Sie sind auf Seite 1von 8

INTRODUCTION

Chocolate lifesaver from cancer to dementia written by Fiona Macrae of the


health section of the Mail Online in March 2007
[1]
This article concerns the possible benefits of compounds called flavonoids found
in chocolate in relation to Cancer, Diabetes, Heart Disease and Dementia
[chocolate] could prove to be as important to medicine as penicillin
[1]
.
A study of the central American Indian Kuna tribe whose diet is exceptionally rich
in cocoa, showed they rarely suffer from high blood pressure and have lower rates
of cancer, heart disease, and diabetes. It suggests this is due to their high intake
of epicatechin (a flavonoid), which they get from drinking up to five cups of cocoa
a day
[1]
.
It is believed that flavonoids in chocolate could be used in future to develop
preventative medicine or dietary supplements, hence is an interesting area of
research.
DIABETES
Diabetes mellitus is a disease of disordered glucose metabolism, resulting in hyperglycaemia. Blood
glucose levels are controlled by a complex interaction of chemicals and hormones in the body,
including insulin, made in the beta cells of the pancreas. Diabetes develops due to a diminished
production of insulin (in type I) or resistance to its effects (in type II and gestational), both of which lead
to hyperglycaemia. The majority of new cases will be Type 2 diabetes, attributable to the ageing
population and rapidly rising numbers of overweight and obese individuals.
Due to the absence of insulin and inability of cells to absorb glucose in diabetics, the consumption of
glucose containing chocolate, would seem an unlikely weapon against diabetes. However, new
research shows that eating dark chocolate reduces the risk of damaging changes in the body that can
lead to the condition
[1]
.
The Daily Mail article states that Diabetes deaths were six times less common in reference to the
diabetes related mortality rate of the Kuna people on the Island of San Blas compared to that of on the
mainland of Panama
[1]
.
However the data has been age adjusted, therefore is misleading as it is not actually six times less
common: Deaths due to diabetes mellitus were much more common in the mainland (24.1 0.74)
than in the San Blas (6.6 1.94)
[13]
.
In a study by Song et al. it was found that the flavonoids in chocolate may prevent the progressive
impairment of pancreatic -cell function due to oxidative stress and may thus reduce the occurrence of
type 2 diabetes
[14]
. However, the results did not support this hypothesis, and although the modest
inverse association with intake of flavonoids cannot be ruled out, it is not conclusive enough to state
that high intake of flavonoids reduces the development of diabetes.
In conclusion, our findings have shown that although flavonoids may have a beneficial effect on
some aspects of health, their impact on diabetes is inconclusive.
CANCER
Cancer is caused by the uncontrolled proliferation of cells in the body. Cancerous
cells grow without instruction from the body, do not stop growing, do not die or age
and feed themselves by angiogenesis. There are over 200 different types of
cancer. Currently 1 in 3 people will develop cancer in their lifetime, hence
prophylaxis and anti-carcinogen research is essential.
Cocoa's anti-carcinogenic
properties
Cocoa has proven to have anti-
carcinogenic effects due to
antioxidant activity. They are
believed to reduce carcinogenesis
by removing growth factors and
contributing factors such as
inflammation. Antioxidants have
been shown to inhibit chemically
induced carcinogenesis and exert
antioxidant activity in humans
[4]
.
Oxygen radical damage to DNA is a
well-recognised effect of
carcinogenic agents. Antioxidants
slow down and/or inhibit oxidation
by removing free radicals. Blocking
oxygen radical production may
provide a major protective effect
against carcinogenesis
[5]
.
Polyphenols
The antioxidants in cocoa are
polyphenols
[6]
which may reduce the
risk of cancer. Research shows that
polyphenols act as antioxidants in
vitro by scavenging reactive oxygen
and nitrogen species and chelating
redox-active transition metal ions
[7]
.
They function as antioxidants
through inhibition of pro-oxidant
enzymes, such as inducible NO
synthase, COXs, and antioxidant
enzymes. These contribute to
carcinogenesis. By activating these
processes, polyphenols have been
shown to induce apoptosis, inhibit
angiogenesis, and inhibit growth
thereby blocking carcinogenic cell
cycle progression.
Cocaos anti-inflammatory properties
Polyphenols have also been found to prevent
inflammation. Inflammation clears damaged cells
including DNA damaged cells but can also cause DNA
damage to cells leading to the proliferation, survival and
migration of cancerous cells via mediators such as
prostaglandins, histamine, cytokines and reactive
oxygen species such as Nitric Oxide.
The COX and NF-B pathways are also implicated in
malignant tumour formation
[8]
, which can be inhibited by
polyphenols.
Flavonoids: The best studied of the polyphenols. They have been found to
enhance detoxification, direct antioxidant action to the initiation stage of
carcinogenesis and prevent DNA-carcinogen interaction
[9],[10]
.
Two flavonoids in particular have been found to have anti-carcinogenic
benefits:
1. Catechins: Found abundantly in chocolate. In research it has been found
that catechins reduce carcinogenesis in vitro and in particular to have benefits
for human breast carcinoma
[11]
. Epigallocatechin-3-gallate has protective
properties against UV radiation-induced damage and skin tumour formation,
preventing skin cancer
[12]
.
2. Quercetin: Has been found to inhibit the inflammatory mediator histamine.
Chocolate containing polyphenol flavonoids hence has been shown to have
antioxidant, anti-inflammatory, and in consequence anti-carcinogenic
properties, and thus could be a prophylactic treatment of cancer.
CORONARY HEART DISEASE
CHD occurs when the coronary arteries are blocked by plaques (atheroma) of fatty and scar tissue.
A short duration of hypoxia caused by the blockage will kill myocardial cells.
One risk factor of CHD is high blood pressure. High blood pressure can cause lesions in the
endothelium of the coronary arteries. This damage triggers aggregation of platelets and, eventually, a
block
[15]
.
Flavonoids in chocolate reduce plaque formation and hence the risk of CHD
[16]
.
In a study by Pearson et al. 16 healthy adults consumed aspirin (81 mg), cocoa (as a beverage), or
aspirin plus cocoa. Results showed that chocolate containing polyphenols was found to lower the
levels of leukotrienes by 29% and increase the levels of prostacyclin by 32%. Leukotrienes stimulate
vasoconstriction and platelet aggregation. Prostacyclins are vasodilators and inhibit platelet
aggregation. It was, however, found that aspirin has the most successful and long-lasting antiplatelet
effect, lasting for days rather than hours
[17]
.
Also, in cocoa feeding trials, chocolate has been found to increase HDL (good) cholesterol. HDL is
believed to remove cholesterol from plaques in arteries and hence decreases blood pressure
[16]
.
HOWEVER
There was only a small sample size of 16 subjects and a short
duration of Flavonoid action. Leukotrienes and Prostacyclins play
a small role inplatelet aggregation. Also LDL increase clearly
outweighs antiplateletfunction and HDL action
[18]
.
Produced by: Amy Balmer, Ashley Cottrell, Charlotte Goul d, Maximillian Jul ve, Madi ha Li ghtwood, Jonathan Noble, Sadia Rahman, Humera Sheikh, Seema Vawda
[20]
PET
Scan of
dementia
(top)
compare
d to
normal
patient
[20]
Table 1. showing the
various foods monitored in
the study
[22]
.
DEMENTIA
Dementia is a general term for a disease of the brain
characterised by the progressive loss of higher
intellectual and cognitive functions. Symptoms
include memory loss, change in personality, inability
to learn and understand new information and
disorientation. There are numerous potential causes:
Dementia is most common in the elderly population; 1
of 20 people over 65 and 1 of 5 over 80 year olds
suffer some form of it.
Preventative measures of dementia have been widely
investigated. One such measure is the use of
flavonoids found in chocolate as studied by
Commenges et al
. [22]
.
The Daily Mail article relies on this paper to infer that
chocolate can reduce the risk of developing dementia
[1]
. The paper took a cohort of 1375 people over the
age of 65 in south-west France and monitored them
from 1991-1996. At the end of this time, 66 of the
participants had developed a form of dementia (46
developed Alzheimer's, 20 developed other types).
Questionnaires and interviews were given at the start
of the study and at intervals throughout to assess how
much of their diet comprised those foods seen in
Table 1. Each food was measured for its content of
the five major flavonoids including quercetin.
From this, they concluded that the intake of flavonoids
was inversely proportional to the risk of developing
dementia.
HOWEVER
In this study, chocolate was not explicitly considered
only the major flavonoids found in many foods were,
thus its specific effect on flavonoid intake is not clear.
The paper also only applies to those over 65 years of
age no mention made of younger people. The article
also only concludes that more research into this area
should be done before firm conclusions can be drawn.
Degenerative diseases such as Alzheimer's
(most common, afflicting an estimated 62%
of all dementia suffers) and Picks
Vascular diseases
Head trauma
Even vitamin deficiency
REFERENCES
1. Daily Mail Online, Chocolate lifesaver - from cancer to
dementia, 2007. Available at:
http://www.dailymail.co.uk/health/article-
441600/Chocolate-lifesaver--cancer-dementia.html
[accessed 03/10/08].
2. The Healthy Chocolate Revolution, 2004, Available
at: http://darkcocoariches.info/images/img_activ.gif
[accessed 17/10/08]
3. Flavonoids, Wikipedia, 2008, Available at:
http://upload.wikimedia.org/wikipedia/commons/2/20/Epi
catechin.png, [accessed 20/10/08]
CANCER:
4. Kang, N.J., Lee, K.W., Lee, D.E. et al. Cocoa
procyanidins suppress transformation by inhibiting
mitogen-activated protein kinase kinase. Journal of
Biological Chemistry, 2008, 283(30), pp. 20664-73.
5. Ruddon, R.W. Cancer Biology. 4
th
ed. Oxford
University Press, USA, 2007.
6. Arts, I.C. & Hollman, P.C. Polyphenols and disease
risk in epidemiologic studies. American Journal of
Clinical Nutrition, 2005, 81(1 Suppl), pp. 317S-325S.
7. Frei, B. & Higdon, J.V. Antioxidant activity of tea
polyphenols in vivo: evidence from animal studies.
Journal of Nutrition, 2003, 133(10), pp. 3275S-84S.
8. Hull, M.A., Booth, J.K, Tisbury, A. et al.
Cyclooxygenase 2 is up-regulated and localized to
macrophages in the intestine of Min mice. British
Journal of Cancer, 1999, 79(9-10), pp. 1399-405.
9. Surh, Y. Molecular mechanisms of chemopreventive
effects of selected dietary andmedicinal phenolic
substances. Mutation Research, 1999, 428(1-2), pp.305-
27.
10. Sale, S., Tunstall, R.G., Ruparelia, K.C. et al.
Comparison of the effects of the chemopreventive agent
resveratrol and its synthetic analog trans 3,4,5,4'-
tetramethoxystilbene (DMU-212) on adenoma
development in the Apc(Min+) mouse and
cyclooxygenase-2 in human-derived colon cancer cells.
International Journal of Cancer, 2005, 115(2), pp. 194-
201
11. Mittal, A., Pate, M.S., Wylie, R.C. et al. EGCG down-
regulates telomerase in human breast carcinoma MCF-7
cells, leading to suppression of cell viability and
induction of apoptosis. International Journal of
Oncology, 2004, 24(3), pp. 703-10.
12. Katiyar, S., Elmets, C.A. & Katiyar, S.K. Green tea
and skin cancer: photoimmunology, angiogenesis and
DNA repair. Journal of Nutritional Biochemistry, 2007,
18(5), pp. 287-96.
DIABETES:
13. Bayard, V., Chamorro, F., Motta, J., et al. Does
flavanol intake influence mortality from nitric oxide-
dependent processes? Ischemic heart disease, stroke,
diabetes mellitus, and cancer in Panama. International
Journal of Medical Sciences, 2007, 4(1), pp. 53-8.
14. Song, Y., Manson, J.E., Buring, J.E. et al.
Associations of dietary flavonoids with risk of type 2
diabetes, and markers of insulin resistance and
systemic inflammation in women: a prospective study
and cross-sectional analysis. Journal of the American
College of Nutrition, 2005, 24(5), pp. 376-84.
CORONARY HEART DISEASE:
15.Michelson, A.D. Platelets, 2
nd
Ed., Elsevier Inc., USA,
2003
16. Ding, E.L., Hutfless, S.M., Ding, X. et al. Chocolate
and prevention of cardiovascular disease: a systematic
review. Nutritional Metabolism (London), 2006, 3, pp. 2.
17. Pearson, D.A., Paglieroni, T.G., Rein, D. et al. The
effects of flavanol-rich cocoa and aspirin on ex vivo
platelet function. Thrombosis Research, 2003, 106(4-5),
pp. 191-7.
18. Holt, R.R., Schramm, D.D., Keen C.L. et al.
Chocolate Consumption and Platelet Function. Journal
of the American Medical Association. 2002, 287(17), pp.
2212-2213.
19. Haemstasis, 2007, Available at:
http://www.haemostasis.se/resource/3.Platelet-plug-
formation.jpg [accessed 17/10/08]
DEMENTIA
20. Geriatrics & Aging, 2005, Available at:
http://www.geriatricsandaging.ca/ga_folder_new/may_2
001/dementia.gif [accessed 31/10/08].
21. Science Clarified, 2008, Available at:
http://www.scienceclarified.com/images/uesc_04_img01
78.jpg, [accessed 31/10/08].
22. Commenges D, Scotet V, Renaud S et al. of
flavonoids and risk of dementia. European Journal of
Epidemiology.2000, 16, pp. 357-363.
CONCLUSION
23. BBC News Online, Chocolate's double-edged
health message, 2001, Available at:
http://news.bbc.co.uk/1/hi/in_depth/sci_tech/2001/glasg
ow_2001/1521982.stm[accessed 01/11/08]
24. BBC News Online, Dark chocolate may be healthier,
2003. Available at:
http://news.bbc.co.uk/1/hi/health/3185363.stm [accessed
01/12/08].
CONCLUSION
Flavonoids in cocoa could have positive health affects and could have huge implications
for prevention of illnesses. Dark chocolate is better because of the effect of milk on
flavonoid uptake
[23]
.
Most commercially available chocolate bars contain very small amounts of flavonoids,
which are swamped by milk, sugar and fats which can lead to increased cholesterol intake
[24]
.
Fruit and vegetables contain much higher levels of flavonoids and antioxidants
than chocolate as well as many other beneficial vitamins and minerals
without the fat though this does not make such sensational news.
It should be noted that the research behind the Daily Mail article
is funded by MARS.
The BHF does not endorse regular chocolate snacking to
protect our hearts. And advising people to eat chocolate regularly
for their hearts' sake is reckless
[24]
.
Articles such as this one, especially headlines, which grab
the public's attention, are evidence that one should not believe
everything we see and hear in the media.
WHAT ARE FLAVONOIDS?
Figure 1. Flavonoids are the largest of the plant polyphenols. They are
widely distributed in plants. Scientists have identified several cocoa
flavonoids, including epicatechin, catechin, and their oligomeric forms,
and their antioxidant properties.
[3]
[2]
Pr ost at e c anc er The PSA t est
The Pr ost at e Gl and
The prostate is an exocrine gland of the male reproductive system
The main function of the prostate is to store and secrete a slightly alkaline fluid, contributing
from a quarter to a third of the semen. This fluid helps to neutralise the acidity of the vaginal
tract and prolong the lifespan of sperm
The prostate also contains smooth muscle that help to expel the semen during ejaculation
The healthy prostate is about 3cm across and surrounds the urethra inferiorly to the bladder
(figure 1)
Prostate cancer is the commonest cancer in men within the UK, with nearly 35,000 new cases
each year. The lifetime risk of being diagnosed with prostate cancer is 1 in 14 (reference 1).
Conc l usi on
What el se i s avai l abl e?
The PSA t est
Di sc ussi on
While the PSA test is one of the first line diagnostic procedures for finding prostate
cancer, there are other methods for diagnosis.
A confirmed high PSA reading will be followed up by a digital rectal examination. The
doctor will insert a gloved finger into the rectum to feel for any abnormalities. If cancer
is present then the prostate may feel hard and rough.
Another test includes trans-rectal ultrasound, this involves insertion of a probe into the
rectum to get an ultrasound image of the gland. A biopsy is often taken at the same
time.
10 samples of tissue are often taken from the prostate in biopsy for microscopic
examination. This yields a false negative 5-10% of the time though, meaning a repeat
biopsy is required for negative results (ref 13).
A novel genetic test is available to complement the PSA test, however this test is
expensive (over 200). This test requires a prostate massage with 10ml of urine
sampled afterwards. The PCA3 gene is measured in the sample. This gene is over-
expressed specifically in prostate cancer (ref 14).
Prostate specific antigen (PSA) is a glycoprotein produced by prostate gland epithelia.
Blood serum PSA levels may rise with prostatic disease, including cancer, due to increased
production of PSA and by architectural changes in the prostate allowing better access to the
circulation.
There may be many causes for increased PSA levels other than prostate cancer, including acute
urinary retention and acute prostatitis (REFERENCE 3).
In the USA the test costs around $50-$80 (36-58). It is estimated that if every male over the age
of 50 had the PSA test it would cost $28billion (20billion) per year (Reference 4)
Met hodol ogy of t he PSA t est
Fut ur e Resear c h
Figure 1: The anatomy of
the male reproductive
system showing location
of the prostate gland.
Notice its proximity to the
rectum. (Image taken from
reference 2)
Prostate cancer is often discovered with a PSA test but there is concern about the accuracy of
this test.
The use of PSA testing also varies considerably between the UK and the USA.
Through this poster we aim to discuss the benefits and drawbacks of aggressive screening for
PSA and some of the reasons why there is such a discrepancy between testing between the UK
and the USA.
In the UK, the PSA test costs
around 10 per person (ref 5).
According to cancer research
UK, The current and annual cost
of treating prostate cancer to the
NHS in England and Wales is
likely to exceed 55million (ref 6)
Figure 2: Image showing the
percentage chance of false
positive and negative PSA test
results and number of prostate
cancers detected
(taken from reference 7)
The PSA test is a blood test
It can take up to 2 weeks to get the results (reference 8)
The normal range for PSA blood serum levels is between 0.0 4ng per millilitre of blood
(ref 9)
In the laboratory, the prostate specific antigens are detected by a method called the
monoclonal antibody technique. In this method, the antibody that the prostate specific
antigen will bind to is produced. (REF 10)
Mice are used to isolate the antibody-forming cells. These antibody-forming cells are
then mixed with a tissue culture and allowed to replicate until sufficient numbers are
produced. After various safety tests are carried out, the antibodies can be isolated from
the tissue culture.
When the patients blood sample is received, the prostate specific antigens present in
that sample will bind to isolated antibodies. Depending on the concentration of PSA
present in the sample, more or less antibody-antigen complexes will form.
There has been much debate across the world on whether the PSA test is a
useful test or discriminant of prostate disorders. There are many advantages of
the test, but increasingly worrying are the possible drawbacks of including the
PSA test as part of a prostrate cancer screening process. Some of the
advantages and disadvantages of the test are described in the table below.
(Adapted from McMi llan Cancer Trust)
As soon as the PSA test was introduced in 1987, it soon became part of the
preventive health care system in the USA, for men over the age of 40. Though
there was some debate at the time, on the value of the test, it is now understood
the views of the PSA test were based on modelled data. Recent studies reported
in the NEJM (Reference 15, 16), illustrated that American men who received
annual PSA tests did not have a reduced rate of death from prostate cancer. The
figures produced from the studies, therefore determine the PSA test to be
ineffective in prostate cancer prevention.
The feeling that the PSA test brings about unnecessary worry on the patient is
now ever growing. False- positive results have also led to individuals being
wrongly diagnosed and treated. With the high number of false- positive results
and the ineffectiveness of the PSA test in preventing death from prostrate cancer
is it now time for the American health system to abandon the PSA test and the
consequent Prostrate Cancer screening programme. Data suggests America
might need to.
In European countries, like the UK, the PSA test is only suggested by a GP when
a patient is showing other symptoms of prostate cancer such as urgent or very
frequent need to urinate, or difficulty starting and stopping urination (NHS
Choices).
The prostate specific antigen-
antibody complexes that are
formed can be detected by
radioactive markers, so that
when the antigen binds to the
antibody, the antibody
undergoes a conformation
change and this emits some form
of radiation which can be
detected. The amount of
radiation detected gives
quantitative results as to how
much PSA is present in that
blood sample. (REF 11)
Figure 3: This shows the
production of antibodies from
mice. These antibodies can
then be used to detect the
amount of PSA present in the
blood sample (Image taken
from reference 12)
There are several new tests available for the detection of prostate cancer. A
Gene expression test based of 4 genes can be used to detect prostate cancer
with a 93% sensitivity. This test could lower the number of false negatives of
prostate biopsy and reduce the necessity for invasive procedures in prostate
diagnosis (ref 17).
The PCA3 test is also likely to be used more widely in the diagnosis of prostate
cancer as it is less invasive than biopsy and more sensitive. This test is
expensive though (ref18).
Pet er J ar vi s
J oge-J ossy Toni son
J onat han Nesar aj
Seema Vawda
A false-positi ve resul t can lead to unnecessary
follow-up testing that is more
invasive, i.e., multiple bi opsies.
The test is a quick, simple and pai nless
procedure involving taking a
sample of blood for testing in a
lab.
Men over the age of 75 may not benefi t from the
test because the prostate is
generall y very sl ow growing and
treatment is unlikel y to lengthen
their lives.
The test may contribute to si gni ficant reducti on
deaths from prostate cancer.
The test does not disti nguish between prostate
cancer and other prostate probl ems
such as infecti on.
Earl y detecti on before the cancer has spread
outside the prostate provides men
with more treatment options and a
better chance for a cure.
High rate of false-positi ve results. The test detects cancer 5 to 10 years earlier than
digi tal rectal exams (DREs).
Significant number of false negati ves. In 1 out of
5 cases, the PSA test comes back
'normal' with PSA levels in men
with earl y prostate cancer.
Prostate cancer can be detected by the test long
before symptoms present
themselves.
Disadvantages Advantages
Overall, data suggests the PSA test should not be part of a prostrate cancer
screening programme in the USA. However, the truth is many American
patients and doctors are happy with the introduction of the PSA test as it can
inform them of a possible health problem.
Due to the inaccuracy of the PSA test, better methods for detecting prostate
cancer are needed.
Mixed messages in media portrayal of obesity
The article stated that thinking makes you want to eat more. The intake of 14
students was measured after relaxing, a summarizing task, and computerised
memory test. It was found that the students consumed 203 and 253 more calories
after the summarising and computer tests respectively when compared to the rest
condition.
Scienti fic Summary
The study attempted to investigate the impact of
knowledge-based work in energy intake and
glucose homeostasis. The calorific intake of 14
female students was measured after 3 different
test conditions: resting, writing a summary, and
performing computerised tests. Plasma glucose,
insulin and cortisol levels were also measured. It
was found that the energy intake for the
summarising and computer tasks compared to the
rest condition was increased by 848kJ and 1057kJ
respectively. The cortisol levels were found to be
significantly higher in the knowledge-based work
conditions, and fluctuations in glucose and insulin
levels were observed. The study concluded that
knowledge-based work is thought to be a stimulus
that has the potential to alter the precision of the
regulation of carbohydrate balance and favour an
increased caloric intake as a mechanism of
maintaining homeostasis.
Obesity and the Media
Obesity has become a regular staple of media coverage, on any
given day it would be difficult not to find some type of coverage on
obesity, in the news. This coverage and the increased awareness
has led to obesity becoming a public health concern, but do the
statistics support this coverage? As can be seen in the two case
studies, the media portrayal of an issue does not always line up
with the reality of the science. The social issues research centre
(SIRC) was commisioned in 2003 by the government to investigate
this very claim, it was granted access to all government data from
the annual Health Survey for all of the UK for the prior 10 years. In
the 10 years of the study the BMI of both boys and girls did not
increase in a significant way and the overall prevalence of obesity
did not increase significantly (Figure 5).
Clearly the data does not reflect the pandemic levels of child obesity
reported. The latest data, released in the 2006 Health Survey data
results, shows the percentage of overweight children has decreased
or remained steady since 2000 (Health Survey Data 2006).
Within adult populations the SIRC did find a significant
increase in BMI between 1993 and 2003 (Figure 5). The 2006 Health
survey with overall prevalence of adult male obesity within all age
groups averaged at an increase of 22.2 % to 23.7%, though it is
worth mentioning that within 3 of the 7 age categories the rate
decreased (National Health Survey Data 2006). In females an
increase in overall prevalence was noted from 23.0% to 24.2%.
Within all age categories except 16-25 female obesity rates have
increased (National Health Survey 2006).
Without question obesity rates within adult populations is on
the rise, but it has yet to be proven with any certainty that they are
increasing significantly within children, this is not reflected within
media coverage however (Figure 6). Many government initiatives
and policies reflect this high reported childhood obesity rates even if
they are not accurate. In the 2003 report on obesity in the UK, the
SIRC concluded that this high rate of investment in prevention of
childhood obesity could not at this point be supported by actual
scientific data, and that obesity rates within children were not rising at
the levels that were being reported in the media (SIRC 2003).
Inverse Pyramid Writing
Journalists can get away with writing outrageous headlines by simply removing some
information and not giving whole truths. The media use many ways to rope readers in
and make a point quickly and succinctly. The purpose of these techniques is to drive
home immediately the theme of an article in such a way that the readers interest may be
captured.
One of the most common and most successful types of writing is referred to as
inverse pyramid writing. Whilst an essay or academic paper would place a summary at
the end of a paper, these articles would do the opposite, by starting with the summary.
This methodology is important as it means all the essential facts are communicated at the
beginning of the article and the reader can therefore stop reading at any point in the
article and still come away with the majority of the useful and intended information. In this
case, the broader the point, the more important the information and the further down the
article it needs to go. As an illustration of this, the beginning of this explanation has been
written in such a style hopefully meaning that your eye was caught as you saw the rather
bold title and your continuing desire to read was due to a gradual release of information,
getting more detailed down the paragraph. This inverse style itself also has the ability to
allow emergency cuts by an editor since the bottom few lines are intended to be
supplementary rather than necessary. Clearly providing a wealth of informative articles is
not high on the medias agenda.
Limitations of the study
The paper refers to the mental tasks as
knowledge based, none of the activities actually
relied on the use of knowledge.
The study was only tested on a very small sample
of women, aged 20 to 30 so can not be generalised
to the whole population.
The study also took place between May and
October, allowing possible seasonal variations.
There was no randomisation of order that the
subjects performed each task, resulting in a
possible learned response and un-blinding of the
study.
below).
Scienti fic summary
Experiment 1
14 males (av. BMI 22.5) took part in an experiment
to test whether comparing new food with recalled
food affects intake. Participants recalled their lunch
today and their lunch yesterday on two days in
random order. They rated bowls of popcorn and ate
freely any leftovers. They scaled hunger, desire to
eat, and fullness in a questionnaire. An ANOVA was
used to determine variance and amount eaten was
calculated. It was found that those who recalled
todays lunch ate less than those who recalled
yesterdays lunch. No effect was found of condition
on rated liking of popcorn types suggesting
compared palatability does not affect food intake.
Experiment 2
73 females (av. BMI 21) took part in a study to test
whether the effect of food recall is dependent on
dietary traits. Four groups were created.
1.Low restraint / low disinhibition
2.Low restraint / high disinhibition
3.High restraint / low disinhibition
4.High restraint / high disinhibition
Participants were subdivided into lunch today and
lunch yesterday groups. The experiment followed
the procedures above. Intake was
not affected by condition, restraint, or disinhibition
overall, however in low
disinhibition participants there was a significant
decrease in intake in those who
recall todays lunch compared to those who recalled
yesterdays lunch.
Experiment 3
47 females (av. BMI 22) took part in a study to
determine the impact of time on the affect of food
recall. Two groups were created.
1.Recall todays lunch
2.Recall journey to test centre
Participants carried out tests 1 hour or 3 hours after
lunch. They were provided with a
standard lunch then hunger, fullness, and desire to
eat (HFD) were rated and participants returned 1 or
3 hours later. Participants wrote details of their
lunch or journey then were then free to eat cookies.
HFD was rated and cookie consumption calculated.
Cookie intake was greater after 3 hours however
food recall did not lower intake in high disinhibition
participants, however in low disinhibition participants
intake was lowered and the effect was greater after
3 hours.
Limitations of the study
Cannot demonstrate how this effect occurs.
All participants were of normal weight.
All participants were relatively young.
The study only shows a short term effect
The effect was only significant in low disinhibition
participants
Dail y express article anal ysis
The article gives a brief overview of the study only
after making claims that do not fit with the research
conclusions. It states recall can prevent snacking;
the study merely claims that it may reduce the
amount consumed. It then claims the harder you
think about the meal, the greater the effect, a
parameter never even investigated by the
researchers.
Dail y Mail article anal ysi s
This article gives a more comprehensive overview
of the studys procedures, results and conclusions.
However, it fails to mention its limitations. It states
recall reduces the desire to snack when in fact
appetite was not found to be affected by recall. The
article does however describe other research
expanding on and supporting the original study
including the idea that memory function may affect
the quantity consumed.
The article begins by stating that scientists have found the cure for snacking to be
thinking about you last meal. People who think about their lunch before snacking ate less
than those who thought about their journey. The effect grew with time up to three hours.
Those with brain damage will eat many lunches but can be helped by being reminded of
the food they have already eaten.
Method
In this study we examined media coverage of two scientific studies. All of our
primary literature was garnered from the NHS Choices website dealing with
media coverage. The first article was a study investigating the effect of
knowledge based tasks on calorific intake by Chapput et al. 2008. Using the
NHS website, a media article from each the Daily Express and the Daily
Telegraph that covered the original paper were investigated in their online
format. The second article was a study investigating the effect of recalling lunch
on afternoon snacking and other factors that could impact this effect. It was
published by Higgs et al. in 2008. Two media articles covering the paper were
found, again through the NHS Choices website. One from the Daily Mail and
another from the Daily Express. The journal papers themselves were analysed
and criticed. The newspaper articles were then compared to the original
scientific papers and were analysed to see how accurately the facts and
conclusions of the research were portrayed. The style of writing used in
newspaper articles to portray scientific research was also analysed , particularly
a technique often seen called inverse pyramid writing. Finally, the data from the
SIRC and UK national health survey relating to obesity and media coverage
rates were analysed to see the larger effect of obesity coverage and whether
this coverage is proportional to the problem.
Abstract
The media is a large force within society and has become the primary source of
scientific information for the general public. Despite this enormous responsibility
there is little to ensure that their portrayals are accurate as few checks and
balances exist and the media has a different bottom line than science and
medicine. Four different media articles from 3 newspapers were investigated
and found to have contradicting messages on the relationship of thinking to
food intake. It was found that the media articles used inverse pyramid writing to
capture the reader and portray the desired conclusion of the tabloid rather than
the scientific journal. This is worrying since the media should not be used as a
source of scientific information, which it invariably is in the case of much of the
general population.
Conclusion
Obesity is a topic that is largely publicised in the media. Although obesity rates in adults
may be increasing, government health data shows that child obesity rates are not on such
a dramatic rise as the media suggest. The media articles investigated in this study deliver
opposing messages, two of which, only five months apart in the same paper. After
analysing the original scientific papers upon which the articles were based, with the use of
pyramid writing, the respective media articles modified the content. Clear cut conclusions
that thinking makes you both fatter and thinner were made, something not implied in the
original papers. In conclusion, it is not viable to believe everything that is presented in the
media and it should not be used as a source of scientific information. Instead all evidence
should be reviewed and primary literature found. This causes concern, as the media is the
main source of information for the general public, who therefore may be mislead in the
information they rely on.
Arora S., Chahwan A., Francis R., Husseneux A., Kumar A., Moss S., Pickard A., Samiy S., Thompson G.,
Department of Medicine, Barts and the London School of Medicine and Dentistry, London, UK.
Figure 5 Mean BMI of Adults and Children 1993-2006
Discussi on
Scientific journals are designed as a method of communication within the scientific
community, no provision was ever made to pass this information on to the general public.
Many complex scientific debates take years before they can be agreed upon by a
majority, and the nature of science means that theories and information are constantly
being refined. The media, mainly news agencies have become over time the means by
which science is disseminated to the public, but the media has a different set of rules and
a different bottom line than science. The media often attempts to show both sides of a
debate sometimes giving equal weighting to an argument that within the scientific
community is definitely not evenly divided. In this way the general public can receive
mixed and confusing messages about issues, and can believe that science is divided on
an issue when it in fact isn't. Within this study we examined media coverage of two
scientific papers and looked overall at the media interpretation of the scientific outcomes,
in all cases the media came to conclusions that were not supported by the scientific
papers which they were based upon (Chaput et al. 2008) (Higgs et al. 2008).
Furthermore government sponsored reviews have found that media coverage of obesity
was not to always accurately representative of the true rate and prevalence of obesity
within the UK. Particularly media representations of childhood obesity rates have been
exaggerated and cannot be supported by UK national health data as they cannot be seen
as rising any faster than proportional to the population (SIRC 2005) (National Health
Survey 2006) (Figure 6).
Led by the increased media coverage the public are more and more wanting input into
the scientific process and increasingly interested in this bite-size science; science that
has been removed from the framework of the debate and the scientific discussion that it
is part of. Medicine and science face increasing scrutiny from the public and media, and
face the very real possibility of having to justify legitimate research lines, to people with
little or no scientific background. Whether or not you agree with increasing public
ownership and participation in the direction of science and medical research the
increased powers given to the media in this respect are disstressing. The media has now
become the main mechanism of disseminating science to the public, this is worrying as
the media owes no allegiance to anyone but its investors and its primary goal is not to
disseminate the truth but to sell its brand. This study has illustrated the perils of believing
everything you read and has shown extreme caution should be used when we interact
with the media as health professionals. Whenever possible we should rely on primary
literature and actively contribute to public education about the issues they read about.
Furthermore a need for a more responsible mechanism of disseminating and debating
scientific and medical advances within the media is needed.
Introduction
The past 10 years have seen obesity within the UK rise to become a major
public health concern, legislation, funding and research have all been directed
at this growing problem. Media coverage of obesity rates has without any
doubt been a major driving force behind this. The media has come to have
many different roles within the framework of public education on health issues,
it not only reports on scientific discoveries but can in many ways direct them by
covering the stories it likes. The scientific community has no control on the
types of articles that are written and the coverage of issues by the general
media, and very few checks and balances are in place to ensure accuracy of
information. This study investigates media coverage of two rather esoteric
scientific articles both related to cognitive processes and weight gain. This
study also examines recent government health surveys for actual prevalence
of obesity to identify if the media accurately portrays obesity rates in the UK.
Within media interpretations of both scientific papers the conclusions of the
scientific paper are not represented truthfully, leading a reader to believe the
scientific papers to be far more certain than they were.
Figure 4 Test condition results Mean +/- SD
Figure 6 Global trends in Media Coverage of Obesity
Dail y Express article anal ysi s
The media articles state thinking makes you crave
food but increased food intake does not imply a
craving of food. The titles of the articles are
misleading especially think bigand get fat as
this implies a relationship which the original study
did not conclude. Information taken from the study
was used to make generalisations about the
general public that were not implied in the study.
Although the study comes to no real conclusion on
the issue, the media articles put more importance
on the issues raised and imply they should be a
concern for the public.
Figure 1 Global Obesity Map
Figure 2 BMI Chart
This article explained that subjects partook in the following tasks: relaxing in a
sitting position, reading and summarising, memory attention and vigilance tests on a
computer for 45 minutes each. They explained that different tasks caused
fluctuations in glucose and insulin levels which resulted in an increase in food intake
of 23.6 and 29.4% to restore balance, which they assert could be a contributing
factor to the obesity epidemic.
Figure 3 Test Conditions
The article states that remembering your last meal can suppress appetite and that
people can teach themselves to resist snacking. An overview of the experiment and
its results is given followed by a description of a study in which women who were
distracted by television ate more than those who focused on their food. The
hippocampus is the part of the brain involved in recalling food and may be
manipulated to treat obesity in the future.
References
Chaput J., Drapeau V., Poirier P., Teasdale N., Tremblay A. 2008 Glycemic Instability and Spontaneous Energy Intake:
association With Knowledge-Based Work. Psychosomatic Medicine 70;797-804
Global Trends in Media Coverage of Obesity 2008 last viewed November 10
th
2008
<http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=539952>
Health Survey for England 2006 National Statistics UK 2008 last viewed November 30
th
2008
< http://www.ic.nhs.uk/pubs/hse06trends>
Health Survey Raw Data for Adults and Children 2006 National Statistics Uk 2008 last viewed November 30
th
2008
< http://www.ic.nhs.uk/pubs/hse06trends>
Higgs S., Williamson A.C., Attwood A.S. 2008 Recall of lunch and its effect on subsequent snack intake Physiology and
Behavior 94;454-462
Image of World Health Organization Map of World Prevalence of Obesity 2005, BBC News UK 2008 last viewed 10
th
December 2008
< http://news.bbc.co.uk/1/hi/health/7151813.stm>
Image of BMI Chart 2006 BBC News UK 2008 last viewed 1
st
December 2008
<http://news.bbc.co.uk/nolpda/ukfs_news/hi/newsid_5297000/5297790.stm>
S i l I R h C t R i f N ti l H lth S l t i d D b 10
th
2008
0.0
5.0
10.0
15.0
20.0
25.0
30.0
1
99
3
1
99
4
1
99
5
1
99
6
1
99
7
1
99
8
1
99
9
2
00
0
2
00
1
2
00
2
2
00
3
2
00
4
2
00
5
2
00
6
Years
All Men (16-75+) All Women (16-75+)
All Boys (2-15) All Girls (2-15)