Measured energy content of frequently purchased restaurant meals: multi-country cross sectional study

Objective To measure the energy content of frequently ordered meals from full service and fast food restaurants in five countries and compare values with US data. Design Cross sectional survey. Setting 223 meals from 111 randomly selected full service and fast food restaurants serving popular cuisines in Brazil, China, Finland, Ghana, and India were the primary sampling unit; 10 meals from five worksite canteens were also studied in Finland. The observational unit was frequently ordered meals in selected restaurants. Main outcome measure Meal energy content, measured by bomb calorimetry. Results Compared with the US, weighted mean energy of restaurant meals was lower only in China (719 (95% confidence interval 646 to 799) kcal versus 1088 (1002 to 1181) kcal; P<0.001). In analysis of variance models, fast food contained 33% less energy than full service meals (P<0.001). In Finland, worksite canteens provided 25% less energy than full service and fast food restaurants (mean 880 (SD 156) versus 1166 (298); P=0.009). Country, restaurant type, number of meal components, and meal weight predicted meal energy in a factorial analysis of variance (R 2 =0.62, P<0.001). Ninety four per cent of full service meals and 72% of fast food meals contained at least 600 kcal. Modeling indicated that, except in China, consuming current servings of a full service and a fast food meal daily would supply between 70% and 120% of the daily energy requirements for a sedentary woman, without additional meals, drinks, snacks, appetizers, or desserts. Conclusion Very high dietary energy content of both full service and fast food restaurant meals is a widespread phenomenon that is probably supporting global obesity and provides a valid intervention target.

Exercise-Induced Syncope in a Sedentary Woman

Vasovagal (neurocardiogenic) syncope, a subtype of reflex syncope, has many well-known triggers. However, we found no previous report of vasovagal exercise-induced syncope in a sedentary person. We present the case of a 35-year-old sedentary woman who experienced vasovagal syncope as she underwent an exercise stress test. Results of evaluations, including resting and stress electrocardiography and echocardiography, were normal. Her presentation is highly unusual: syncope has typically not been associated with exercise except in young athletes, people with structural heart abnormalities, or people with a prolonged QT syndrome. To our knowledge, this is the first report of vasovagal syncope associated with exercise in a sedentary patient who had normal cardiac and electrophysiologic function. We suggest possible physiologic mechanisms and diagnostic strategies.

Stress fracture of the lumbar pedicle bilaterally: surgical repair using a percutaneous minimally invasive technique

Bilateral pedicle fractures in the spine are uncommon in the absence of bony abnormality, previous surgery, or trauma. The authors report a case of spontaneous bilateral lumbar pedicle fracture in a 50-year-old sedentary woman, which caused intractable pain and did not respond to months of conservative management. The fractures were surgically treated using a percutaneous, minimally invasive technique with screws placed directly through the fractures into the vertebral body. The pedicles were strategically tapped to achieve the lag effect and reapproximate the posterior fragment with the anterior elements. The patient tolerated the procedure well and experienced early improvement of her symptoms, and follow-up imaging showed evidence of fracture healing. Transpedicular fixation and the use of the lag effect could be a useful strategy in the treatment of future cases involving poorly healing pedicle fractures causing persistent symptoms.