Sabrina Koperski

Association Between More Frequent Chocolate Consumption and Lower Body Mass Index

Chocolate has shown favorable metabolic associations with blood pressure (BP),1–3 insulin sensitivity,1 and cholesterol level.3 Chocolate is rich in antioxidant phytonutrients like catechins that could contribute to favorable relationships of chocolate consumption to insulin sensitivity and BP. However, because chocolate is often consumed as a sweet and bears calories, there are concerns related to its intake. Body mass index (BMI) is part of the metabolic syndrome (MetS) picture, and other MetS elements relate favorably to moderate chocolate consumption. Therefore, we hypothesized that the benefits of modest frequent chocolate intake might extend to reduced fat deposition, potentially offsetting the added calories. To evaluate this, we examined the cross-sectional relationship of chocolate consumption frequency to BMI.

Mood Food: Chocolate and Depressive Symptoms in a Cross-sectional Analysis

BACKGROUND Much lore but few studies describe a relation of chocolate to mood. We examined the cross-sectional relationship of chocolate consumption with depressed mood in adult men and women. METHODS A sample of 1018 adults (694 men and 324 women) from San Diego, California, without diabetes or known coronary artery disease was studied in a cross-sectional analysis. The 931 subjects who were not using antidepressant medications and provided chocolate consumption information were the focus of the analysis. Mood was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Cut points signaling a positive depression screen result (CES-D score, >or=16) and probable major depression (CES-D score, >or=22) were used. Chocolate servings per week were provided by 1009 subjects. Chocolate consumption frequency and rate data from the Fred Hutchinson Food Frequency Questionnaire were also available for 839 subjects. Chocolate consumption was compared for those with lower vs higher CES-D scores. In addition, a test of trend was performed. RESULTS Those screening positive for possible depression (CES-D score >or=16) had higher chocolate consumption (8.4 servings per month) than those not screening positive (5.4 servings per month) (P = .004); those with still higher CES-D scores (>or=22) had still higher chocolate consumption (11.8 servings per month) (P value for trend, <.01). These associations extended to both men and women. These findings did not appear to be explained by a general increase in fat, carbohydrate, or energy intake. CONCLUSION Higher CES-D depression scores were associated with greater chocolate consumption. Whether there is a causal connection, and if so in which direction, is a matter for future prospective study.

What's in Placebos: Who Knows? Analysis of Randomized, Controlled Trials

BACKGROUND No regulations govern placebo composition. The composition of placebos can influence trial outcomes and merits reporting. PURPOSE To assess how often investigators specify the composition of placebos in randomized, placebo-controlled trials. DATA SOURCES 4 English-language general and internal medicine journals with high impact factors. STUDY SELECTION 3 reviewers screened titles and abstracts of the journals to identify randomized, placebo-controlled trials published from January 2008 to December 2009. DATA EXTRACTION Reviewers independently abstracted data from the introduction and methods sections of identified articles, recording treatment type (pill, injection, or other) and whether placebo composition was stated. Discrepancies were resolved by consensus. DATA SYNTHESIS Most studies did not disclose the composition of the study placebo. Disclosure was less common for pills than for injections and other treatments (8.2% vs. 26.7%; P = 0.002). LIMITATION Journals with high impact factors may not be representative. CONCLUSION Placebos were seldom described in randomized, controlled trials of pills or capsules. Because the nature of the placebo can influence trial outcomes, placebo formulation should be disclosed in reports of placebo-controlled trials.

The older the better: are elderly study participants more non-representative? A cross-sectional analysis of clinical trial and observational study samples

Objective Study participants can differ from the target population they are taken to represent. We sought to investigate whether older age magnifies such differences, examining age-trends, among study participants, in self-rated level of activity compared to others of the same age. Design Cross-sectional examination of the relation of participant age to reported ‘relative activity’ (ie, compared to others of the same age), a bidirectionally correlated proxy for relative vitality, in exemplars of randomised and observational studies. Setting University of California, San Diego (UCSD) Participants 2404 adults aged 40–79 including employees of UCSD, and their partners (San Diego Population Study, observational study). 1016 adults (aged 20-85) not on lipid medications and without known heart disease, diabetes, cancer or HIV (UCSD Statin Study, randomised trial). Measurements Self-rated activity relative to others’ age, 5-point Likert Scale, was evaluated by age decade, and related via correlation and regression to a suite of health-relevant subjective and objective outcomes. Results Successively older participants reported successively greater activity relative to others of their age (greater departure from the norm for their age), p<0.001 in both studies. Relative activity significantly predicted (in regression adjusted for age) actual activity (times/week exercised), and numerous self-rated and objective health-predictors. These included general self-rated health, CES-D (depression score), sleep, tiredness, energy; body mass index, waist circumference, serum glucose, high-density lipoprotein-cholesterol, triglycerides and white cell count. Indeed, some health-predictor associations with age in participants were ‘paradoxical,’ consistent with greater apparent health in older age—for study participants. Conclusions Study participants may not be representative of the population they are intended to reflect. Our results suggest that departures from representativeness may be amplified with increasing age. Consequently, the older the age, the greater the disparity may be between what is recommended based on ‘evidence, ’ and what is best for the patient. Trial Registration UCSD Statin Study—Clinicaltrials.gov # NCT00330980 (http://ClinicalTrials.gov)

Risk marker associations with venous thrombotic events: a cross-sectional analysis

Objective To examine the interrelations among, and risk marker associations for, superficial and deep venous events—superficial venous thrombosis (SVT), deep venous thrombosis (DVT) and pulmonary embolism (PE). Design Cross-sectional analysis. Setting San Diego, California, USA. Participants 2404 men and women aged 40–79 years from four ethnic groups: non-Hispanic White, Hispanic, African-American and Asian. The study sample was drawn from current and former staff and employees of the University of California, San Diego and their spouses/significant others. Outcome measures Superficial and deep venous events, specifically SVT, DVT, PE and combined deep venous events (DVE) comprising DVT and PE. Results Significant correlates on multivariable analysis were, for SVT: female sex, ethnicity (African-American=protective), lower educational attainment, immobility and family history of varicose veins. For DVT and DVE, significant correlates included: heavy smoking, immobility and family history of DVEs (borderline for DVE). For PE, significant predictors included immobility and, in contrast to DVT, blood pressure (BP, systolic or diastolic). In women, oestrogen use duration for hormone replacement therapy, in all and among oestrogen users, predicted PE and DVE, respectively. Conclusions These findings fortify evidence for known risk correlates/predictors for venous disease, such as family history, hormone use and immobility. New risk associations are shown. Striking among these is an association of PE, but not DVT, to elevated BP: we conjecture PE may serve as cause rather than consequence. Future studies should evaluate the temporal direction of this association. Oxidative stress and cell energy compromise are proposed to explain and predict many risk factors, operating through cell-death mediated triggering of coagulation activation.

Pondering the Ponderous: Are the “Moral Challenges” of Bariatric Surgery Morally Challenged?

reimburse for the surgery and in theory by patients to determine which surgeons they should consult for care. On their face, these initiatives are at least partial embodiments of the recommendations of Mastroianni and others. As a result, their role in improving care in bariatric surgery should be monitored carefully, and if successful, should be championed, expanded, and applied to other innovative medical modalities as they surface. Medical advancements—like bariatric surgery— inevitably proliferate before the benefits, limitations, risks, and degree of operator skill are fully uncovered. Policymakers, institutions, and the medical profession have an ethical obligation to anticipate that essential information will arise only after a procedure is used consistently in the general physician and patient population and to take explicit steps to integrate these insights into clinical and institutional practice. While some period of adjustment is unavoidable, ethics, patient safety, and professional responsibility mandate that the period of refinement be as abridged as possible.

Improvement in sleep apnoea associated with switch from simvastatin to pravastatin.

Sleep problems have been reported as an adverse effect of statins. In a randomised trial, simvastatin at 20 mg produced significantly worse sleep quality than either placebo or pravastatin 40 mg. A possible relation to sleep apnoea was hypothesised. Here, the case of a 67-year-old man who experienced sleep apnoea on simvastatin 20 mg is presented. Objective nightly testing showed a prompt, marked, sustained and statistically significant improvement in the obstructive apnoea index when the patient switched to pravastatin 20 mg.

Assessing Bioenergetic Compromise in Autism Spectrum Disorder With 31P Magnetic Resonance Spectroscopy Preliminary Report

We sought to examine, via Phosphorus-31 magnetic resonance spectroscopy (31P-MRS) in a case-control design, whether bioenergetic deficits in autism spectrum disorders extend to the brain and muscle. Six cases with autism spectrum disorder with suspected mitochondrial dysfunction (age 6-18 years) and 6 age/sex-matched controls underwent 31P magnetic resonance spectroscopy. The outcomes of focus were muscle resting phosphocreatine and intracellular pH as well as postexercise phosphocreatine recovery time constant and frontal brain phosphocreatine. Intracellular muscle pH was lower in each autism spectrum disorder case than their matched control (6/6, P = .03; P = .0048, paired t test). Muscle phosphocreatine (5/6), brain phosphocreatine (3/4), and muscle phosphocreatine recovery time constant (3/3) trends were in the predicted direction (not all participants completed each). This study introduces 31P magnetic resonance spectroscopy as a noninvasive tool for assessment of mitochondrial function in autism spectrum disorder enabling bioenergetic assessment in brain and provides preliminary evidence suggesting that bioenergetic defects in cases with autism spectrum disorder are present in muscle and may extend to brain.

Assessing Bioenergetic Compromise in Autism Spectrum Disorder With 31P Magnetic Resonance Spectroscopy

We sought to examine, via Phosphorus-31 magnetic resonance spectroscopy (31P-MRS) in a case-control design, whether bioenergetic deficits in autism spectrum disorders extend to the brain and muscle. Six cases with autism spectrum disorder with suspected mitochondrial dysfunction (age 6-18 years) and 6 age/sex-matched controls underwent 31P magnetic resonance spectroscopy. The outcomes of focus were muscle resting phosphocreatine and intracellular pH as well as postexercise phosphocreatine recovery time constant and frontal brain phosphocreatine. Intracellular muscle pH was lower in each autism spectrum disorder case than their matched control (6/6, P = .03; P = .0048, paired t test). Muscle phosphocreatine (5/6), brain phosphocreatine (3/4), and muscle phosphocreatine recovery time constant (3/3) trends were in the predicted direction (not all participants completed each). This study introduces 31P magnetic resonance spectroscopy as a noninvasive tool for assessment of mitochondrial function in autism spectrum disorder enabling bioenergetic assessment in brain and provides preliminary evidence suggesting that bioenergetic defects in cases with autism spectrum disorder are present in muscle and may extend to brain.