In This Issue of Archives of Internal Medicine


IN THIS ISSUE OF ARCHIVES OF INTERNAL MEDICINE

Physical Activity and the
Association of Common FTO
Gene Variants With Body
Mass Index and Obesity

C ommon FTO (fat mass andobesity associated) gene vari-
ants have recently been associated
with increased body mass index and
obesity in several large studies. In this
study of 704 Old Order Amish adults
who were enrolled in the Heredity
and Phenotype Intervention Heart
Study, the authors not only repli-
cated this finding but also showed
that the association between FTO
variants and body mass index is abol-
ished in those who are the most
physically active as determined by ob-
jective movement monitoring with
accelerometers. These findings em-
phasize the important role of physi-
cal activity in public health efforts to
combat obesity, particularly in ge-
netically susceptible individuals.

See page 1791

Postmenopausal Hormone
Use and Symptoms of
Gastroesophageal Reflux

T his study examined the asso-ciation between postmeno-
pausal hormone use and symptoms
of gastroesophageal reflux disease
(GERD) among 51 637 participants
in the Nurses’ Health Study. Investi-
gators found that use of estrogens, but
not necessarily progesterone, is sig-
nificantly associated with an in-
creased risk for GERD symptoms. The
authors observed significant trends in
risk for both increasing doses and du-
rations of estrogen use in a prospec-
tive fashion. In addition, use of selec-
tive estrogen receptor modulators,
such as tamoxifen and raloxifene, and
use of over-the-counter hormone
preparations also carries an in-
creased risk for GERD symptoms.
These findings suggest that there may
be a hormonal component to the
pathophysiologic characteristics of
gastroesophageal reflux.

See page 1798

Association Between Blood Pressure Responses
to the Cold Pressor Test and Dietary Sodium Intervention
in a Chinese Population

C hen et al examined the association between blood pressure (BP) re-sponses to the cold pressor test and to dietary sodium and potassium
interventions among 1906 study participants in rural China. The dietary in-
tervention included three 7-day periods of low sodium intake (51.3 mmol/d),
high sodium intake (307.8 mmol/d), and high sodium intake plus potassium
supplementation (60 mmol/d). Compared with the lowest quartile of BP re-
sponse to the cold pressor test, systolic BP changes for the top 3 quartiles were
–2.02, –3.17, and –5.98 mm Hg during the low-sodium intervention; 0.40,
0.44, and 2.30 mm Hg during the high-sodium intervention; and –0.26, –0.95,
and –1.59 mm Hg during the high-sodium intervention plus potassium supple-
mentation (all P � .001). These results indicate that BP response to the cold
pressor test was associated with salt sensitivity and potassium sensitivity.

See page 1740

Practice-Linked Online Personal Health Records
for Type 2 Diabetes Mellitus

W eb-based personal health records (PHRs) have been advocated as ameans to improve diabetes care. However, few Web-based systems
are linked directly to the electronic medical record used by physicians. Grant
et al randomized 11 primary care practices to receive access to either (1) a
diabetes-specific PHR that imported clinical and medications data and en-
abled the patient to author a “diabetes care plan” before upcoming appoint-
ments vs (2) a PHR to update and submit family history and health mainte-
nance information (“active control” arm). Previsit use of the diabetes PHR
increased rates of diabetes-related medication adjustment compared with ac-
tive controls (53% vs 15%; P � .001). However, low rates of online patient
account registration and good baseline diabetes control among study partici-
pants limited the intervention’s impact on overall risk factor levels.

See page 1776

Actigraphy-Measured Sleep Characteristics
and Risk of Falls in Older Women

T his study uses objective es-timation of sleep charac-
teristics using wrist actigraphy to
explore the relationship be-
tween sleep and risk of incident
falls in a cohort of nearly 3000
c o m m u n i t y - d w e l l i n g o l d e r
women. After accounting for a va-
riety of potential risk factors for
falls including comorbidities, use
of benzodiazepines and other
medications, older women who
experienced short nighttime sleep
durations (�5 hours per night)
and those with more fragmented sleep had a significantly increased risk
of falls.

See page 1768

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Any use Short acting Long acting

Use of Benzodiazepines

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Association of benzodiazepine use and risk of 2 or more
falls during 1 year after the eighth examination.

(REPRINTED) ARCH INTERN MED/ VOL 168 (NO. 16), SEP 8, 2008 WWW.ARCHINTERNMED.COM
1730

©2008 American Medical Association. All rights reserved.

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