You probably struggle to find your kids just the right cereal for breakfast.

You don’t want a lot of sugar or salt, but you do want lots of nutrition.

“Consumer Reports” has taken some of the guesswork out, by rating 27 popular cereals aimed at kids, and you might be surprised by some of those that got higher scores for nutritional value.

Gayle Williams, deputy health editor of Cosumer Reports, worked on the study, and told co-anchor Chris Wragge about it, on The Saturday Early Show.

She says CR looked at commercials on kids’ networks, such as Nickelodeon and the Cartoon Network, to see which cereals were most heavily marketed to kids. That’s why you don’t see cereals such as Raisin Bran or Special K on the list. CR only wanted to consider cereals marketed directly to children.

None of the cereals is considered bad. They were rated very good, good, and fair.

None of them is poisonous; none would make you ill. CR considered sugar, sodium fiber, calcium and iron content.

The ones dubbed fair have some nutritional value; CR isn’t saying not to eat them, but don’t make them your everyday cereal. They may be high in sugar, but some are also high in iron.

The top-rated cereal was Cheerios. It has, Williams said, “very little sugar, and was good in sodium, and did well in fiber as well. It’s a good source of a lot of things that has iron and calcium in it as well, and it’s good cereal for you.”

Also rated “very good”: Kix which, Williams said, “is a little bit more fun for kids, and also did well in terms of sodium and sugar and fiber. So that rated well.”

Lucky Charms and Frosted Mini-Wheats were rated “good.”

Rice Krispies didn’t do as well as many at home might think. “After all,” Williams pointed out, “it’s puffed rice, but basically, it has no fiber in it. It didn’t have a lot of sugar, but it also has a lot of sodium in it, so if you’re watching your sodium, this is not a good choice.”

Amolng those that didn’t rate well were Corn Pops, Honey Smacks and Golden Crisps. They are, Williams said, “high in sugar, and you can make better choices than those.”

Some others that did pretty well included Cocoa Pebbles and Chocolate Crisps. “When you look at the lower sodium and the more fiber in it, that’s what made those pretty good choices,” Williams expalined.

SOME OF CONSUMER REPORTS’ RATINGS

Ranks are in parentheses next to the cereal’s name.

Very Good

Cheerios (1)
Fiber: 3 grams
Sugar: 1 gram

Kix (2)
Fiber: 3 grams
Sugar: 3 grams

Frosted Mini-Wheats (5)
Fiber: 6 grams
Sugar: 12 grams

Lucky Charms (9)
Fiber: 1 gram
Sugar: 11 grams

– — – — – — – -

Rating: Good
Fiber Sugar
Cookie Crisp (7) 1 grams 11 grams
Cocoa Puffs (10) 1 grams 12 grams
Trix (12) 1 grams 13 grams
Cocoa Pebbles (14) 3 grams 11 grams

– — – — – — – —

Rice Krispies (22)
Sugar: 4 grams
Sodium: 220 mgs

– — – — – — – —
Rating: Fair
Sugar Sodium
Froot Loops (24) 12 grams 135 mgs
Golden Crisp (25) 14 grams 25 mgs
Honey Smacks (26) 15 grams 50 mgs
Corn Pops (27) 12 grams 110 mgs



Does even the thought of packing up the whole family for a flight have you dreading the holidays, even though they’re still a couple of months away?

Family travel doesn’t have to be a nightmare and, on The Saturday Early Show, Laura Begley, deputy editor of Travel + Leisure magazine, shared some ideas for lightening the stress load when flying with the kids ar holiday time.

Begley says it’s not too late to get a good deal on holiday flights. Bookings have been down due to the poor economy, so there are more open seats available then usual. To find a good deal, try SmarterTravel.com. It has lots of good prices and great package deals.

Six Commandments for Flying with Kids:

  • Book early morning flights

  • Travel on Saturday

  • Fly non-stop

  • Check airline baggage policy (on set carry-on diaper bag)

  • Keep the kids entertained (on set products, coloring books, kid camera, portable DVD player)

  • Hang on to your stroller (stroller with detachable car seat)

    Travel + Leisure Show-and-Tell Items for Family Air Travel

  • SkipHop Duo Diaper Bag $54 www.skiphop.com

  • Toshiba Portable DVD Player - SPD71S $129.99 www.toshiba.com

  • Fisher-Price Kid Tough Digital Camera $50 www.fisher-price.com

  • Range of activity books/crayons

  • Maclaren Easy Traveler $75 www.maclarenbaby.com

    Book early morning flights: Basically, early morning flights are the least likely to be delayed. And when you’re traveling with kids, you don’t want them to be tired or cranky. Because cranky kids = stressed-out moms and dads.

    Travel on Saturdays: According to our research, Saturday is a much quieter day at the airport. Most people leave for weekend trips on Friday, and there are no business travelers on a Saturday, so the airport is relatively empty and easy to navigate.

    Fly non-stop: For families, the most stressful time is getting on and off the plane. If you fly non-stop, you have fewer headaches to deal with. You also have to deal with all the stuff, bags, carriages, toys, kids going to the bathroom, etc - it’s just easier to do it once. I think it’s worth the extra money. First, you’ll get there faster, have less hassle and, most importantly, the possibility of delays is lessened. And long delays and kids are a terrible mix. Also, a lot of airlines are eliminating (United, for instance) pre-boarding for families - so boarding with the kids will be that much harder.

    Check airline baggage policy: You really want to do this. A lot of people don’t realize that many carriers don’t count the stroller as a checked item, so you won’t be charged if you bring it along. But you must check with the airlines. Also, it’s good to note - if you have a kid with a ticket, your child can bring one carry-on item, a personal item, and have a checked bag. So, even your one month-old can actually carry-on an adult-sized suitcase!

    And speaking of carry-on bags, we like to recommend the SkipHop Duo Diaper Bag - it’s a great big diaper/overnight bag that’s stylish, light, and very functional. It retails for $54. Makes a great gift for Mom.

    Keep the kids entertained : This is probably the most important commandment. Once kids get bored, they get cranky, start crying, and even try to run around the cabin. I recommend several products to help them pass the time:

    a) Good old fashioned coloring books, drawing paper, crayons, etc.

    b) A portable DVD player (Toshiba $130) - fits right on the tray table and can play all your child’s favorite movies and TV shows.

    c) A children’s camera (Fisher Price $50) - enables your kids to document the trip. It will keep them busy and be a lot of fun at the same time.

    d) Also that old standby - let them set in the window seat!

    Hang onto your stroller: This just makes it easier for you to get around the airport. A stroller makes more sense than carrying or dragging around your young child, especially when you’re also carrying your own luggage. So, you want to hang onto that stroller to make your life easier. Gate-check the stroller when you’re about to board the plane, and they’ll have it for you just as you depart the aircraft. It’s the only way to travel.

    We also have a great stroller that should help make your trip easier: Maclaren’s Easy Traveler (rightstart.com; $75). It’s a stroller and a car seat all in one. It’s perfect for when you arrive at your destination and need a baby seat for your rental car.



  • During the free-form days of summer, vacations, picnics and carefree attitudes can all get in the way of healthy eating and weight control.

    January may be the traditional time to start a weight loss program, but with kids back in school and routines becoming more structured, fall is the perfect time to launch a diet and fitness regimen.

    Even the fall weather can serve as an inspiration to be active and eat more healthfully. It’s the perfect time of year to hit the hiking trail, or bite into a crisp, delicious apple. Just breathing the fresh fall air makes you feel healthier.

    In fact, in a survey of 1,500 moms conducted by the National Dairy Council’s “3-A-Day of Dairy” program, participants said fall is the ideal season to jump-start healthy eating and exercise programs.

    The moms said they look forward to getting back to their regular routines (53%) and having more time to focus on themselves (41%) when their kids go back to school. They ranked summer second (behind the winter holidays) as the time of year when they tended to put on the most weight.

    “Routines are ideal for helping people, especially moms, find time to fit in fitness, prepare healthier meals and make sure they take care of their own personal health needs,” says Cynthia Sass, MPH, MA, RD, an American Dietetic Association spokeswoman.

    “The combination of more free time, regular routines, and the beautiful fall weather is an inspiration to eat better and be more active outdoors.”

    A Bounty Of Fall Foods

    Sass suggests seeking out farmers’ markets to select from the nutritious bounty of fall produce.

    “Eating foods in season tastes best because of the peak flavors,” she says. “Find a new recipe, or use a food in a different way than before.”

    For example, pumpkin is great for far more than pie. How about pumpkin soup, toasted pumpkin seeds, or even a pumpkin smoothie?

    “Toss some pumpkin, skim milk, and pumpkin pie spices into a blender for a nutritious breakfast or snack loaded with protein and lots of nutrients,” suggests Sass.

    More suggestions: Stir apples into garden or chicken salads. Or make a mock cobbler by mixing cut-up apples (leave the peel on for more fiber), a teaspoon of brown sugar, a squeeze of lemon juice, and a pinch of cinnamon into the microwave for 5 minutes - it makes a delicious treat or oatmeal topping.

    Also, hearty soups are a terrific vehicle for all sorts of nutritious and delicious fall vegetables.

    “Soups are super-filling, easy to make and freeze well,” says Ellie Krieger, RD, host of the Food Network’s “Healthy Appetite.” “Make them with lots of vegetables and broth, instead of cream, for satisfying meals the whole family will enjoy.”

    7 Ways To Jump-Start Weight Loss

    If you need help getting started, here are seven expert tips to help you jump-start your weight loss this fall:

    1. Control your cravings. In the 3-A-Day survey, 52% of the moms said cravings were their biggest challenge in losing weight. Eating every few hours will prevent hunger, keep your blood sugar stable, and reduce cravings, says Sass. “Moms are so busy they tend to go too long without eating, then end up eating too fast, or the wrong kind of foods,” she says. One trick is to plan ahead: Bring along a baggie full of unsalted nuts and dried fruit for when hunger strikes. If sweet cravings are your downfall, Sass recommends chocolate - a few small pieces, that is. Let it melt slowly in your mouth so you can really savor the taste. Don’t avoid the foods you crave; just eat them in small portions.

    2. Lace up your sneakers. Half the surveyed moms wanted to lose more than 20 pounds but 72% said they had 30 minutes or less to devote to exercise each day. “Something is better than nothing even if it is 10 minutes in the morning and 10 minutes at night,” says Sass. “It does not need to be formal; just find ways to add more steps into your day.” If you make exercise social (such as walking with a neighbor), it’s more fun, less of a chore, and more likely to become routine. Owning a dog is another great way to get more exercise, as they need to be taken on walks regularly.

    3. Don’t fail to plan. Write down your master plan for how you’ll fit in fitness and eat healthier and factor it in as you plan schedules for the new school year. “It is not enough to say you are going to exercise daily; you need to be more specific, such as going to the gym on the way to work Monday, Wednesday and Friday,” says Elisa Zied, RD, author of “So What Can I Eat?” And don’t forget to include snacks in your planning: “If you think of them as random eating, they are less likely to be healthy,” says Krieger. She suggests buying portable snacks such as fruit, nuts, single-serving yogurts, and low-fat cheese so they’ll always be handy. Snacks high in fiber and lean protein will keep you feeling full between meals.

    4. Stock your kitchen with healthy choices. Having nutritious foods readily available makes it easier to work them into your diet. Always have cut-up fruits and vegetables on hand; pair them with low-fat yogurt dip for an instant snack or side dish. “Make it a rule to have some fruit or vegetables before you have a treat, like chocolate, and this way you are less likely to overdo the treat,” suggests Zied.

    5. Start each day with breakfast. “Having breakfast gets your engine started during those critical morning hours when you are busy at school or work,” says Zied. “Skipping breakfast is an invitation for over-consumption of less nutritious foods later in the day.” Try to work fiber, lean protein, and fruits or vegetables into your breakfast. If you’re not a breakfast person, you don’t have to have much: A low-fat yogurt and a piece of fruit is enough to get your day started and control your appetite.

    6. Strive for progress, not perfection. If you follow healthy food and fitness guidelines 80% of the time, the new habits will become a part of your life without overwhelming you. “Many people think in terms of black and white when they think about eating and fitness habits,” says Zied. “In reality, we should get comfortable living in gray, somewhere in between. Doing even 20 minutes of exercise, cutting portions by even a few bites, and switching from 2% milk to 1% milk - these small things can have a big impact on your health and on your life.”

    7. Don’t forget portion control. As you get back into a more structured routine, it is a great time to get more detail-oriented. “Just like sharpening your pencils to get ready for school, break out the measuring cups and see how much food you have been putting on your plate,” says Krieger. “Portions have a tendency to get larger, so keep portion sizes in check by measuring the quantity once in a while.”



    How many times have you gone to the grocery store and wondered where that vegetable was grown or where that piece of meat came from?

    Well, you need wonder no more.

    Shoppers will now know where a lot of food was grown. A new law requires country of origin information to be displayed on fresh and frozen vegetables, most meats and some kinds of nuts, reports CBS News correspondent Michelle Miller.

    Are the new labels a good idea?

    “More information is always better,” one shopper in Bloomfield, N.J. told her.

    The law was originally intended, in part, to promote U.S. products, but benefits consumers as well, says Jean Halloran, a Consumers Union food policy expert.

    “Consumers do care where their food comes from,” she said. “Consumers Union conducted its own poll a year ago and found that 92 percent of consumers would like to know the country of origin for the food they buy.”

    Even though supermarkets pull products when tainted food scares occur, experts say the new rules will make consumers smarter shoppers.

    “For example,” says Halloran, “where we had this problem last summer with salmonella in peppers from Mexico. In the future, we’ll be able to avoid buying the peppers from Mexico and go on buying the peppers that come from somewhere else. Consumers definitely will want to avoid the problem food. ”

    “It’s kind of scary these days,” another shopper observed. “You hear about milk, and you hear about chocolate. They found it tainted. So now, now you kind of worry about things.

    In the meat aisle, Miller pointed out, you may find products labeled with more than one country. For example, cattle raised in Mexico, then exported to the U.S. for processing.

    Is it kind of confusing to see three different countries on the same piece of meat?

    “Yes. I’d like to see one country,” shopper Jean LaBriola says. “I just worry about how things are raised in countries that maybe don’t have the same standards as the United States.”

    Many foods won’t be required to carry country of origin labels, including processed meats, such as sausage, Miller notes.

    The exemptions can be a bit confusing. For example, the country of origin must be labeled on raw cashews, but roasted cashews are exempt. Frozen vegetables will have to have the labels, but frozen mixed vegetables won’t. And Spam, sometimes called mystery meat, will be allowed to “remain” a mystery. It’s exempt as well.

    Grocery stores will have up to six months in order to comply with the new regulations.



    About one in four American teen girls last year got the groundbreaking vaccine that prevents cervical cancer, federal health officials reported Thursday.

    The figures represent the U.S. government’s first full year of vaccination rate data for the Gardasil vaccine, which came on the market in mid-2006. Merck & Co.’s heavily advertised, three-shot series targets the sexually transmitted human papillomavirus.

    Health officials recommend that girls get the shots when they are 11 or 12, if possible, before they become sexually active. Also, age 11 is when kids are generally due for another round of vaccinations.

    The survey only covered children in the 13-17 age range.

    Vaccine proponents had been hoping for much higher vaccination rates, saying the shots could dramatically reduce the nearly 4,000 cervical cancer deaths that occur each year in the United States.

    But many families are cautious about the safety of new vaccines, said Patti Gravitt, a Johns Hopkins University associate professor of epidemiology.

    Other things about the vaccine may give some families pause. It is expensive, retailing for about $375, although many health insurers now cover it. And there are questions about whether it confers lifetime immunity or if a booster shot will be needed.

    “Some parents may be adopting the attitude with their daughters that, ‘Well, you’re still young. I can wait a couple more years before you’re sexually active,”‘ said Gravitt, who was not involved in the research.

    “My personal opinion is that this seems quite reasonable after the first year,” Gravitt said, of the 25 percent vaccination rate.

    Merck officials said they were pleased with the vaccination rate.

    The Centers for Disease Control and Prevention based the study on household telephone surveys done in late 2007. The results are based on nearly 3,000 teens ages 13 to 17 for whom the researchers could verify vaccination information through medical records.

    Of the girls in the survey, 25 percent had gotten at least one Gardasil shot.

    The CDC, which has been promoting other shots for adolescents, also studied other teen vaccination rates.

    About 32 percent of teenagers got a recommended meningitis shot last year, up from 12 percent in a 2006 survey. Also, 30 percent got another relatively new shot, one that guards against tetanus, diphtheria and whooping cough. That’s up from 11 percent the year before.

    As with the cervical cancer shot, health officials say children should get both those shots when they are 11 or 12.

    About 75 to 90 percent of children got the better-known vaccinations that have long been required by schools, such as chickenpox, hepatitis B and measles, mumps and rubella, the study found.

    “The overall trends are good news,” said Dr. Lance Rodewald, director of the CDC’s Division of Immunization Services, in a prepared statement.

    “We are seeing more preteens and teenagers being protected against serious, sometimes deadly diseases. But we remain short of our goals. For almost all of these vaccines we want at least 90 percent of adolescents to be fully immunized.”



    Schools in the Massachusetts city where girls reportedly made a “pregnancy pact” will allow contraceptives to be distributed - with parental consent.

    Gloucester school board Chairman Greg Verga says the vote Wednesday night was unanimous. It allows contraceptives to be distributed at the high school’s health clinic.

    The board also could have voted to distribute the materials without parental consent or continue its policy of not giving them out at all.

    Verga says the school board will vote on language of a parental consent form before the policy takes effect.

    Time magazine reported that some of the 17 pregnant girls at the high school had agreed to have kids and raise them together. The mayor and some of the pregnant girls denied any pact existed.



    An early-pregnancy blood test promises to tell women whether their fetus has Down syndrome without the need for risky, invasive procedures.

    First- and second-trimester screening tests can detect pregnancies at high risk of Down syndrome. Many women opt to terminate such pregnancies.

    But even if it never comes to having to make such a heart-rending decision, Down syndrome screening can be anguishing.

    Noninvasive ultrasound and blood tests can tell women whether they need more invasive tests. These confirmatory tests mean inserting a needle into the womb to sample amniotic fluid (amniocentesis) or snipping off a small piece of the placenta for analysis (chorionic villus sampling or CVS).

    The vast majority of the time these tests go smoothly. But there’s a real risk they can cause a miscarriage. Moreover, by the time all these tests confirm Down syndrome, the pregnancy is often 18 or 19 weeks along - making the decision to terminate even more emotionally difficult.

    No wonder the decision to undergo Down syndrome screening is fraught with anxiety. It certainly was an anxious time for Stanford University bioengineer Stephen Quake, PhD, and his family, when his wife underwent amniocentesis during her first pregnancy and CVS during her second. “It was nerve-wracking for all of us, and I can only imagine how the fetus felt,” Quake tells WebMD.

    Safe Blood Test for Down Syndrome
    Quake started looking for a better way to screen. He knew that a small amount of fetal DNA enters a pregnant woman’s bloodstream. Researchers already were trying to separate that DNA from the mother’s own DNA, but were having little luck.

    That’s when Quake had a brainstorm. Down syndrome is a genetic defect — an extra copy of chromosome 21. Quake realized it isn’t necessary to separate fetal DNA from maternal DNA. All he had to do was count the DNA that belonged to chromosome 21. Too much of this DNA signaled a fetus with an extra chromosome.

    “We sequence millions of molecules from each blood sample and map the DNA back to the chromosome. And then we look to see if any chromosomes are over-represented,” Quake says.

    Quake’s team ran the test on small blood samples from 18 pre-selected pregnant woman and a single male donor.

    Some of the women had normal pregnancies. Nine of the women carried fetuses with Down syndrome. Two of the women carried fetuses with Edward syndrome (an extra copy of chromosome 18) and one woman carried a fetus with Patau syndrome (an extra copy of chromosome 13).

    The score: A plus. The test detected every genetic defect and was able to identify every normal pregnancy (as well as the male donor).

    “That makes us feel pretty good. But one has to reserve judgment until this can be tested in thousands of samples,” Quake cautions.

    “This would be a big step forward. This is exciting stuff,” says J. Christopher Glantz, MD, MPH, director of the perinatal outreach program and professor of obstetrics and gynecology at the University of Rochester Medical Center, N.Y.

    Glantz, who was not involved in the Quake study, agrees that the DNA test must be tested in a very large number of women. Before it’s ready for prime time, researchers will have to show that it misses very few cases of Down syndrome - and that it sounds almost no false alarms.

    “If this is confirmed to be as useful as the authors say, it would be quite a significant step forward, because women would no longer have to undergo an invasive test,” Glantz says.

    Quake thinks the test will be able to detect Down syndrome as early as the fifth week of pregnancy. Currently, the test would cost about $700. But that cost would drop considerably if it were widely used.

    “We are two to three years away from a viable test,” Quake says. “This technology is not common in hospitals now, but we anticipate it will be soon. We are very excited about the prospects of improving health and saving lives.”

    Quake and colleagues report their findings in the Oct. 6 early online edition of the Proceedings of the National Academy of Sciences.



    Cells taken from men’s testicles seem as versatile as the stem cells derived from embryos, researchers reported Wednesday in what may be yet another new approach in a burgeoning scientific field.

    The new type of stem cells could be useful for growing personalized replacement tissues, according to a study in Thursday’s issue of the journal Nature. But because of their source, their highest promise would apply to only half the world’s population: men.

    Embryonic stem cells can give rise to virtually any tissue in the body and scientists believe they may offer treatments for diseases like Parkinson’s and diabetes and for spinal cord injuries.

    The testicular cells avoid the ethical dilemma of embryonic stem cells, which are harvested in a process that destroys the embryos. For that reason, some people, including President George W. Bush, oppose their use for ethical or religious reasons.

    “The advantage these cells have in comparison to embryonic stem cells is that there is no ethical problem with these cells and that they are natural,” said study lead author Thomas Skutella, a professor at the Center for Regenerative Biology and Medicine in Tuebingen, Germany.

    Using testicular cells isn’t the only promising method that avoids embryos; there have been impressive experiments in reprogramming ordinary body cells into stem cells by slipping certain genes into them.

    The new findings and the reprogrammed cells - which still have technical hurdles - “take some pressure off the stem cell issue,” said White House science adviser Jack Marburger.

    The advantage these cells have in comparison to embryonic stem cells is that there is no ethical problem with these cells and that they are natural

    Thomas Skutella, a professor at the Center for Regenerative Biology and Medicine in Tuebingen, Germany Earlier studies showed promise using so-called spermatogonial cells from the testes of mice. The new study used cells taken from biopsied tissue from 22 different men undergoing various medical treatments. The men ranged in age from 17 to 81. Researchers found that after a few weeks of growth, the cells could differentiate into various types of cells just like those taken from embryos.

    Other scientists hailed the idea as promising, but not a reason to give up on research on embryonic stem cells.

    “It’s exciting. We could do it for males; that leaves women without as easy a method,” said stem cell scientist George Daley of Children’s Hospital in Boston and the Harvard Stem Cell Institute. He was not part of the new research.

    Embryonic stem cells “have their own place in biology,” Daley said.

    Skutella said a female equivalent could be in women’s egg cells, but Daley said that’s unlikely because of the makeup of those cells.

    Using the new findings to treat patients could take years. But Daley said the work on the cells from testes can benefit from a decade’s worth of research into embryonic cells and advance at a fast pace.

    He said the new research showed how similar these testicular cells are to embryonic stem cells; now science needs to see what specific differences exist because those could be important.



    A German farmer who received the world’s first complete double arm transplant said Wednesday that incredulity gave way to joy when he woke from surgery to discover he had arms again.

    Karl Merk, who lost his arms in a farming accident six years ago, said he at first could not believe that the transplant appeared to have been successful.

    “It was really overwhelming when I saw that I had arms again,” said the 54-year-old, who wore a sleeveless black shirt showing clearly where his new arms had been grafted.

    “These are my arms, and I’m not giving them away again,” he told reporters at the Munich University Clinic where he remains nearly three months after the 15-hour operation.

    Merk is recovering well and can perform simple tasks such as opening doors and turning lights on and off. His ultimate goals are to eat and dress himself - and ride a motorcycle.

    “All in all, our wildest expectations have pretty much been fulfilled,” said Christoph Hoehnke, one of the lead doctors.

    A total of 40 surgeons, anesthesiologists, nurses and other support staff carried out the 15-hour operation on July 25-26 to graft the donor’s arms on to the body of Merk, who lost his own just below the shoulder in a combine harvester accident.

    Doctors said there were good indications of nerve growth in the arms but it could take up to two years before he relearns how to use his hands.

    Merk appeared at the news conference Wednesday with lower arms bandaged and supported with a series of straps attached to shoulder pads.

    Merk said he was looking forward to going home after four to six more weeks of an intensive program of physiotherapy, electric stimulation and psychological counseling.

    There is also still a risk that Merk’s immune system will react, though doctors said so far there was no sign of them being rejected.



    Circumcision offers little HIV protection to gay/bisexual men - overall. But it might cut HIV risk in predominantly insertive partners.

    It’s now clear that circumcision reduces heterosexual men’s risk of getting HIV from sexual intercourse. Can circumcision reduce HIV infection rates among men who have sex with men?

    To find out, behavioral scientist Gregorio A. Millett, MPH, and colleagues at the CDC’s division of HIV/AIDS prevention analyzed data on circumcision and HIV risk from 15 different studies of 54,000 men who had sex with men.

    Overall, the data showed a weak effect: a 14% lower risk of HIV in circumcised gay/bisexual men. The finding was not statistically significant. That means even this small benefit could very well be due to chance.

    But there was one highly significant finding. Back when AIDS was still a death sentence - before the 1997 advent of highly effective HIV drugs - circumcision cut men’s risk of getting HIV by 53 percent.

    “There has been an increase in sexual risk behavior in men who have sex with men since the availability of highly effective treatment for HIV,” Millett tells WebMD. “If a man is engaged in unprotected sex or has lots of sex partners, that contributes more to his risk of HIV than being uncircumcised. So in recent years, the benefit of circumcision may have been overridden by the risks of unsafe sex.”

    Of course, that was yesterday. Today the world still struggles to control the spread of the AIDS virus. And there’s another key finding from the Millett study.

    In the few studies that looked specifically at men who predominantly engaged in insertive anal sex, circumcision seemed to offer more protection. This effect was much stronger in populations where relatively few men are circumcised.

    It’s a very important issue, says Sten Vermund, MD, PhD, director of Vanderbilt University’s Institute for Global Health.

    “The prospect that predominantly insertive men might derive considerably more benefit from circumcision is as logical as the day is long,” Vermund tells WebMD. “What benefit is a predominantly receptive man going to gain from circumcision?”

    Vermund notes that there is good evidence that, in many parts of the world, a high proportion of men who have sex with men are exclusively or predominantly insertive sexual partners. In areas where few men now are circumcised, circumcision could have a powerful effect on HIV transmission — if it went hand-in-hand with safer sexual behavior.

    “To add one more tool to our HIV prevention toolbox - even if it affects only 40 percent of a risk group - would be substantial,” Vermund says.

    Vermund and Millett agree that a clinical trial to test this approach is needed. Whether such a study can attract increasingly scarce funding is an open question.

    The Millett study, and an accompanying editorial by Vermund and colleague Han-Zhu Qian, MD, PhD, appear in the Oct. 8 issue of The Journal of the American Medical Association.




     

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