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This week in BMJ Saturday 15 March 1997

Multiple pregnancies in older women have increased

Over the past few years an increasing number of women have undergone treatments to enhance fertility, with its increased risk of multiple pregnancy. On p 775 Westergaard et al report rates of multiple pregnancy in Denmark during 1980-94. They found that the rate increased particularly in primiparous women of 30 and over (the group most likely to undergo fertility treatment), whose rate of twin births increased threefold and rate of triplet births ninefold during 1989-94. The increase in multiple births also seemed to have a significant impact on infant deaths.

Bacterial gastroenteritis is linked to the irritable bowel syndrome

Ten per cent of the population probably has an illness like food poisoning each year. Many people with the irritable bowel syndrome report their symptoms starting after such an illness. On p 779 Neal et al report the prevalence of gastrointestinal symptoms in over 500 patients six months after an episode of microbiologically confirmed gastroenteritis. One in four patients still had an altered bowel habit, and one in 14 developed irritable bowel syndrome. The authors conclude that bacterial food poisoning may be responsible for many new cases of irritable bowel syndrome.

Modifiable risk factors predict nephropathy in diabetic patients

Non-insulin dependent diabetic patients with microalbuminuria (urinary albumin excretion of 30-299 mg/24 h) have an increased risk of developing diabetic microangiopathy and macroangiopathy compared with normoalbuminuric patients (urinary albumin excretion rate >30 mg/24 h). Prevention of incipient diabetic nephropathy (persistent microalbuminuria) and overt diabetic nephropathy (persistent macroalbuminuria) is feasible only if the risk factors that initiate the change from normal to abnormally increased rates of albumin excretion can be identified. From a prospective study of normoalbuminuric, white, non-insulin dependent diabetic patients, Gall and colleagues (p 783) found that 36 of 176 (20%) patients developed incipient diabetic nephropathy and five (3%) overt diabetic nephropathy over 5.8 years. An increased rate of urinary albumin excretion, long term poor glycaemic control, and hypercholesterolaemia predicted the development of nephropathy in these patients.

Good outcome for coronary heart disease increases mortality from other cardiovascular diseases

The reduction in mortality from coronary heart disease should increase the number of patients at risk from other cardiovascular diseases, which share many of the same risk factors. On p 789 Bonneux et al present a time series analysis of Dutch nationwide statistics which shows such an increase in mortality from other cardiovascular diseases. The longstanding decline in mortality from stroke has stopped and diagnoses of congestive heart failure have increased. Health services will have to cope with more patients disabled by chronic cardiovascular disease, with their high needs for care.

Adult onset wheeze is common and undertreated

In contrast to wheeze that begins in childhood, little is known about wheeze that begins in adulthood. In a 30 year follow up study of a random cohort of children originally studied in 1964 in Aberdeen, Bodner et al (p 792) report a prevalence of adult onset wheeze (after age 15 years) of 11.5%. The risk was higher in those who smoked and were in the manual social class. Over 40% of subjects who reported limitation in their activities were not receiving treatment for wheeze. Adult onset disease accounted for a greater proportion of the overall burden of current wheeze in middle age than child onset disease (60% v 40%).

Higher risk of thromboembolism occurs in first year of HRT use

Recent epidemiological studies have shown a twofold to fourfold increased risk of venous thromboembolism among postmenopausal women using hormone replacement therapy. On p 796 Pérez Gutthann et al further assess the risk in a population based case-control study conducted with data from the General Practice Research Database. Current use of replacement therapy was associated with a twofold increased risk of venous thromboembolism. This risk was restricted to users during their first year of treatment. No major differences in risk were observed between users of low and high doses of oestrogens, unopposed and opposed treatment, and oral and transdermal preparations.