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This Week in JAMA
JAMA. 2004;292:1403.
Diet and Lifestyle vs Death and Vascular Disease
The relationship of a Mediterranean-style diet to disease outcomes is the subject of 2 articles in this issue of JAMA. First, Knoops and colleagues (SEE ARTICLE) report results of a cohort study examining the contributions of a Mediterranean diet, moderate physical activity, moderate alcohol use, and nonsmoking to mortality in healthy elderly individuals. The authors found that individuals who reported at least 2 of the lifestyle factors had significantly reduced all-cause and cause-specific mortality rates compared with individuals who reported one or none. In a second article, Esposito and colleagues (SEE ARTICLE) describe results of a randomized trial of patients with the metabolic syndrome who were allocated to a Mediterranean-style diet or a prudent diet of similar macronutrient composition and featuring healthful food choices. Patients in the Mediterranean-style diet group had greater weight loss, larger reductions in levels of thrombosis-associated inflammatory markers, and reduced prevalence of the metabolic syndrome. In an editorial, Rimm and Stampfer (SEE ARTICLE) discuss the accumulated evidence and questions still in need of investigation related to primary disease prevention through maintenance of a healthful lifestyle.
Physical Activity and Cognitive Function
Evidence suggests that physical activity may reduce the risk of dementia and cognitive decline; however, the required intensity of activity is not known. Data collected in 2 prospective cohort studies were analyzed to address this question, and the results are reported in this issue of JAMA. First, Abbott and colleagues (SEE ARTICLE) analyzed the association between walking and future risk of dementia in physically capable men aged 71 to 93 years. They found that men who walked less than a mile a day had a significantly increased risk of developing dementia compared with men who walked more than 2 miles a day. In the second study, Weuve and colleagues (SEE ARTICLE) report their analyses of the relationship of long-term regular physical activity to cognitive function in women aged 70 to 81 years. These authors found that higher levels of physical activity during 8 to 15 years of follow-up were associated with significantly better cognitive function and less cognitive decline.
Exercise Testing and Global CVD Risk Predict Mortality
Aktas and colleagues examined the usefulness of 2 cardiovascular disease (CVD) risk scores—the Framingham Risk Score and the European Systematic Coronary Risk Evaluation (SCORE)—and exercise testing to predict all-cause mortality in a prospective cohort study of asymptomatic individuals. They found that the European SCORE was a better predictor of mortality risk than the Framingham Risk Score. When combined with an abnormal exercise test, the European SCORE provided clinically useful estimates of increasing risk of death.
(SEE ARTICLE)
Duty to Warn Patients' Families About Genetic Risk
Offit and colleagues discuss clinicians' ethical and legal responsibilities to patients and patients' relatives when genetic tests for heritable diseases are performed.
(SEE ARTICLE)
Medical News & Perspectives
A strategic plan to rebuild Iraq's once-prestigious health care system emphasizes basic needs, from restoring water and electricity in hundreds of primary care centers to alleviating shortages of common medications like antibiotics and  -blockers.
(SEE ARTICLE)
International Infectious Disease Control
International efforts to control infectious diseases, 1851 to the present.
(SEE ARTICLE)
CLINICIAN'S CORNER
Family Cancer History
The Rational Clinical Examination
An evidence-based analysis of the accuracy of self-reported family cancer history.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about dementia.
(SEE ARTICLE)
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