PrimeCuts: This Week in the Journals

November 9, 2009

victoriaMegha Shah MD

Faculty peer reviewed

Do we fail to make healthy choices simply because we lack information? If we knew that a tall sized Starbucks Caramel Frappuccino with whip had 300 calories, would we order it anyway? Or would we go for the zero calorie Tazo tea option instead? Well, the jury’s still out…In April 2008, a law was passed that required calorie counts to be posted next to prices in all chains with at least 15 outlets nationwide, affecting close to 2,000 restaurants around New York City. This week, the New York Times reports on two separate studies analzying the effects of this law. The first , performed here at the New York University School of Medicine, and published in the journal Health Affairs is a survey taken of 1,156 adults at four fast-food restaurants in low-income, minority New York communities compared to that of a similar sample population in Newark, New Jersey, where calorie labels have not yet been introduced. Specific survey locations were identified because of high rates of obesity and type II diabetes. The researchers collected about 1,100 receipts two weeks before and four weeks after the law took effect. They found that 27.7 percent stated that calorie labeling had influenced their fast-food choices though overall there was no significant change in the number of calories purchased as seen on the receipts.

A more recent preliminary study released by the city’s health department reports that the calorie labeling law, brought into effect last year and analyzing 10,965 receipts before and 12,153 purchases after the law took effect, showed slightly more promising results, with patrons ordering fewer calories at 4 of the 13 chains surveyed. Though, of note, 8 of the chains had no change at all, and one chain, Subway had an increase in calories ordered, possibly due to the $5 sandwich promotion. Both groups of researchers, though, agree that that the differences in their studies may be from differences in study size and focus. The study by the city health department encompassed most neighborhoods in the city without any particular socioeconomic characteristics with a much larger survey size. Additionally, the first study was conducted shortly after the law took effect and may not have captured more gradual behavioral changes.

Do we overscreen for cervical cancer? A study published in this week’s Annals of Internal Medicine, reports that we just might be. Of the 1,212 physicians surveyed about cervical cancer screening, only about one-fifth were in line with recommendations from groups including the American Cancer Society and United States Preventive Services Task Force. The survey consisted of 4 different situations and asked whether a Pap smear would be appropriate in each. Most responded that they would recommend annual Pap smears for at least three years for an 18 year old, recently sexually active, woman, in line with the current recommendations. Against current recommendations, though, they also advised the same for a 35 year old woman with no history of cancer whose cervix had been removed. This study reminds us of the importance of keeping up-to-date with screening guidelines to ensure that patients do not undergo unnecessary testing and add to already high health costs.

The advent of flu season and particularly that of H1N1 has unsurprisingly put the demand for N95 respirators at an all time high. With fears that these masks may be in short supply during a pandemic, researchers at Ontario area hospitals compared surgical masks with N95 respirators for the prevention of flu in healthcare workers. In a study published in Journal of the American Medical Association, 446 nurses were randomized to either a surgical mask or N95 fitted respirators and monitored for PCR confirmed influenza. The results showed that surgical masks were noninferior to N95 respirators in preventing influenza. The study noted that the results should only be applied to routine care in the health care setting.

Fresh from the lab: In this week’s Science, a group of researchers initiated a gene therapy trial in two X-linked adrenoleukodystrophy (ALD) patients without a matched stem cell donor. ALD, a severe demyelinating disease in boys caused by a deficiency in ABCD1, a gene encoding the ALD protein, can only be managed by allogeneic hematopoietic stem cell transplantation (HCT). In this study, CD34+ cells were removed from the patients and genetically corrected ex vivo with the wild-type ABCD1 gene. These cells were then reinfused into the patients and 24-30 months after the procedure, the normal ALD protein was found to be expressed in a polyclonal cell population. Between 14-16 months after the reinfusion, progressive cerebral demyelination stopped in both patients, showing that gene therapy may be a promising therapy for those unable to go undergo HCT.

And lastly, a new tool for our fight against obesity? Liraglutide, a glucagon-like peptide 1 (GLP-1) analog, marketed under the brand name Victoza by Novo Nordisk for the treatment of type II diabetes, was recently studied for the treatment of obesity. In double blind, randomized trial published in the The Lancet, four different doses of liraglutide were compared to placebo and orlistat, another drug used in obesity management in 564 patients with a controlled diet and exercise regimen. Results showed that most patients lost on average of 5-7kg with liraglutide, approximately 4kg with orlistat, and 3kg on placebo. The drug had minimal side effects including transient nausea and vomiting. Although liraglutide has yet to be approved for use in the United States, with current obesity rates on the rise, this certainly will be a drug to look out for.

Peer reviewed by Sandeep Mangalmurti, MD JD, Chief Resident, NYU Department of Medicine

Dr. Shah is a first year resident in internal medicine at NYU Medical Center.

References:

1. Rabin, Roni Caryn. How Posted Calories Affect Food Orders. The New York Times. Published online November 2, 2009
2. Elbel B, Kersh R, Brescoll VL et al. Calorie Labeling and Food Choices: A First Look at the Effects on Low-Income People in New York City. Health Affairs. Published online October 6, 2009
3. Yabroff KR, Saraiya M, Meissner HI et al. Specialty Differences in Primary Care Physician Reports of Papanicolaou Test Screening Practices: A National Survey, 2006 to 2007. Annals of Internal Medicine. 2009; 151 (9): 602-611
4. Loeb M, Dafoe N, Mahony J et al. Surgical Mask vs. N95 Respirator for Preventing Influenza Among Health Care Workers. JAMA. 2009; 302 (17): 1865-1871
5. Cartier N, Hacein-Bey-Abina S, Bartholomae CC et al. Hematopoietic Stem Cell Gene Therapy with a Lentiviral Vector in X-linked Adrenoleukodystrophy. Science. 2009; 326 (5954): 818-823
6. Astrup A, Rossner S, Van Gaal L et al. Effects of liraglutide in the treatment of obesity: a randomized, double-blind, placebo-controlled study. The Lancet. 2009; 374 (9701): 1006-1616.

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