Wednesday, August 03, 2016
Being fat does NOT kill you
An absolutely fascinating study just out in JAMA. Those authoritarian Swedes with their detailed tracking of their population have made possible what would normally be an almost inconceivable study of obesity. They have done a study which controls for genetic factors. There are lots of twin registers around but Sweden has such a big one that the researchers were able to look for a needle in a haystack and find it.
They wanted to find not only identical twins with obesity but twins where one was much fatter than the other. As soon as I saw that design, I scoffed mentally and said they would be lucky to find half a dozen of those -- a completely useless sample size. But because the researchers were looking at a nationwide database, they found, not half a dozen suitable pairs but 4046: A brilliant sample size that allows great confidence in the results. Most unusual in medical research.
The full results are below and they are striking. Decades of medical wisdom have been knocked into a cocked hat. With twins you have the perfect controls. Whatever you find is NOT genetic. It is due to lifestyle and environment. So this data is miles more conclusive than all previous studies of the question. And there was NO difference in lifespan or heart attacks according to how fat you were. Even if you ate your head off all your life, you lived just as long as if you had adopted a so-called "healthy" diet. I have been saying for a long time that there is no such thing as a "healthy" diet and this is strong reinforcement of that view.
The fatties in the study WERE slightly more likely to get diabetes but there has long been an association between over-eating and diabetes so that is not too surprising. You can mostly control diabetes just by eating less. The important thing is that the diabetes did NOT kill them.
So this stuy is a body-blow to the obesity "war". We have the strongest evidence possible that obesity does not kill you. So what will be the outcome? Will articles about diet vanish from our newspapers?
Thay should vanish. But they won't. The study will be tucked into the back of the minds of a lot of obesity researchers but nothing will change overnight. The obesity "war" will go on as before. Eventually, however, some notice will be taken of the study. Researchers will mention it and GPs will learn of it and patients with weight concerns will be quietly assured that they don't have to be too bothered about their weight. There will always be social reasons to stay slim -- fat is unattractive -- but medical reasons will be downplayed.
Risks of Myocardial Infarction, Death, and Diabetes in Identical Twin Pairs With Different Body Mass Indexes
Peter Nordström et al.
Importance: Observational studies have shown that obesity is a major risk factor for cardiovascular disease and death. The extent of genetic confounding in these associations is unclear.
Objective: To compare the risk of myocardial infarction (MI), type 2 diabetes, and death in monozygotic (MZ) twin pairs discordant for body mass index (BMI).
Design, Setting, and Participants: A cohort of 4046 MZ twin pairs with discordant BMIs (difference >0.01) was identified using the nationwide Swedish twin registry. The study was conducted from March 17, 1998, to January 16, 2003, with follow-up regarding incident outcomes until December 31, 2013.
Main Outcomes and Measures: The combined primary end point of death or MI and the secondary end point of incident diabetes were evaluated in heavier compared with leaner twins in a co-twin control analysis using multivariable conditional logistic regression.
Results: Mean (SD) baseline age for both cohorts was 57.6 (9.5) years (range, 41.9-91.8 years). During a mean follow-up period of 12.4 (2.5) years, 203 MIs (5.0%) and 550 deaths (13.6%) occurred among heavier twins (mean [SD] BMI, 25.9 [3.6] [calculated as weight in kilograms divided by height in meters squared]) compared with 209 MIs (5.2%) and 633 deaths (15.6%) among leaner twins (mean [SD] BMI, 23.9 [3.1]; combined multivariable adjusted odds ratio [OR], 0.75; 95% CI, 0.63-0.91). Even in twin pairs with BMI discordance of 7.0 or more (mean [SE], 9.3 [0.7]), where the heavier twin had a BMI of 30.0 or more (n = 65 pairs), the risk of MI or death was not greater in heavier twins (OR, 0.42; 95% CI, 0.15-1.18). In contrast, in the total cohort of twins, the risk of incident diabetes was greater in heavier twins (OR, 2.14; 95% CI, 1.61-2.84). Finally, increases in BMI since 30 years before baseline were not associated with the later risk of MI or death (OR, 0.97; 95% CI, 0.89-1.05) but were associated with the risk of incident diabetes (OR, 1.13; 95% CI, 1.01-1.26).
Conclusions and Relevance: In MZ twin pairs, higher BMI was not associated with an increased risk of MI or death but was associated with the onset of diabetes. These results may suggest that lifestyle interventions to reduce obesity are more effective in decreasing the risk of diabetes than the risk of cardiovascular disease or death.
JAMA Intern Med. Published online August 01, 2016. doi:10.1001/jamainternmed.2016.4104
Vegetarians live longer but what does that tell us?
Nothing basically. It has long been known that Seventh Day Adventists, who are mostly vegetarians, live longer. But why? It could be that a strong religious commitment has a destressing effect or it could be that they also deplore smoking. Or it could be that they spend time in church instead of doing dangerous sports. Church is a pretty safe place. So you just can't disentangle cause and effect in the case of the Adventists.
So it is no surprise that a new study just out -- Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality by Song et al. -- also tells us that vegetarians live longer. Their data was from two high quality U.S. databases but they appear not to have bothered at all with controls.
And you can understand why. Vegetarians will mostly be health conscious people with strong will-power and such people will undoubtedly engage in a range of safer behaviors -- smoking less, avoiding dangerous drugs, exercising more, driving more slowly, climbing fewer mountains etc, etc. And all those things could contribute to a longer lifespan. Vegetarianism may be only the indicator, not the cause -- JR.
Dick Morris Corrects the Record on Hillary Clinton
Dick Morris is a nationally recognized political campaign adviser, analyst and author. He was the senior political adviser to Bill Clinton before and after his occupation of the White House. He was campaign manager of Clinton's 1996 re-election, and the architect of his successful "triangulation" rhetorical ruse. Clinton's communications director George Stephanopoulos said of Morris, "No single person had more power over [Bill Clinton]."
This week, in a message entitled "What Bill Left Out, Morris corrected the record regarding Clinton's glowing remarks about Hillary Clinton, her personal attributes and professional achievements. Morris's insights into the Clintons are priceless.
What follows is a transcript of Morris's comments:
"Bill Clinton talked at length about Hillary's idealistic work in college and law school, but he omits that she was defending the Black Panthers who killed security guards; they were on trial in New Haven. She monitored the trial while she was in law school to find evidence that could be grounds for reversal in the event they were convicted.
"That summer she went to work for the True-Haft (SP) law firm in CA, headed by True Haft who is the head of the CA Communist Party and that's when she got involved with Saul Alinsky, who became something of a mentor for the rest of her life.
"Then Bill says that she went off to Massachusetts and he went to Arkansas, and eventually Hillary followed her heart to join him in Arkansas. He omits that she went to work for the Watergate Committee and was fired from that job for taking home evidence and hiding documents that they needed in the impeachment inquiry. Then she took the DC Bar exam and flunked it, she went to Arkansas because that is the only bar exam she could pass.
"He talked about how in the 1970's she took all kinds of pro-bono cases to defend women and children. In her memoirs, she cites one which was a custody case and that's it. In fact, in 1975 she represented a guy accused of raping a 14-year-old girl and got him off by claiming the girl had had fantasies of sex with an older man. In 1980 she gave an interview about it and she joked that she knew the guy was guilty but got him off anyway.
"Then Bill discusses Hillary's legal career at the Rose Law firm. He doesn't mention that she made partner when he was elected governor and was only hired when he got elected as attorney general.
"He makes as if it was a public service job — it wasn't. Her main job was to get state business, and she got tens-of-millions of dollars of state business, then hid her participation and the fees by taking an extra share of non-state business to compensate for the fees on state business that she brought in. Her other job was to call the state banking commissioner any time one of her banks got into trouble to get them off.
"Bill speaks at length how Hillary was a mother, juggling career and family, taking Chelsea to soccer games and stuff — that's non-sense. Hillary was a mother but Chelsea in the Arkansas governor's mansion had a staff of nannies and agents to drive her around and people to be with her, and Hillary didn't have to bother with any of that. All of that was paid for by the state.
"He says she became the warrior in chief over the family finances and that was true, and the result is she learned how to steal.
"She accepted a $100,000 bribe from the poultry industry in return for Bill going easy on regulating them, despite new standards. Jim Blair, the poultry lobbyist, gave her $1,000 to invest in the Futures Market and lined up seven to eight other investors and their winnings were all deposited into Hillary's account. She made $100,000 in a year and she was out. That essentially was a bribe.
"[She did] a phony real-estate deal for Jim McDougal and the Madison Bank to deceive the federal regulators by pretending someone else was buying the property. She was called before a grand jury in 1995 about that but, conveniently, the billing records were lost, couldn't be found and there wasn't proof that she worked on it.
"Bill talks about her work on the health care task force but doesn't say the reason it didn't pass was the task force was discredited because the meetings were all held in secret. A federal judge forced them open and fined the task force several hundred thousand dollars because of their secrecy.
"He says that after the health care bill failed in 1994, Hillary went to work on adopting each piece of it piecemeal — mainly health insurance for children.
"That is completely the opposite of the truth. The fact is when that bill failed, I called Hillary and I suggested that she support a proposal by Republican Bob Dole that we cover children, and she said, 'We can't just cover one part of this. You have to change everything or change nothing.' Then in 1997 when I repeated that advice to Bill Clinton, we worked together to pass the Children's Health Insurance Program. I found a lot of the money for that in the tobacco settlement that my friend Dick Scruggs was negotiating.
"Then Bill extols her record in the U.S. Senate. In fact, she did practically nothing. There were seven or eight bills that she introduced that passed; almost all of were symbolic — renaming a courthouse, congratulating a high school team on winning the championship. There was only one vaguely substantive bill, and that had a lot of co-sponsors of whom Hillary was just one.
"Then he goes to her record in the State Department and manages to tell that story without mentioning the word Benghazi, without mentioning her secret emails, without mentioning he was getting tens of millions — $220 million in speaking fees in return for favorable actions by the State Department.
"Also totally lacking in the speech was anything about the war on terror — terror is a word you don't hear at the Democratic Convention.
"Bill says that Hillary passed tough sanctions on Iran for their nuclear program. The opposite is true.
"Every time a tough sanction bill was introduced by Senators Menendez or Kirk, Hillary would send Deputy Secretary Wendy Sherman to Capital Hill to testify against it and urge it not to pass, and it was over Hillary's objections that those sanctions were put into place.
"[Liberal columnist] Maureen Dowd called the speech by Bill Clinton "air brushed."
"It was a hell of a lot more than that — it was fiction".
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Posted by JR at 12:19 AM