Annals of Internal Medicine tip sheet for July 17, 2012 issue

Reduction in Trans Fat Consumption Can Reduce Cardiovascular Disease Risk

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Trans fat, such as partially hydrogenated oil, is a mostly processed form of fat that significantly increases risk for coronary heart disease. Just 40 calories of trans fat a day can increase risk for heart disease by up to 23 percent. In 2006 New York City issued unprecedented restrictions on the use of trans fats in chain restaurants – an important strategy because more than one-third of daily calorie intake in the United States comes from food purchased outside the home. To assess the effect of the ban on the trans fat and saturated fat content of fast-food meals, researchers surveyed patrons of 168 randomly selected NYC locations of 11 fast food chains about their lunchtime purchases. The researchers compared the trans fat and saturated fat content of 6,969 fast food purchases made before the ban to trans fat and saturated fat content of 7,885 fast food purchases made after the ban. Following the ban, restaurant lunch patrons purchased lunches containing substantially less trans fat without increasing their intake of saturated fat. The average lunchtime purchase dropped 2.4 grams of trans fat per patron. The greatest reductions in trans fat purchases were seen in patrons of hamburger chains followed by Mexican food and fried chicken chains. The number of meals containing zero grams of trans fat purchased before and after the ban increased from 32 percent to 59 percent. According to the researchers, this study is the first hard evidence that trans fat regulations in local communities can make a difference in the public's dietary intake.

Studies have shown that pregnancy contributes to urinary incontinence, or UI. Among women who have given birth, UI affects up to 12 percent of those 30 and younger, and up to 20 percent of those between 31 and 40. Fewer studies have been done to show the prevalence of UI among younger women who have never been pregnant. Researchers conducted a survey of Australian women between the ages of 16 and 30 who had never been pregnant to investigate the rate of UI, its potential risk factors, and effect on quality of life in this population. Women were recruited at six medical clinics in diverse geographic locations, two allied health clinics (dental and physiotherapy), and three university campuses. Researchers reviewed 1,002 questionnaires and found that 12.6 percent reported UI, suggesting that UI may be a common problem among young women who have never been pregnant. Women who reported having ever been sexually active and who were not currently using oral contraceptives had the highest rate of UI. Young women experiencing UI had an increased sense of shame and fear of humiliation. More than one-third of the women with UI at least sometimes wore pads to keep dry. They also reported worrying about leakage and body odor, suggesting that UI has adverse effects on behavior and psychological well-being for young women. In contrast to previous studies, the researchers did not find an association between UI and age, BMI, physical activity, or past urinary tract infections.

Patients with chronic hepatitis C virus, or HCV, are commonly treated with pegylated interferon-a combined with antiviral agents. Up to 70 percent of HCV patients treated with interferon-a will experience mild to moderate depressive symptoms, and up to 40 percent have major depression. Preventing depression in these patients is imperative because it can derail treatment adherence and effectiveness, and suicide attempts also become a major concern. Researchers sought to determine if prophylactic escitalopram treatment can decrease the incidence or severity of depression associated with interferon-a treatment. The researchers randomly assigned 181 HCV-infected patients with no history of psychiatric disorders to either escitalopram 10 mg/d (n=90) or placebo (n=91) starting two weeks before and continuing for 24 to 48 weeks during antiviral therapy. They found that preemptive treatment with escitalopram is effective in reducing the incidence and severity of depressive symptoms in this patient population. According to the authors, this research has implications for other patients, as interferon-a has current or future indications in gastroenterology, dermatology, and oncology, as well.