Annals
Established in 1927 by the American College of Physicians

FOR THE PRESS

4 September 2012 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians on the first and third Tuesday of every month. These highlights are not intended to substitute for articles as sources of information. For a copy of an article, call 215-351-2653 or e-mail Angela Collom at acollom@acponline.org

1. No Nutritional or Safety Differences Between Organic and Conventional Foods

There is generally no difference in nutritional value or risk for bacterial contamination between organic and conventional foods, according to a new study being published in Annals of Internal Medicine, the flagship journal of the American College of Physicians (ACP). While the consumption of organic fruits and vegetables reduced exposure to any detectable pesticide residues by 30 percent, pesticide levels were generally within the allowable limits for safety.

Researchers conducted a systematic review of 17 human studies and 223 studies of nutrient and contaminant levels in unprocessed foods such as fruits, vegetables, grains, milk, eggs, chicken, pork and meat to compare the health, nutritional, and safety characteristics of organic and conventional foods. They found that the published literature lacks strong evidence that organic foods are significantly more nutritious than conventional foods.

“Some believe that organic food is always healthier and more nutritious,” said Crystal Smith-Spangler, MD MS, a VA Physician Fellow at CHP/PCOR, and lead author of the paper. “My colleagues and I were a little surprised that we didn’t find that.”

The researchers did find weak evidence of the nutritional superiority of organic foods in that organic produce contained significantly higher levels of total phenols, a compound that may have antioxidant properties, and that organic milk and chicken contained significantly higher levels of omega-3 fatty acids. However, the researchers concluded that since few people have phosphorous deficiency, the finding has little clinical significance.

Sales of organic foods have increased dramatically is the US. Between 1997 and 2010 organic food sales have risen from $3.6 billion to over $26 billion annually. Prices vary, but consumers my pay up to twice as much for organic foods versus conventional. In general, to be certified “organic,” produce must be grown without synthetic pesticides or fertilizers or routine use of antibiotics or growth hormones. Organic livestock are fed organically produced feed and are free to roam outdoors. In addition, organic regulations typically require that organic foods are processed without irradiation or chemical food additives and are not grown from genetically modified organisms.

“There are many reasons why consumers may choose to purchase organic food,” said Smith-Spangler. “We examined published literature to assess the evidence for significant differences in nutrition, food safety, and health outcomes between organic and conventional foods and populations consuming these foods. However, consumers may choose to purchase organic foods for other reasons besides nutrition and food safety, such as concern for animal welfare, the environment, or preferences in taste.”

2. NA-ACCORD Proves a Useful Tool for Monitoring Trends and Outcomes in HIV Care

Many studies report trends in clinical outcomes of persons receiving HIV care in the U.S., but few have been specifically designed to be nationally representative. This is an important distinction as researchers strive to continue to make improvements in care and outcomes for all people living with HIV in the U.S. NA-ACCORD (North American AIDS Cohort Collaboration on Research and Design) is the largest cohort of HIV-infected adults in North America with 100,000 patients enrolled. Researchers pooled and analyzed NA-ACCORD data on approximately 45,000 U.S. patients from 2000 - 2008 to determine its utility in monitoring trends in the HIV epidemic, HIV treatment, and related health outcomes. They found that participants in NA-ACCORD were demographically similar to all U.S. persons living with HIV infection. An analysis of data from 2000 – 2008 showed that the percentage of U.S. participants in clinical care who were prescribed HAART (highly active antiretroviral therapy) increased, as did the percentage of all patients who achieved a suppressed HIV viral load. At the same time, the media CD4 cell count at death increased. The researchers conclude that data from NA-ACCORD can inform progress toward national HIV goals.

3. Claims Data Lacks Accuracy and Consistency Needed to Inform Nonpayment or Hospital Comparisons

The Centers for Medicare & Medicaid Services (CMS) limits payment for key “preventable” complicating conditions acquired during hospital stay. The claims data is used to deny payment, and the data is reported publicly so that hospitals can be compared by complication rate. Catheter-associated urinary tract infection (CAUTI) was the first condition targeted for such nonpayment. Researchers examined data from 96 Michigan hospitals to compare rates of UTIs in adults that are coded in claims data as hospital-acquired and catheter-associated events and evaluate how often nonpayment of CAUTI lowers hospital payments. The researchers found that only 2.6 percent of all hospital-acquired UTIs were described in the claims data as catheter-related, making financial savings based on nonpayment negligible. Further, epidemiologic studies report that most hospital-acquired UTIs are catheter-associated (59 – 86 percent), which makes the accuracy of the claims data suspect. The researchers and the author of an accompanying editorial conclude that current hospital claims data may not be an accurate source for measures used to compare institutions and guide financial incentives. According to the editorialist, consistent use of electronic health records, sharing best practices, and focusing on patient-centered care and safety can improve the accuracy of the data hospitals are reporting.