Adults get 11 percent of calories from fast food

ATLANTA (AP) — On an average day, U.S. adults get roughly 11 percent of their calories from fast food, a government study shows.

That's down slightly from the 13 percent reported the last time the government tried to pin down how much of the American diet is coming from fast food. Eating fast food too frequently has been seen as a driver of America's obesity problem.

For the research, about 11,000 adults were asked extensive questions about what they ate and drank over the previous 24 hours to come up with the results.

Among the findings:

— Young adults eat more fast food than their elders; 15 percent of calories for ages 20 to 39 and dropping to 6 percent for those 60 and older.

— Blacks get more of their calories from fast-food, 15 percent compared to 11 percent for whites and Hispanics.

— Young black adults got a whopping 21 percent from the likes of Wendy's, Taco Bell and KFC.

The figures are averages. Included in the calculations are some people who almost never eat fast food, as well as others who eat a lot of it.

The survey covers the years 2007 through 2010 and was released Thursday by the Centers for Disease Control and Prevention. The authors couldn't explain why the proportion of calories from fast food dropped from the 13 percent found in a survey for 2003 through 2006.

One nutrition professor cast doubts on the latest results, saying 11 percent seemed implausibly low. New York University's Marion Nestle said it wouldn't be surprising if some people under-reported their hamburgers, fries and milkshakes since eating too much fast food is increasingly seen as something of a no-no.

"If I were a fast-food company, I'd say 'See, we have nothing to do with obesity! Americans are getting 90 percent of their calories somewhere else!'" she said.

The study didn't include the total number of fast-food calories, just the percentage. Previous government research suggests that the average U.S. adult each day consumes about 270 calories of fast food — the equivalent of a small McDonald's hamburger and a few fries.

The new CDC study found that obese people get about 13 percent of daily calories from fast food, compared with less than 10 percent for skinny and normal-weight people.

There was no difference seen by household income, except for young adults. The poorest — those with an annual household income of less than $30,000 — got 17 percent of their calories from fast food, while the figure was under 14 percent for the most affluent 20- and 30-somethings with a household income of more than $50,000.

That's not surprising since there are disproportionately higher numbers of fast-food restaurants in low-income neighborhoods, Nestle said.

Fast food is accessible and "it's cheap," she said.

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Arias Leaves Stand After Describing Killing, Her Lies

Jodi Arias stepped down from the witness stand today after mounting an emotional effort to save herself from death row, insisting to the Arizona jury that an explosive fight with ex-boyfriend Travis Alexander led to his death, and that her lies about killing him masked deep regret and plans to commit suicide.

Arias, 32, will now face what is expected to be a withering cross-examination beginning Thursday from prosecutor Juan Martinez, who has been aggressive to many witnesses throughout the trial and who is expected to go after Arias' claim that she was forced to kill Alexander or be killed herself.

She is charged with murder for her ex-boyfriend's death and could face the death penalty if convicted.

Catching Up on the Trial? Check Out ABC News' Jodi Arias Trial Coverage

The day's dramatic testimony started with Arias describing the beginning of the fight on June 4, 2008 when she and Alexander were taking nude photos in his shower and she claims she accidentally dropped his new camera, causing Alexander to lose his temper. Enraged, he picked her up and body slammed her onto the tile floor, screaming at her, she told the jury.

Arias said she ran to his closet to get away from him, but could hear Alexander's footsteps coming after her down the hall. She grabbed a gun from his shelf and tried to keep running, but Alexander came after her, she said.

"I pointed it at him with both of my hands. I thought that would stop him, but he just kept running. He got like a linebacker. He got low and grabbed my waist, and as he was lunging at me the gun went off. I didn't mean to shoot. I didn't even think I was holding the trigger," she said.

"But he lunged at me and we fell really hard toward the tile wall, so at this point I didn't even know if he had been shot. I didn't see anything different. We were struggling, wrestling, he's a wrestler.

"So he's grabbing at my clothes and I got up, and he's screaming angry, and after I broke away from him. He said 'f***ing kill you bitch,'" she testified.

Asked by her lawyer whether she was convinced Alexander intended to kill her, Arias answered, "For sure. He'd almost killed me once before and now he's saying he was going to." Arias had earlier testified that Alexander had once choked her.

Timeline of the Jodi Arias Trial

Arias on Ex-Boyfriend's Death: 'I Don't Remember' Watch Video

Jodi Arias Describes Violent Sex Before Shooting Watch Video

Jodi Arias Testifies Ex Assaulted Her, Broke Her Fingers Watch Video

But Arias' story of the death struggle ended there as she told the court that she has no memory of stabbing or slashing Alexander whose body was later found with 27 stab wounds, a slit throat and two bullets in his head. She said she only remembered standing in the bathroom, dropping the knife on the tile floor, realizing the "horror" of what had happened, and screaming.

"I have no memory of stabbing him," she said. "There's a huge gap. I don't know if I blacked out or what, but there's a huge gap. The most clear memory I have after that point is driving in the desert."

Arias said that she decided in the desert not to admit to killing Alexander, a decision that would last for two years as Arias lied to friends, family, investigators and reporters about what really happened in Alexander's bathroom.

During that time she initially claimed she got lost that night while driving to a friend's house and never went to Alexander's home in Mesa,Ariz. She later changed her story and said two masked people, a man and a woman, burst into the home and killed Alexander and threatened to kill her family if she told anyone what happened.

She eventually confessed to killing her ex-boyfriend, but insisted it was self defense.

"The main reason (for lying) is because I was very ashamed of what happened. It's not something I ever imagined doing. It's not the kind of person I was. It was just shameful," she said. "I was also very scared of what might happen. I didn't want my family to know that I had done that, and I just couldn't bring myself to say that I did that."

"From day one there was a part of me that always wanted to (tell the truth) but didn't dare do that. I would rather have gone to my grave than admit I had done something like that," she said.

Arias said that she continued to lie because she figured she would never get caught; she was planning to kill herself before trial.

"I was concerned with how it would affect my family. I wanted to die. I was going to definitely kill myself," she said. "That was my plan. You can purchase different things in jail and I bought a bunch of Advil... and took it all in the next few days so it was in my system. They have razors for shaving, so I got one and took it apart one night with intentions to slit my wrists."

Arias said she balked at slitting her wrists after accidentally cutting herself, but that she still planned to commit suicide sometime in the future. When she told news reporters that "no jury would convict her," she claims she said it believing that she would be dead before they'd have a chance to put her on trial, Arias testified.

Arias said support from the public and her family eventually led her to change her mind.

"My family remained very supportive, and told me 'it doesn't matter what happens, we love you anyway.' I realized even if I told the truth they would still be there and wouldn't walk away," she testified.

"By the time spring, 2010, rolled around, I confessed. I basically told everyone what I could remember of the day and that the intruder story was all BS pretty much."

She said that her testimony today, a third version of events, was the truth.

Arias was arrested a month after Alexander's death, and prosecutors have argued that her behavior during those weeks showed a lack of remorse for the killing and an attempt to get away with murder.

Arias said today that after she killed Alexander and drove away from his Mesa, Ariz., home in a panic, it dawned on her that police would soon be looking for Alexander's killer, and she decided that she would pretend the bloody confrontation had never happened.

"I knew that it was really bad, that my life was probably done now. I wished it was just a nightmare I could wake up from, but I knew I had messed up pretty badly and the inevitable was going to be something I could not really run from," she testified.

"I didn't want anyone to know that that had happened or that I did it, so I started taking steps in the aftermath to cover it up. I did a whole bunch of things to try to make it seem like I was never there," she said.

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Bulgarian government resigns amid growing protests

SOFIA (Reuters) - Bulgaria's government resigned on Wednesday after violent nationwide protests against high power prices, joining a long list of European administrations felled by austerity during Europe's debt crisis.

Prime Minister Boiko Borisov, a former bodyguard who swept to power in 2009 on pledges to root out corruption and raise living standards in the European Union's poorest member, now faces a tough task to prop up eroding support ahead of a probable early election.

Wage and pension freezes and tax hikes have bitten deep in a country where living standards are less than half the EU average and tens of thousands of Bulgarians have rallied in protests that have turned violent, chanting "Mafia" and "Resign".

On Tuesday, 11 people were hospitalized - including one man bleeding heavily from the head - and 11 arrested after protesters threw flares at police, who fought demonstrators with shields and truncheons.

"I will not participate in a government under which police are beating people," Borisov, who began his career guarding the Black Sea state's communist dictator Todor Zhivkov, said as he announced his resignation on Wednesday.

Parliament is expected to accept the resignation later in the day.

The spark for the protests was high electricity bills, after the government raised prices by 13 percent last July. But it quickly spilled over into wider frustration with Borisov's domineering manner and unpredictable decision making.

The prime minister made sacrifices in an attempt to cling on, sacking his finance minister, cutting power prices and risking a diplomatic row with the Czech Republic by punishing foreign-owned companies, a move that conflicted with EU norms on protection of investors and due process.

Borisov's rightist GERB party is the dominant faction in parliament but will not take part in talks to form a new government, Interior Minister Tsvetan Tsvetanov said, indicating that an election planned for July will now be held early.

"He made my day," student Borislav Hadzhiev, 21, in central Sofia said, commenting on Borisov's resignation. "The truth is that we're living in an extremely poor country."

IRE

GERB's popularity has held up well and it still leads, just, in the polls, largely because budget cutbacks have been relatively mild compared with those in many other European countries. Salaries and pensions were frozen rather than cut.

But the last opinion poll, taken before protests grew last weekend already showed the opposition Socialists were nearly tied with the ruling party and analysts said the protests had boosted the Socialists' chances.

Unemployment in the country of 7.3 million is far from the highs hit in the decade after the end of communism but remains at 11.9 percent and average salaries are stuck at around 800 levs ($550) a month.

Millions have emigrated in search of a better life, leaving swathes of the country depopulated and little hope for those who remain.

The measures announced this week has also put the country on a collision course with the EU and financial investors without easing the tension at home.

Czech Prime Minister Petr Necas demanded an explanation from Bulgaria and accused it of "politicizing" the power sector by threatening to revoke the electricity distribution license of central Europe's largest listed company CEZ, 70 percent of which is owned by the Czech state.

There have also been fines for another Czech company, Energo-Pro and Austria's EVN.

The precedent is unlikely to encourage other foreign investors, who already have to navigate complicated bureaucracy and widespread corruption and organized crime if they want to take advantage of Bulgaria's 16-percent flat tax rate.

"The resignation is the only responsible move," said Kantcho Stoychev, an analyst with pollster Gallup International. "It also gives Borisov some legitimacy to stay in political life in the future, despite the violent police actions last night."

(Additional reporting by Angel Krasimirov; editing by Patrick Graham)

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Tunisia president holds crisis talks over new PM

TUNIS: President Moncef Marzouki was holding urgent talks on Wednesday with political leaders in a bid to steer Tunisia out of a weeks-long crisis exacerbated by the resignation of Prime Minister Hamadi Jebali.

Marzouki was meeting in the morning with leader of the Islamist ruling Ennahda party, Rached Ghannouchi, and later with Maya Jribi of the opposition Republican party, his office said.

Tunisia was plunged into its worst political crisis since the 2011 Arab Spring revolt that ousted President Zine El Abidine Ben Ali when leftist politician Chokri Belaid was shot dead outside his home in Tunis on February 6.

Though no one claimed responsibility, Belaid's family accused Ennahda of being behind the killing, which the party vehemently denied.

The killing did little to ease the misgivings of liberals and secularists who believe Ennahda is failing to rein in religious extremists threatening the stability of the country.

Belaid's murder also sparked deadly street protests as well as strikes, which Jebali attempted to defuse by announcing plans for a non-partisan cabinet of technocrats to lead Tunisia into early elections.

The proposal quickly foundered and Jebali received a final rebuff by his own Ennahda party on Monday, prompting him the following day to carry out his threat to resign if he failed to win sufficient support.

Late on Tuesday he announced the resignation, saying he had failed in a last-ditch effort to push for "another solution" to the long-running crisis in a meeting with Marzouki.

Ghannouchi, whose Ennahda party dominates the national assembly, will be asked by Marzouki to nominate a new prime minister. Names being mentioned are those of Health Minister Abdelatif Mekki and Justice Minister Noureddine Bhiri.

Jribi's opposition Republican party, meanwhile, has in recent days made it clear it is ready to support a cabinet comprising a mix of politicians and technocrats.

The 63-year-old Jebali had said he was convinced a non-political team was "the best way to save the country from wandering off track".

Analysts said it is possible Marzouki will ask Jebali to try again to form a government.

But Jebali said he would not sign on again with "any initiative that does not fix a date for new elections. What about the constitution? What about elections?"

As well as the row over the new government, there is deadlock over the drafting of a constitution, with parliament divided over the nature of Tunisia's future political system 15 months after it was elected.

The prospect of Jebali carrying on is "on the table, but we still have to discuss it, and there are several competent people in the event he refuses," said Ennahda parliamentary bloc chief Sahbi Attig.

Jebali's plans had been bitterly opposed by Ennahda hardliners, represented by Ghannouchi, who refused to give up key portfolios and insist on Ennahda's electoral legitimacy.

The Islamists control the interior, foreign and justice ministries and dominate the national assembly.

The political deadlock has left the country paralysed.

"Everything has stopped. The problem is that nobody thinks about the general interest but only of their special interests," a government official told AFP.

Since the revolution, Tunisia has also been rocked by violence blamed on radical Salafists, and ongoing social unrest over the government's failure to improve poor living conditions.

- AFP/fl

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DRDO says it has capability to produce VVIP choppers

NEW DELHI: With the deal for procuring VVIP choppers from AgustaWestland facing the prospect of being scrapped, DRDO today said it has the capability to manufacture such helicopters even though it contended that producing anything entirely indigenously was impractical.

"We have the capability to manufacture any system. We are manufacturing LCH (Light Compact Helicopter). We have already manufactured ALH (Advanced Light Helicopter) and our own aircraft," DRDO Chief V K Saraswat said.

"There is no dearth of capability and capacity of manufacturing any advanced technology system," he said. Saraswat was asked on the sidelines of a seminar here whether DRDO is capable of manufacturing choppers such as AgustaWestland AW-1O1.

His statement assumes significance against the backdrop of controversy surrounding the Rs 3600 crore deal for acquiring 12 helicopters from AgustaWestland for the use of Indian VVIPs. The Defence Ministry has initiated the process of scrapping the deal in the wake of allegations that kickbacks to the tune of Rs 362 crore were paid to bag the contract.

Saraswat said it is not cost effective to produce each and everything right from needle to an aircraft in the country. "Because, if you produce something which we need 20 in numbers and you set up a facility for producing which will cost Rs 1000 crore, it is meaningless," he said.

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Drug overdose deaths up for 11th consecutive year

CHICAGO (AP) — Drug overdose deaths rose for the 11th straight year, federal data show, and most of them were accidents involving addictive painkillers despite growing attention to risks from these medicines.

"The big picture is that this is a big problem that has gotten much worse quickly," said Dr. Thomas Frieden, head of the Centers for Disease Control and Prevention, which gathered and analyzed the data.

In 2010, the CDC reported, there were 38,329 drug overdose deaths nationwide. Medicines, mostly prescription drugs, were involved in nearly 60 percent of overdose deaths that year, overshadowing deaths from illicit narcotics.

The report appears in Tuesday's Journal of the American Medical Association.

It details which drugs were at play in most of the fatalities. As in previous recent years, opioid drugs — which include OxyContin and Vicodin — were the biggest problem, contributing to 3 out of 4 medication overdose deaths.

Frieden said many doctors and patients don't realize how addictive these drugs can be, and that they're too often prescribed for pain that can be managed with less risky drugs.

They're useful for cancer, "but if you've got terrible back pain or terrible migraines," using these addictive drugs can be dangerous, he said.

Medication-related deaths accounted for 22,134 of the drug overdose deaths in 2010.

Anti-anxiety drugs including Valium were among common causes of medication-related deaths, involved in almost 30 percent of them. Among the medication-related deaths, 17 percent were suicides.

The report's data came from death certificates, which aren't always clear on whether a death was a suicide or a tragic attempt at getting high. But it does seem like most serious painkiller overdoses were accidental, said Dr. Rich Zane, chair of emergency medicine at the University of Colorado School of Medicine.

The study's findings are no surprise, he added. "The results are consistent with what we experience" in ERs, he said, adding that the statistics no doubt have gotten worse since 2010.

Some experts believe these deaths will level off. "Right now, there's a general belief that because these are pharmaceutical drugs, they're safer than street drugs like heroin," said Don Des Jarlais, director of the chemical dependency institute at New York City's Beth Israel Medical Center.

"But at some point, people using these drugs are going to become more aware of the dangers," he said.

Frieden said the data show a need for more prescription drug monitoring programs at the state level, and more laws shutting down "pill mills" — doctor offices and pharmacies that over-prescribe addictive medicines.

Last month, a federal panel of drug safety specialists recommended that Vicodin and dozens of other medicines be subjected to the same restrictions as other narcotic drugs like oxycodone and morphine. Meanwhile, more and more hospitals have been establishing tougher restrictions on painkiller prescriptions and refills.

One example: The University of Colorado Hospital in Aurora is considering a rule that would ban emergency doctors from prescribing more medicine for patients who say they lost their pain meds, Zane said.

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Stobbe reported from Atlanta.

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Online:

JAMA: http://www.jama.ama-assn.org

CDC: http://www.cdc.gov

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com

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Chavez back in Venezuela, on Twitter with four million followers

CARACAS (Reuters) - After Hugo Chavez spent two months out of the public eye for cancer surgery in Cuba, the Venezuelan government hailed his homecoming on Monday and said the president had achieved another milestone - four million followers on Twitter.

The 58-year-old flew back from Havana before dawn and was taken to a military hospital. No new details were given on his health, and there were no images of his arrival. Officials say his condition remains delicate.

The normally loquacious socialist leader, who is struggling to speak as he breathes through a tracheal tube, took to Twitter with a passion back in April 2010, tweeting regularly and encouraging other leftist Latin American leaders to do likewise.

His @chavezcandanga account quickly drew a big mixed following of fans, critics and others just curious to see how his famously long speeches and fiery anti-U.S. invective would work within the social media network's 140-character limit.

But as he fought the cancer and underwent weeks of grueling chemotherapy and radiation therapy, he began to tweet less and less frequently, before stopping altogether on November 1.

Early on Monday morning, he made his reappearance.

"It was 4:30, 5 a.m. He got to his room and surprised everyone: rat-tat-tat, he sent three or four messages, and at that moment fireworks began to go off around the country," Vice President Nicolas Maduro said in a televised cabinet meeting.

During the day, Maduro added, the president's number of followers had shot up to well over four million.

"It's incredible, in just a few hours ... he's the second most-followed president in the world (after Barack Obama), and the first if we make the comparison by per capita," he said.

Obama has more than 27 million Twitter followers and is No. 5 most followed globally. Chavez is Twitter's No. 190 globally.

4TH MILLION FOLLOWER

Maduro said Chavez's four millionth follower was a 20-year-old single Venezuelan woman named Alemar Jimenez from the gritty San Juan neighborhood in downtown Caracas, near the military hospital where the president arrived earlier in the day.

"She's one of the golden generation of youth who support the fatherland and have been waiting with growing love for commander Hugo Chavez," Maduro said, before presenting a dazzled-looking Jimenez to the cameras and giving her a bunch of flowers.

"We were really emotional" she said, recounting how she was with her mother when they heard Chavez had returned. "I sent him a message on Twitter saying he must get better."

There are still big questions over the president's health. He could have come back to govern from behind the scenes, or he may be hoping to ease political tensions and pave the way for a transition to Maduro, his preferred successor.

Chavez has often ordered followers to fight back against opposition critics of his self-styled revolution by using social media, leading from the front himself on Twitter and referring to the Internet as a "battle trench."

As his ranks of followers grew, Chavez said he hired 200 assistants to help him respond to messages - which he said were a great way to receive first-hand the requests, demands, complaints and denunciations of citizens in the thousands.

During his re-election campaign last year, the government launched an SMS text message service that forwards his tweets to cellphones that lack Internet service, broadening their reach to the poorest corners of the South American country.

"He's a communication revolution!" Maduro said, later unbuttoning his shirt on TV to show he was wearing a T-shirt bearing Chavez's eyes emblazoned across his chest.

For the tens of thousands who signed up on Monday to follow Chavez on Twitter, it is unclear how much will be posted there in the weeks and months ahead. Venezuela's 29 million people are mostly wondering something similar.

(Additional reporting by Diego Ore; Editing by Todd Eastham)

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S'pore's fiscal surplus for FY2012 expected to surpass govt's estimates: economists

SINGAPORE: Despite booking a slower GDP growth of 1.2 percent last year, economists expect Singapore's fiscal surplus to surprise on the upside for FY 2012.

The projections, which range from S$1.6 billion to nearly S$5 billion, surpass the government's estimates of a S$1.27 billion surplus for the year.

The record number of new homes sold last year despite additional cooling measures and the high property prices are likely to prop up government revenue for FY2012.

Vishnu Varathan, market economist at Mizuho Corporate Bank, said: "If you are looking at adding to the coffers by 30 to 40 per cent, that is not unimaginable given how heated activity was in the property market. Overall, the surplus should come up much stronger than expected and I think that reinforces that Singapore runs a pretty strong budget position year after year."

In addition, economists say motor vehicle taxes, rising COE premiums as well as higher foreign worker levy will all add to the state's coffers.

Meanwhile, corporate and personal income taxes and the Goods & Services tax will remain top revenue generators, accounting for more than half of total operating revenue.

Taking into account higher expenditure outlays due to higher than expected inflation, DBS Bank forecasts a S$1.62 billion overall fiscal surplus for 2012.

Meanwhile, OCBC Bank projects a S$4.96 billion overall surplus while keeping expenditure unchanged from initial estimates.

Economists say with the higher surplus, the government could offer some incentives help lower income households and businesses cope with rising cost.

However, it is unlikely to do a U-turn on foreign manpower policies. In fact, economists expect the government to further tighten foreign labour rules, albeit at a more moderate pace to allow more time for companies to restructure.

Broadly, they expect Budget 2013 to focus on boosting productivity and fostering inclusive growth.

Some economists say the upcoming budget could also focus on interim projects that will be undertaken over the next few years to complement the longer term objectives and targets set out in the Population White Paper.

Among the government's future plans are the doubling of rail networks in Singapore and building another 700,000 homes by 2030 to support a larger population.

Social expenditure could also increase to cater for an ageing population

Irvin Seah, senior economist at DBS Bank, explained: "As the population continues to age in the next 10 to 20 years, social expenditure would continue to rise. Furthermore, the government is embarking on infrastructure capacity expansion exercise. This would be the most extensive and most comprehensive infrastructure expansion exercise ever since independence.

"Those two considerations will definitely take a toll on the fiscal position therefore there is a need to raise the tax revenues. Hiking GST is out of the question due to political concerns. The only area where there is room for increase in tax rate would be income tax rate so we expect a hike of one to two percentage point for income tax for the top income brackets in the upcoming budget."

Different tax rates apply for Singapore residents at between two per cent and 20 per cent depending on the chargeable income for the year.

Currently, Singapore has one of the most competitive personal income tax rate in the world.

The government will announce the Budget on February 25.

- CNA/fa

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UPA won't return to power, Sharad Yadav says

BHOPAL: The Congress-led UPA government was "mired in corruption" and had "failed on all fronts", and there was no way it could return to power at the Centre after next general elections, NDA convener Sharad Yadav said on Tuesday.

"The UPA government has been hit by one scam after another during its second tenure. There is no doubt that it has failed on all fronts and it would not return to power after next year's general elections," Yadav, who had come here for a private visit, told reporters.

Yadav said various issues including scams, corruption and rising prices would be discussed in the Budget session of Parliament starting on February 21.

Asked if Parliament would be allowed to run smoothly, he said he was hopeful that there would be no problem in its functioning this time.

Referring to the alleged choppergate, Yadav, who is also president of Janata Dal(United), said the Indian government did not know anything about the scandal till it became an issue in Italy where the media highlighted it in a big way.

Right from Bofors in the 80s to the bribery in helicopter deal, initial reports about scams first appeared in media abroad, he said.

About controversial remarks by Union home minister Sushilkumar Shinde on saffron terror, Yadav said, "It would be better if Shinde concentrates only on his job and does not waste his time in making meaningless statements".

Responding to a query, he said the CBI's credibility had sunk to a new low thanks to the manner in which the UPA government was handling the investigation agency.

On the unity of NDA, Yadav said, "It was united, it is united and it will remain united in future as well," and added that some more parties may join it before the polls.

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Hip implants a bit more likely to fail in women

CHICAGO (AP) — Hip replacements are slightly more likely to fail in women than in men, according to one of the largest studies of its kind in U.S. patients. The risk of the implants failing is low, but women were 29 percent more likely than men to need a repeat surgery within the first three years.

The message for women considering hip replacement surgery remains unclear. It's not known which models of hip implants perform best in women, even though women make up the majority of the more than 400,000 Americans who have full or partial hip replacements each year to ease the pain and loss of mobility caused by arthritis or injuries.

"This is the first step in what has to be a much longer-term research strategy to figure out why women have worse experiences," said Diana Zuckerman, president of the nonprofit National Research Center for Women & Families. "Research in this area could save billions of dollars" and prevent patients from experiencing the pain and inconvenience of surgeries to fix hip implants that go wrong.

Researchers looked at more than 35,000 surgeries at 46 hospitals in the Kaiser Permanente health system. The research, published Monday in JAMA Internal Medicine, was funded by the U.S. Food and Drug Administration.

After an average of three years, 2.3 percent of the women and 1.9 percent of the men had undergone revision surgery to fix a problem with the original hip replacement. Problems included instability, infection, broken bones and loosening.

"There is an increased risk of failure in women compared to men," said lead author Maria Inacio, an epidemiologist at Southern California Permanente Medical Group in San Diego. "This is still a very small number of failures."

Women tend to have smaller joints and bones than men, and so they tend to need smaller artificial hips. Devices with smaller femoral heads — the ball-shaped part of the ball-and-socket joint in an artificial hip — are more likely to dislocate and require a surgical repair.

That explained some, but not all, of the difference between women and men in the study. It's not clear what else may have contributed to the gap. Co-author Dr. Monti Khatod, an orthopedic surgeon in Los Angeles, speculated that one factor may be a greater loss of bone density in women.

The failure of metal-on-metal hips was almost twice as high for women than in men. The once-popular models were promoted by manufacturers as being more durable than standard plastic or ceramic joints, but several high-profile recalls have led to a decrease in their use in recent years.

"Don't be fooled by hype about a new hip product," said Zuckerman, who wrote an accompanying commentary in the medical journal. "I would not choose the latest, greatest hip implant if I were a woman patient. ... At least if it's been for sale for a few years, there's more evidence for how well it's working."

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Online:

Journal: http://www.jamainternalmed.com

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