

After further adjustment for lifestyle and dietary risk factors, only bran consumption remained significantly associated with mortality.

Compared to women in the lowest quintile of bran consumption, those in the highest quintile had a 28% decrease in the risk of all-cause mortality and a 35% increase in the risk of mortality associated with cardiovascular disease.

“To my knowledge, this is the first study of whole grain and its components and risk of death in diabetic patients,” Dr. Lu Qi, also of the Harvard School of Public Health and the study's senior author, said in a statement.

“These findings suggest a potential benefit of whole grain, and particularly bran, in reducing death and cardiovascular risk in diabetic patients,” Dr. Qi said.

The Nurses' Health Study began in 1976 with 121,700 female registered nurses aged 30–55 years.

Data on participants' medical history, lifestyle, and medical diagnoses have been updated every 2 years.

For this study, the investigators focused on 7,822 women diagnosed with type 2 diabetes between 1976 and 2006.

They excluded women diagnosed with diabetes before age 30 years and those with a history of cardiovascular disease or cancer reported on the 1980 questionnaire, when diet was first assessed [doi:10.1161/CIRCULATIONAHA.109.907360]).

Women completed semi-quantitative food frequency questionnaires every 2 or 4 years between 1980 and 2002.

Investigators used data on how often they consumed certain foods and beverages to estimate each woman's average intake of whole grains, as well as her intake of bran and cereal fiber.

Investigators followed the women for 26 years, for a total of 70,102 person-years.

During that time, 852 women died, 295 of cardiovascular disease.

They adjusted for age, smoking status, body mass index, alcohol intake, physical activity, parental history of myocardial infarction, menopausal status, use of hormone therapy, duration of diabetes, and various dietary factors including total energy intake, and intake of polyunsaturated fat, saturated fat, trans fat, magnesium, and folate.

Several different mechanisms could explain the association between bran consumption and mortality in women with diabetes, Dr. He and colleagues wrote. Their earlier research suggested that consumption of whole grains might protect against systemic inflammation and endothelial dysfunction.

“Diabetes is thought to be a chronic state of inflammation characterized by moderately increased levels of chemical markers for inflammation and endothelial dysfunction,” Dr. Qi said in the prepared statement, which was issued by the American Heart Association, one of the study's sponsors.

“Those markers have been found to be related to increased risk of CVD in both diabetic and nondiabetic populations,” Dr. Qi said.

After adjustment for lifestyle and dietary risk factors, only bran consumption remained significantly associated with mortality reduction.

Source ©Mark Herreid/iStockphoto.com

Major Finding: Women with type 2 diabetes in the highest quintile of bran consumption had a 28% lower risk of all-cause mortality and 35% lower risk of cardiovascular disease–specific mortality than women in the lowest quintile.

Data Source: The Nurses' Health Study.

Disclosures: The study was funded by the National Institutes of Health, the American Heart Association, and the Boston Obesity Nutrition Research Center. The investigators reported that they had no other disclosures.

Consumption of whole grains, especially the bran component of whole grains, was associated with a significant decrease in the risk of all-cause mortality and cardiovascular disease–specific mortality in women with type 2 diabetes who were followed as part of the Nurses' Health Study.

After adjustment for age, women in the highest quintile of whole grain, cereal fiber, bran, and germ consumption had 16%-31% lower all-cause mortality than women in the lowest quintile, Dr. Meian He of the Harvard School of Public Health, Boston, and colleagues reported.

After further adjustment for lifestyle and dietary risk factors, only bran consumption remained significantly associated with mortality.

Compared to women in the lowest quintile of bran consumption, those in the highest quintile had a 28% decrease in the risk of all-cause mortality and a 35% increase in the risk of mortality associated with cardiovascular disease.

“To my knowledge, this is the first study of whole grain and its components and risk of death in diabetic patients,” Dr. Lu Qi, also of the Harvard School of Public Health and the study's senior author, said in a statement.

“These findings suggest a potential benefit of whole grain, and particularly bran, in reducing death and cardiovascular risk in diabetic patients,” Dr. Qi said.

The Nurses' Health Study began in 1976 with 121,700 female registered nurses aged 30–55 years.

Data on participants' medical history, lifestyle, and medical diagnoses have been updated every 2 years.

For this study, the investigators focused on 7,822 women diagnosed with type 2 diabetes between 1976 and 2006.

They excluded women diagnosed with diabetes before age 30 years and those with a history of cardiovascular disease or cancer reported on the 1980 questionnaire, when diet was first assessed [doi:10.1161/CIRCULATIONAHA.109.907360]).

Women completed semi-quantitative food frequency questionnaires every 2 or 4 years between 1980 and 2002.

Investigators used data on how often they consumed certain foods and beverages to estimate each woman's average intake of whole grains, as well as her intake of bran and cereal fiber.

Investigators followed the women for 26 years, for a total of 70,102 person-years.

During that time, 852 women died, 295 of cardiovascular disease.

They adjusted for age, smoking status, body mass index, alcohol intake, physical activity, parental history of myocardial infarction, menopausal status, use of hormone therapy, duration of diabetes, and various dietary factors including total energy intake, and intake of polyunsaturated fat, saturated fat, trans fat, magnesium, and folate.

Several different mechanisms could explain the association between bran consumption and mortality in women with diabetes, Dr. He and colleagues wrote. Their earlier research suggested that consumption of whole grains might protect against systemic inflammation and endothelial dysfunction.

“Diabetes is thought to be a chronic state of inflammation characterized by moderately increased levels of chemical markers for inflammation and endothelial dysfunction,” Dr. Qi said in the prepared statement, which was issued by the American Heart Association, one of the study's sponsors.

“Those markers have been found to be related to increased risk of CVD in both diabetic and nondiabetic populations,” Dr. Qi said.

After adjustment for lifestyle and dietary risk factors, only bran consumption remained significantly associated with mortality reduction.

Source ©Mark Herreid/iStockphoto.com

Major Finding: Women with depression were 54% more likely to become overweight or obese within 5 years than were those who were not depressed, and women who were overweight or obese were 27% more likely than normal-weight women to develop depression within 5 years.

Data Source: A study of 5,031 men and women aged 45-84 years at baseline.

Disclosures: The lead investigator stated that she had no disclosures.

SAN FRANCISCO — Depression might lead to overweight and obesity, and overweight and obesity might also lead to depression, but only in women, according to a longitudinal study of 5,031 participants in the Multi-Ethnic Study of Atherosclerosis.

Numerous studies have demonstrated associations between depression and the development of type 2 diabetes and cardiovascular disease. According to lead investigator Rosemay A. Remigio-Baker a doctoral candidate at Johns Hopkins Bloomberg School of Public HealthcBaltimore, her study suggests that overweight and obesity might provide the link connecting depression with diabetes and cardiovascular disease.

Participants entered the study between 2000 and 2002, when they were 45-84 years of age. Investigators followed them for 5 years. None of the participants had diabetes at baseline. The investigators defined overweight as a body mass index of 25 kg/m

To see whether depression was associated with the later development of overweight, the investigators restricted their analysis to the 1,496 individuals whose baseline BMI was less than 25. At baseline, 19% of those women and 12% of those men were depressed.

After controlling for age, ethnicity, education, income, smoking status, daily caloric intake, exercise, and levels of interleukin-6 and C-reactive protein, the investigators found that women with depression were 54% more likely to develop overweight or obesity within 5 years than were those without depression. The hazard ratio was statistically significant. The investigators found no statistically significant association between depression and incident overweight among men.

To see whether overweight/obesity was associated with the later development of depression, the investigators restricted their analysis to the 3,801 participants without depression at baseline. At baseline, 65% of those women and 70% of those men were overweight or obese.

After controlling for the same covariates, the investigators found that overweight or obese women were 27% more likely to develop depression within 5 years than were normal-weight women. Again, the hazard ratio was statistically significant, and there was no link between overweight/obesity and depression in men.

“Treating depression should be considered as a public health initiative to prevent development of overweight/obesity, especially among women,” Ms. Remigio-Baker said.

Major Finding: Women with depression were 54% more likely to become overweight or obese within 5 years than were those who were not depressed, and women who were overweight or obese were 27% more likely than normal-weight women to develop depression within 5 years.

Data Source: A study of 5,031 men and women aged 45-84 years at baseline.

Disclosures: The lead investigator stated that she had no disclosures.

SAN FRANCISCO — Depression might lead to overweight and obesity, and overweight and obesity might also lead to depression, but only in women, according to a longitudinal study of 5,031 participants in the Multi-Ethnic Study of Atherosclerosis.

Numerous studies have demonstrated associations between depression and the development of type 2 diabetes and cardiovascular disease. According to lead investigator Rosemay A. Remigio-Baker a doctoral candidate at Johns Hopkins Bloomberg School of Public HealthcBaltimore, her study suggests that overweight and obesity might provide the link connecting depression with diabetes and cardiovascular disease.

Participants entered the study between 2000 and 2002, when they were 45-84 years of age. Investigators followed them for 5 years. None of the participants had diabetes at baseline. The investigators defined overweight as a body mass index of 25 kg/m

To see whether depression was associated with the later development of overweight, the investigators restricted their analysis to the 1,496 individuals whose baseline BMI was less than 25. At baseline, 19% of those women and 12% of those men were depressed.

After controlling for age, ethnicity, education, income, smoking status, daily caloric intake, exercise, and levels of interleukin-6 and C-reactive protein, the investigators found that women with depression were 54% more likely to develop overweight or obesity within 5 years than were those without depression. The hazard ratio was statistically significant. The investigators found no statistically significant association between depression and incident overweight among men.

To see whether overweight/obesity was associated with the later development of depression, the investigators restricted their analysis to the 3,801 participants without depression at baseline. At baseline, 65% of those women and 70% of those men were overweight or obese.

After controlling for the same covariates, the investigators found that overweight or obese women were 27% more likely to develop depression within 5 years than were normal-weight women. Again, the hazard ratio was statistically significant, and there was no link between overweight/obesity and depression in men.

“Treating depression should be considered as a public health initiative to prevent development of overweight/obesity, especially among women,” Ms. Remigio-Baker said.

Major Finding: Women with depression were 54% more likely to become overweight or obese within 5 years than were those who were not depressed, and women who were overweight or obese were 27% more likely than normal-weight women to develop depression within 5 years.

Data Source: A study of 5,031 men and women aged 45-84 years at baseline.

Disclosures: The lead investigator stated that she had no disclosures.

SAN FRANCISCO — Depression might lead to overweight and obesity, and overweight and obesity might also lead to depression, but only in women, according to a longitudinal study of 5,031 participants in the Multi-Ethnic Study of Atherosclerosis.

Numerous studies have demonstrated associations between depression and the development of type 2 diabetes and cardiovascular disease. According to lead investigator Rosemay A. Remigio-Baker a doctoral candidate at Johns Hopkins Bloomberg School of Public HealthcBaltimore, her study suggests that overweight and obesity might provide the link connecting depression with diabetes and cardiovascular disease.

Participants entered the study between 2000 and 2002, when they were 45-84 years of age. Investigators followed them for 5 years. None of the participants had diabetes at baseline. The investigators defined overweight as a body mass index of 25 kg/m

To see whether depression was associated with the later development of overweight, the investigators restricted their analysis to the 1,496 individuals whose baseline BMI was less than 25. At baseline, 19% of those women and 12% of those men were depressed.

After controlling for age, ethnicity, education, income, smoking status, daily caloric intake, exercise, and levels of interleukin-6 and C-reactive protein, the investigators found that women with depression were 54% more likely to develop overweight or obesity within 5 years than were those without depression. The hazard ratio was statistically significant. The investigators found no statistically significant association between depression and incident overweight among men.

To see whether overweight/obesity was associated with the later development of depression, the investigators restricted their analysis to the 3,801 participants without depression at baseline. At baseline, 65% of those women and 70% of those men were overweight or obese.

After controlling for the same covariates, the investigators found that overweight or obese women were 27% more likely to develop depression within 5 years than were normal-weight women. Again, the hazard ratio was statistically significant, and there was no link between overweight/obesity and depression in men.

“Treating depression should be considered as a public health initiative to prevent development of overweight/obesity, especially among women,” Ms. Remigio-Baker said.

Major Finding: Women with type 2 diabetes in the highest quintile of bran consumption had a 28% lower risk of all-cause mortality and 35% lower risk of cardiovascular disease–specific mortality than women in the lowest quintile.

Data Source: Nurses' Health Study.

Disclosures: The study was funded by the National Institutes of Health, the American Heart Association, and the Boston Obesity Nutrition Research Center. The investigators reported that they had no other disclosures.

Consumption of whole grains, especially the bran component of whole grains, was associated with a significant decrease in the risk of all-cause mortality and cardiovascular disease–specific mortality in women with type 2 diabetes who were followed as part of the Nurses' Health Study.

After adjustment for age, women in the highest quintile of whole grain, cereal fiber, bran, and germ consumption had 16%-31% lower all-cause mortality than women in the lowest quintile, Dr. Meian He of the Harvard School of Public Health, Boston, and colleagues reported.

After further adjustment for lifestyle and dietary risk factors, only bran consumption remained significantly associated with mortality.

Compared with women in the lowest quintile of bran consumption, those in the highest quintile had a 28% decrease in the risk of all-cause mortality and a 35% increase in the risk of mortality associated with cardiovascular disease (Circulation 2010 May 25 [doi:10.1161/CIRCULATIONAHA.109.907360]).

“To my knowledge, this is the first study of whole grain and its components and risk of death in diabetic patients,” Dr. Lu Qi, also of the Harvard School of Public Health and the study's senior author, said in a statement.

“These findings suggest a potential benefit of whole grain, and particularly bran, in reducing death and cardiovascular risk in diabetic patients,” Dr. Qi said.

The Nurses' Health Study began in 1976 with 121,700 female registered nurses aged 30-55 years. Data on participants' medical history, lifestyle factors such as diet and activity level, and medical diagnoses have been updated every 2 years.

For this study, the investigators focused on 7,822 women diagnosed with type 2 diabetes between 1976 and 2006.

The researchers excluded women who had been diagnosed with diabetes before age 30 years and those with a history of cardiovascular disease or cancer reported on the 1980 questionnaire, when diet was first assessed.

Women completed semiquantitative food frequency questionnaires every 2 or 4 years between 1980 and 2002.

Investigators used data on how often they consumed certain foods and beverages to estimate each woman's average intake of whole grains, as well as her intake of bran and cereal fiber.

Investigators followed the women for 26 years, for a total of 70,102 person-years. During that time, 852 women died, and of these, 295 died of cardiovascular disease.

Investigators adjusted the data for age, smoking status, body mass index, alcohol intake, amount of physical activity, parental history of myocardial infarction, menopausal status, current and past use of hormone therapy, duration of diabetes, and various dietary factors including total calorie intake and intake of polyunsaturated fat, saturated fat, trans fat, magnesium, and folate.

Several different mechanisms could explain the association between bran consumption and mortality in women with diabetes, Dr. He and colleagues wrote.

Their earlier research suggested that consumption of whole grains might protect against systemic inflammation and endothelial dysfunction.

“Diabetes is thought to be a chronic state of inflammation characterized by moderately increased levels of chemical markers for inflammation and endothelial dysfunction,” Dr. Qi said in the statement, which was issued by the American Heart Association, one of the study's sponsors.

“Those markers have been found to be related to increased risk of CVD in both diabetic and nondiabetic populations,” Dr. Qi said.

After adjustment for lifestyle and dietary risk factors, bran consumption remained significantly associated with mortality.

Source ©Mark Herreid/iStockphoto.com

Major Finding: Women with type 2 diabetes in the highest quintile of bran consumption had a 28% lower risk of all-cause mortality and 35% lower risk of cardiovascular disease–specific mortality than women in the lowest quintile.

Data Source: Nurses' Health Study.

Disclosures: The study was funded by the National Institutes of Health, the American Heart Association, and the Boston Obesity Nutrition Research Center. The investigators reported that they had no other disclosures.

Consumption of whole grains, especially the bran component of whole grains, was associated with a significant decrease in the risk of all-cause mortality and cardiovascular disease–specific mortality in women with type 2 diabetes who were followed as part of the Nurses' Health Study.

After adjustment for age, women in the highest quintile of whole grain, cereal fiber, bran, and germ consumption had 16%-31% lower all-cause mortality than women in the lowest quintile, Dr. Meian He of the Harvard School of Public Health, Boston, and colleagues reported.

After further adjustment for lifestyle and dietary risk factors, only bran consumption remained significantly associated with mortality.

Compared with women in the lowest quintile of bran consumption, those in the highest quintile had a 28% decrease in the risk of all-cause mortality and a 35% increase in the risk of mortality associated with cardiovascular disease (Circulation 2010 May 25 [doi:10.1161/CIRCULATIONAHA.109.907360]).

“To my knowledge, this is the first study of whole grain and its components and risk of death in diabetic patients,” Dr. Lu Qi, also of the Harvard School of Public Health and the study's senior author, said in a statement.

“These findings suggest a potential benefit of whole grain, and particularly bran, in reducing death and cardiovascular risk in diabetic patients,” Dr. Qi said.

The Nurses' Health Study began in 1976 with 121,700 female registered nurses aged 30-55 years. Data on participants' medical history, lifestyle factors such as diet and activity level, and medical diagnoses have been updated every 2 years.

For this study, the investigators focused on 7,822 women diagnosed with type 2 diabetes between 1976 and 2006.

The researchers excluded women who had been diagnosed with diabetes before age 30 years and those with a history of cardiovascular disease or cancer reported on the 1980 questionnaire, when diet was first assessed.

Women completed semiquantitative food frequency questionnaires every 2 or 4 years between 1980 and 2002.

Investigators used data on how often they consumed certain foods and beverages to estimate each woman's average intake of whole grains, as well as her intake of bran and cereal fiber.

Investigators followed the women for 26 years, for a total of 70,102 person-years. During that time, 852 women died, and of these, 295 died of cardiovascular disease.

Investigators adjusted the data for age, smoking status, body mass index, alcohol intake, amount of physical activity, parental history of myocardial infarction, menopausal status, current and past use of hormone therapy, duration of diabetes, and various dietary factors including total calorie intake and intake of polyunsaturated fat, saturated fat, trans fat, magnesium, and folate.

Several different mechanisms could explain the association between bran consumption and mortality in women with diabetes, Dr. He and colleagues wrote.

Their earlier research suggested that consumption of whole grains might protect against systemic inflammation and endothelial dysfunction.

“Diabetes is thought to be a chronic state of inflammation characterized by moderately increased levels of chemical markers for inflammation and endothelial dysfunction,” Dr. Qi said in the statement, which was issued by the American Heart Association, one of the study's sponsors.

“Those markers have been found to be related to increased risk of CVD in both diabetic and nondiabetic populations,” Dr. Qi said.

After adjustment for lifestyle and dietary risk factors, bran consumption remained significantly associated with mortality.

Source ©Mark Herreid/iStockphoto.com

Major Finding: Women with type 2 diabetes in the highest quintile of bran consumption had a 28% lower risk of all-cause mortality and 35% lower risk of cardiovascular disease–specific mortality than women in the lowest quintile.

Data Source: Nurses' Health Study.

Disclosures: The study was funded by the National Institutes of Health, the American Heart Association, and the Boston Obesity Nutrition Research Center. The investigators reported that they had no other disclosures.

Consumption of whole grains, especially the bran component of whole grains, was associated with a significant decrease in the risk of all-cause mortality and cardiovascular disease–specific mortality in women with type 2 diabetes who were followed as part of the Nurses' Health Study.

After adjustment for age, women in the highest quintile of whole grain, cereal fiber, bran, and germ consumption had 16%-31% lower all-cause mortality than women in the lowest quintile, Dr. Meian He of the Harvard School of Public Health, Boston, and colleagues reported.

After further adjustment for lifestyle and dietary risk factors, only bran consumption remained significantly associated with mortality.

Compared with women in the lowest quintile of bran consumption, those in the highest quintile had a 28% decrease in the risk of all-cause mortality and a 35% increase in the risk of mortality associated with cardiovascular disease (Circulation 2010 May 25 [doi:10.1161/CIRCULATIONAHA.109.907360]).

“To my knowledge, this is the first study of whole grain and its components and risk of death in diabetic patients,” Dr. Lu Qi, also of the Harvard School of Public Health and the study's senior author, said in a statement.

“These findings suggest a potential benefit of whole grain, and particularly bran, in reducing death and cardiovascular risk in diabetic patients,” Dr. Qi said.

The Nurses' Health Study began in 1976 with 121,700 female registered nurses aged 30-55 years. Data on participants' medical history, lifestyle factors such as diet and activity level, and medical diagnoses have been updated every 2 years.

For this study, the investigators focused on 7,822 women diagnosed with type 2 diabetes between 1976 and 2006.

The researchers excluded women who had been diagnosed with diabetes before age 30 years and those with a history of cardiovascular disease or cancer reported on the 1980 questionnaire, when diet was first assessed.

Women completed semiquantitative food frequency questionnaires every 2 or 4 years between 1980 and 2002.

Investigators used data on how often they consumed certain foods and beverages to estimate each woman's average intake of whole grains, as well as her intake of bran and cereal fiber.

Investigators followed the women for 26 years, for a total of 70,102 person-years. During that time, 852 women died, and of these, 295 died of cardiovascular disease.

Investigators adjusted the data for age, smoking status, body mass index, alcohol intake, amount of physical activity, parental history of myocardial infarction, menopausal status, current and past use of hormone therapy, duration of diabetes, and various dietary factors including total calorie intake and intake of polyunsaturated fat, saturated fat, trans fat, magnesium, and folate.

Several different mechanisms could explain the association between bran consumption and mortality in women with diabetes, Dr. He and colleagues wrote.

Their earlier research suggested that consumption of whole grains might protect against systemic inflammation and endothelial dysfunction.

“Diabetes is thought to be a chronic state of inflammation characterized by moderately increased levels of chemical markers for inflammation and endothelial dysfunction,” Dr. Qi said in the statement, which was issued by the American Heart Association, one of the study's sponsors.

“Those markers have been found to be related to increased risk of CVD in both diabetic and nondiabetic populations,” Dr. Qi said.

After adjustment for lifestyle and dietary risk factors, bran consumption remained significantly associated with mortality.

Source ©Mark Herreid/iStockphoto.com

Major Finding: Women who drank more than four cups of coffee daily were 56% less likely to develop type 2 diabetes than were those who drank no coffee, a significant difference. After adjustment for SHBG, the difference was not significant.

Data Source: Nested case-control study of 359 women with incident type 2 diabetes and matched controls from the Women's Health Study.

Disclosures: None. Study supported by a grant from the National Institutes of Health.

SAN FRANCISCO — Sex hormone–binding globulin may be the key to the protective effect of coffee consumption against type 2 diabetes, according to an analysis of the Women's Health Study.

Women who drank at least four cups of coffee per day were less than half as likely to develop diabetes, compared with those who drank no coffee. After adjustment for level of sex hormone–binding globulin (SHBG), the interaction disappeared.

It has been known for some time that women who drink coffee are significantly less likely to develop type 2 diabetes than are those who do not, and that the relationship between coffee consumption and diabetes is much less pronounced in men.

SHBG is a glycoprotein with a high affinity for testosterone and estradiol. SHBG levels tend to be substantially higher in women than in men, Atsushi Goto, a doctoral candidate at the University of California, Los Angeles, said at the conference. Previous studies have shown that variations in the genes controlling SHBG have a strong association with the development of diabetes and that coffee consumption increases plasma levels of SHBG.

To determine if SHBG is the link between coffee consumption and the development of diabetes, Mr. Goto and his colleagues used data from the Women's Health Study, in which nearly 40,000 women were followed for a median of 10 years. During that time, 359 of the women developed diabetes.

The investigators matched those women by age, race, and time of blood draw with 359 women who had not developed the disease.

After adjustment for age, smoking, alcohol consumption, physical activity, past use of hormone replacement therapy, total energy intake, fiber intake, body mass index, and plasma testosterone and estradiol levels, the investigators found that women who drank at least four cups of caffeinated coffee (500 mg caffeine) daily had significantly higher mean SHBG levels than did nondrinkers: 27.3 nmol/L versus 24.5 nmol/L. Consumption of decaffeinated coffee was not significantly associated with SHBG levels.

Furthermore, when controlling for all of the above factors plus education levels and family history of type 2 diabetes, the investigators found that women who drank at least four cups of caffeinated coffee daily were 56% less likely to develop diabetes than were nondrinkers.

However, when the investigators additionally controlled for plasma SHBG levels, the decrease in risk associated with coffee consumption became nonsignificant. This suggests that it is SHBG that mediates the decrease in risk of developing type 2 diabetes, Mr. Goto commented.

Women who drank at least four cups of caffeinated coffee daily had significantly higher mean SHBG levels.

Source Elsevier Global Medical News

Major Finding: Women who drank more than four cups of coffee daily were 56% less likely to develop type 2 diabetes than were those who drank no coffee, a significant difference. After adjustment for SHBG, the difference was not significant.

Data Source: Nested case-control study of 359 women with incident type 2 diabetes and matched controls from the Women's Health Study.

Disclosures: None. Study supported by a grant from the National Institutes of Health.

SAN FRANCISCO — Sex hormone–binding globulin may be the key to the protective effect of coffee consumption against type 2 diabetes, according to an analysis of the Women's Health Study.

Women who drank at least four cups of coffee per day were less than half as likely to develop diabetes, compared with those who drank no coffee. After adjustment for level of sex hormone–binding globulin (SHBG), the interaction disappeared.

It has been known for some time that women who drink coffee are significantly less likely to develop type 2 diabetes than are those who do not, and that the relationship between coffee consumption and diabetes is much less pronounced in men.

SHBG is a glycoprotein with a high affinity for testosterone and estradiol. SHBG levels tend to be substantially higher in women than in men, Atsushi Goto, a doctoral candidate at the University of California, Los Angeles, said at the conference. Previous studies have shown that variations in the genes controlling SHBG have a strong association with the development of diabetes and that coffee consumption increases plasma levels of SHBG.

To determine if SHBG is the link between coffee consumption and the development of diabetes, Mr. Goto and his colleagues used data from the Women's Health Study, in which nearly 40,000 women were followed for a median of 10 years. During that time, 359 of the women developed diabetes.

The investigators matched those women by age, race, and time of blood draw with 359 women who had not developed the disease.

After adjustment for age, smoking, alcohol consumption, physical activity, past use of hormone replacement therapy, total energy intake, fiber intake, body mass index, and plasma testosterone and estradiol levels, the investigators found that women who drank at least four cups of caffeinated coffee (500 mg caffeine) daily had significantly higher mean SHBG levels than did nondrinkers: 27.3 nmol/L versus 24.5 nmol/L. Consumption of decaffeinated coffee was not significantly associated with SHBG levels.

Furthermore, when controlling for all of the above factors plus education levels and family history of type 2 diabetes, the investigators found that women who drank at least four cups of caffeinated coffee daily were 56% less likely to develop diabetes than were nondrinkers.

However, when the investigators additionally controlled for plasma SHBG levels, the decrease in risk associated with coffee consumption became nonsignificant. This suggests that it is SHBG that mediates the decrease in risk of developing type 2 diabetes, Mr. Goto commented.

Women who drank at least four cups of caffeinated coffee daily had significantly higher mean SHBG levels.

Source Elsevier Global Medical News

Major Finding: Women who drank more than four cups of coffee daily were 56% less likely to develop type 2 diabetes than were those who drank no coffee, a significant difference. After adjustment for SHBG, the difference was not significant.

Data Source: Nested case-control study of 359 women with incident type 2 diabetes and matched controls from the Women's Health Study.

Disclosures: None. Study supported by a grant from the National Institutes of Health.

SAN FRANCISCO — Sex hormone–binding globulin may be the key to the protective effect of coffee consumption against type 2 diabetes, according to an analysis of the Women's Health Study.

Women who drank at least four cups of coffee per day were less than half as likely to develop diabetes, compared with those who drank no coffee. After adjustment for level of sex hormone–binding globulin (SHBG), the interaction disappeared.

It has been known for some time that women who drink coffee are significantly less likely to develop type 2 diabetes than are those who do not, and that the relationship between coffee consumption and diabetes is much less pronounced in men.

SHBG is a glycoprotein with a high affinity for testosterone and estradiol. SHBG levels tend to be substantially higher in women than in men, Atsushi Goto, a doctoral candidate at the University of California, Los Angeles, said at the conference. Previous studies have shown that variations in the genes controlling SHBG have a strong association with the development of diabetes and that coffee consumption increases plasma levels of SHBG.

To determine if SHBG is the link between coffee consumption and the development of diabetes, Mr. Goto and his colleagues used data from the Women's Health Study, in which nearly 40,000 women were followed for a median of 10 years. During that time, 359 of the women developed diabetes.

The investigators matched those women by age, race, and time of blood draw with 359 women who had not developed the disease.

After adjustment for age, smoking, alcohol consumption, physical activity, past use of hormone replacement therapy, total energy intake, fiber intake, body mass index, and plasma testosterone and estradiol levels, the investigators found that women who drank at least four cups of caffeinated coffee (500 mg caffeine) daily had significantly higher mean SHBG levels than did nondrinkers: 27.3 nmol/L versus 24.5 nmol/L. Consumption of decaffeinated coffee was not significantly associated with SHBG levels.

Furthermore, when controlling for all of the above factors plus education levels and family history of type 2 diabetes, the investigators found that women who drank at least four cups of caffeinated coffee daily were 56% less likely to develop diabetes than were nondrinkers.

However, when the investigators additionally controlled for plasma SHBG levels, the decrease in risk associated with coffee consumption became nonsignificant. This suggests that it is SHBG that mediates the decrease in risk of developing type 2 diabetes, Mr. Goto commented.

Women who drank at least four cups of caffeinated coffee daily had significantly higher mean SHBG levels.

Source Elsevier Global Medical News