Clinical Briefs

By Louis Kuritzky, MD, Clinical Assistant Professor, University of Florida, Gainesville. Dr. Kuritzky is an advisor for Endo, Kowa, Pricara, and Takeda.

Accuracy of Stated Energy Contents of Restaurant Foods

Source: Urban LE, et al. Accuracy of stated energy contents of restaurant foods. JAMA 2011;306:287-293.

Eating out has increased in the general population, and is associated with increased body mass index. Indeed, United States data suggest that more than one-third of all daily calories are provided from restaurants. If clinicians and their patients want to make more healthful choices when eating out, they must rely to some degree on the listed caloric content of these foods, but have little assurance that such listings are accurate.

Urban et al performed bomb calorimetry on 269 food items from 42 different restaurants, and compared calorimetry results with caloric content listed by restaurants.

Nineteen percent of the sampled foods were substantially (more than 100/kcal) above their listed energy content when tested with calorimetry. At the highest decile of discrepancy, foods averaged greater than 250 kcal/portion more than their restaurant listings indicated. It is estimated that eating an extra 100 kcal/d on a chronic basis could result in 5-15 kg of weight gain per year. Encouragingly, the overall food caloric assessments stated in restaurants were reasonably accurate; in the minority of cases where inaccuracies underestimate caloric content, health-conscious consumers may be getting more than they bargained for.

The Past and Future Burdens of Violence Against Women

Source: Rees S, et al. Lifetime prevalence of gender-based violence in women and the relationship with mental disorders and psychosocial function. JAMA 2011;306:513-521.

More than 20% of adult american women report being victims of rape, intimate partner violence, or stalking. Limitations of previous data sets preclude identifying associations between lifetime experiences of violence and subsequent mental health issues.

Rees et al performed an analysis of data from the second Australian National Mental Health and Well-being Survey, which included 4451 adult women ages 16-85. The overall lifetime prevalence of any mental disorder (as per DSM–IV criteria) was 37.8% including anxiety disorder (24.6%), mood disorder (18.3%), substance use disorder (13.9%), and post-traumatic stress disorder (9.8%). One or more of the above mentioned forms of violence was reported by 27.4% of these same women.

Data analysis found that victims of violence were more likely to also experience mental health disorders; additionally, the severity of these victims' mental health disorders was greater, as was the likelihood that more than one mental health disorder would ensue. The authors suggest that the magnitude of the burden of violence against women and its mental health sequelae merit an enhanced public health focus on the problem.

Does Androgen Deprivation Improve Outcomes for Localized Prostate Cancer?

Source: Jones CU, et al. Radiotherapy and short-term androgen deprivation for localized prostate cancer. N Engl J Med 2011;365:107-118.

Antiandrogen treatment has been shown to induce tumor cell regression in some androgen-responsive cancers, including some prostate cancers. Unfortunately, the survival benefits seen in clinical trials with long-term antiandrogens have been tempered by increased adverse effects, including erectile dysfunction and myocardial infarction. Jones et al performed a controlled trial of radiotherapy for men with localized prostate cancer (n = 1979), with or without short-term (4 months) androgen-deprivation treatment (goserelin or leuprolide).

Overall 10-year survival in patients receiving androgen-deprivation treatment was statistically significantly greater than in men who only received radiotherapy (62% vs 57%). Prostate cancer-associated mortality was also superior in the group receiving androgen-deprivation treatment (8% vs 4%). Black men enjoyed the same degree of risk reduction as non-blacks.

Hepatotoxicity did occur in a minority of men treated with androgen-deprivation treatment, but was low-grade in more than 95% of cases. Short-term androgen deprivation improves outcomes in men with localized prostate cancer.