CHICAGO - A drug to prevent bone loss during breast cancer treatment also substantially cut the risk that the cancer would return, results that left doctors excited about a possible new way to fight the disease.
It is the first large study to affirm wider anti-cancer hopes for Zometa and other bone-building drugs called bisphosphonates. Zometa, made by Novartis AG, is used now for cancers that have already spread to the bone.
The new study involved 1,800 premenopausal women taking hormone treatments for early-stage breast cancer. Zometa cut by one-third the chances that cancer would recur — in their bones or anywhere else.
"This is an important finding. It may well change practice," said Dr. Claudine Isaacs, director of the clinical breast cancer program at Georgetown University's Lombardi Cancer Center.
About three-fourths of breast cancers occur in women after menopause. Zometa may help them, too, but it hasn't been tested yet in that age group.
The study was led by Dr. Michael Gnant of the Medical University of Vienna and reported Saturday at an American Society of Clinical Oncology conference in Chicago.
If a second, ongoing study also finds a benefit, doctors predict that Zometa will quickly be tested against other cancers that tend to spread, or metastasize, to bones, such as prostate and kidney cancer.
"Hugely important is whether this has to do with the fact that it just makes the bone hostile, somehow, to metastasis or if there is a more global anti-metastasis effect," said the oncology group's president, Dr. Nancy Davidson of Johns Hopkins University.
"Either of those would be good and would teach us a lot about what to do next."
Breast cancer is the most common cancer in women. About 184,450 cases and 40,930 deaths from the disease are expected in the United States this year.
Standard treatments are surgery, chemotherapy, radiation and hormone-blocking drugs if the tumors are like those in the study — helped to grow by estrogen or progesterone.
The hormone-blockers often weaken bones, so bisphosphonates like the osteoporosis pill Fosamax have become increasingly popular to treat this side effect. However, using them to treat the cancer itself is a very different approach.
Lab studies hinted it would work, and Gnant's is the first to test it in a large group of breast cancer patients.
All had surgery to remove their tumors and were taking hormone-blocking drugs — goserelin plus either tamoxifen or anastrozole — treatments that made them menopausal. Half also were given infusions of Zometa once every six months.
The women were treated for three years and studied for two more. By then, only 6 percent of those given Zometa had suffered a relapse or died, compared to 9 percent of the others. That translated to a 36 percent decline in risk.
Sixteen women given Zometa died versus 26 of the others — a difference that could have occurred by chance alone but an encouraging trend that doctors hope will mean better survival as the groups are followed for a longer time.
There were no big differences in serious side effects, though minor ones like fever and bone and joint pain were more common among women given Zometa. Two percent of all study participants developed a rapid heartbeat, but only three were hospitalized — two on Zometa and one of the others.
The study was sponsored by Zometa's maker, Swiss-based Novartis, and British-based AstraZeneca PLC, which makes Arimidex, the brand name of anastrozole. Gnant consults for the companies and several other breast cancer drugmakers.
With doctor fees for the infusion, a Zometa treatment can run more than $1,200. The other large study is testing it in 3,360 pre- and postmenopausal women with cancer that has spread but not extensively.
Experts stressed that the results so far are only in women who were made menopausal by hormone-blocking treatments — not women who develop breast cancer after natural menopause.
For now, using Zometa to prevent breast cancer recurrence should be confined to those who develop breast cancer before menopause, said Dr. Eric Winer of Dana-Farber Cancer Center in Boston.
"This is a treatment that doctors should talk to a patient about" because of these encouraging new results, Winer said.
In other news at the conference, women with advanced breast cancers who were given Avastin plus Taxotere were a little less likely to have their cancers progress than women given Taxotere alone. However, side effects including high blood pressure were more common for those taking both drugs. Taxotere treatment is more common in Europe and Asia; in the United States, doctors are more likely to use Taxol.
In the study of 736 women, 44 percent of those given just Taxotere had their tumors shrink versus 55 percent of those also given a lower dose of Avastin and 63 percent of those given a higher dose.
Avastin, marketed by California-based Genentech and Swiss-based Roche Holding AG, recently won federal approval for breast cancer — against the recommendations of outside advisers. The approval was based on measurements like those in this study — cancer progression, rather than overall survival. The new study was too short to show any differences in survival.
___
On the Net:
Cancer conference: http://www.asco.org
Patient information: http://www.cancer.net
American Cancer Society: http://www.cancer.org
National Cancer Institute: http://www.cancer.gov/cancertopics/types/lung
Saturday, May 31, 2008
Friday, May 23, 2008
THURSDAY, May 22 (HealthDay News) -- Diet and exercise programs for people at high risk for developing diabetes, when followed for six years, can actually delay the development of diabetes for 14 years after the programs end, a new report finds.
The report is published in the May 24 special diabetes issue of The Lancet.
In another study in the same journal issue, Chinese researchers found that intensive therapy with insulin in patients with newly diagnosed type 2 diabetes can help restore the cells in the body that produce insulin, and thereby restore blood sugar balance.
"Early intensive insulin therapy in patients with newly diagnosed type 2 diabetes has favorable outcomes on recovery and maintenance of B-cell function and prolonged glycemic remission compared with treatment with oral hypoglycemic agents," the researchers concluded.
In terms of the lifestyle study, a series of trials around the world have shown lifestyle changes in diet and exercise can reduce cases of diabetes in people with high blood sugar levels. However, whether these gains remain over an extended period isn't clear, researchers said.
"When you do lifestyle interventions in communities, it seems to have a durability beyond the life of the intervention itself, which is very encouraging," said co-author Edward Gregg, branch chief of the Epidemiology and Statistical Branch in the Division of Diabetes Translation at the U.S. Centers for Disease Control and Prevention.
In the trial, called the China Da Qing Diabetes Prevention Outcome Study, 577 adults with high blood sugar levels, at risk for developing diabetes, from 33 clinics in China, were randomly assigned to one of three lifestyle intervention groups. One group relied on diet, a second group on exercise and a third on a combination of diet and exercise. In addition, there was a group that did not participate in any diet or exercise program.
People were counseled to reduce the amount of food they ate and to cut down on sugar and alcohol, Gregg said. "People were encouraged to eat more vegetables and increase their levels of physical activity," he added.
The study began in 1986, and these groups continued their diet and/or exercise programs until 1992. In 2006, the people in the study were seen again to determine the long-term effect of diet and exercise.
Gregg's team found lifestyle interventions reduced the incidence of diabetes by 51 percent over the six years of the program.
Moreover, over the whole 20-year period, the incidence of diabetes was reduced by 43 percent in those people who had been in diet and exercise programs.
On average, the incidence of newly diagnosed diabetes was 7 percent for people who had participated in diet and exercise programs, compared with 11 percent for people who hadn't, the researchers reported.
By the 20th year, 80 percent of those who had participated in a diet and exercise program had developed diabetes, compared with 93 percent of the people who did not participate in such a program. People who had been in a diet and exercise program, spent 3.6 fewer years with diabetes than people who hadn't, Gregg's team found.
Gregg believes that similar programs could be effective in the United States. "Interventions used in this study are similar to interventions that have been used in the United States and do work," he said.
One expert says that despite these impressive results, the study does have a couple of important limitations.
"The majority of study participants in both intervention and control groups went on to develop diabetes eventually," said Dr. David Katz, director of the Prevention Research Center at Yale University School of Medicine. "Moreover, the study is unable to prove that the intervention conferred a survival benefit."
Another limitation is how these results from lifestyle changes can be translated into the real world, Katz said.
"Despite these limitations and the challenges that lie ahead, the finding that we can teach people to eat well and be active, and thereby provide them meaningful defense against diabetes that lasts for decades, is of extraordinary significance," Katz said.
In a third study, Finnish researchers found that incidence of type 1 diabetes has more than doubled among Finnish children in the past 25 years. The incidence of type 1 diabetes rose from 31.4 percent per 100,000 in 1980 to 64.2 percent per 100,000 in 2005.
The increase is expected to continue. This dramatic increase in type 1 diabetes appears to be a combination of genetic and lifestyle factors, the researchers say. For example, obesity among Finnish children has risen from 9.5 percent in the mid-1980s to 20 percent currently.
More information
For more about diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases.
The report is published in the May 24 special diabetes issue of The Lancet.
In another study in the same journal issue, Chinese researchers found that intensive therapy with insulin in patients with newly diagnosed type 2 diabetes can help restore the cells in the body that produce insulin, and thereby restore blood sugar balance.
"Early intensive insulin therapy in patients with newly diagnosed type 2 diabetes has favorable outcomes on recovery and maintenance of B-cell function and prolonged glycemic remission compared with treatment with oral hypoglycemic agents," the researchers concluded.
In terms of the lifestyle study, a series of trials around the world have shown lifestyle changes in diet and exercise can reduce cases of diabetes in people with high blood sugar levels. However, whether these gains remain over an extended period isn't clear, researchers said.
"When you do lifestyle interventions in communities, it seems to have a durability beyond the life of the intervention itself, which is very encouraging," said co-author Edward Gregg, branch chief of the Epidemiology and Statistical Branch in the Division of Diabetes Translation at the U.S. Centers for Disease Control and Prevention.
In the trial, called the China Da Qing Diabetes Prevention Outcome Study, 577 adults with high blood sugar levels, at risk for developing diabetes, from 33 clinics in China, were randomly assigned to one of three lifestyle intervention groups. One group relied on diet, a second group on exercise and a third on a combination of diet and exercise. In addition, there was a group that did not participate in any diet or exercise program.
People were counseled to reduce the amount of food they ate and to cut down on sugar and alcohol, Gregg said. "People were encouraged to eat more vegetables and increase their levels of physical activity," he added.
The study began in 1986, and these groups continued their diet and/or exercise programs until 1992. In 2006, the people in the study were seen again to determine the long-term effect of diet and exercise.
Gregg's team found lifestyle interventions reduced the incidence of diabetes by 51 percent over the six years of the program.
Moreover, over the whole 20-year period, the incidence of diabetes was reduced by 43 percent in those people who had been in diet and exercise programs.
On average, the incidence of newly diagnosed diabetes was 7 percent for people who had participated in diet and exercise programs, compared with 11 percent for people who hadn't, the researchers reported.
By the 20th year, 80 percent of those who had participated in a diet and exercise program had developed diabetes, compared with 93 percent of the people who did not participate in such a program. People who had been in a diet and exercise program, spent 3.6 fewer years with diabetes than people who hadn't, Gregg's team found.
Gregg believes that similar programs could be effective in the United States. "Interventions used in this study are similar to interventions that have been used in the United States and do work," he said.
One expert says that despite these impressive results, the study does have a couple of important limitations.
"The majority of study participants in both intervention and control groups went on to develop diabetes eventually," said Dr. David Katz, director of the Prevention Research Center at Yale University School of Medicine. "Moreover, the study is unable to prove that the intervention conferred a survival benefit."
Another limitation is how these results from lifestyle changes can be translated into the real world, Katz said.
"Despite these limitations and the challenges that lie ahead, the finding that we can teach people to eat well and be active, and thereby provide them meaningful defense against diabetes that lasts for decades, is of extraordinary significance," Katz said.
In a third study, Finnish researchers found that incidence of type 1 diabetes has more than doubled among Finnish children in the past 25 years. The incidence of type 1 diabetes rose from 31.4 percent per 100,000 in 1980 to 64.2 percent per 100,000 in 2005.
The increase is expected to continue. This dramatic increase in type 1 diabetes appears to be a combination of genetic and lifestyle factors, the researchers say. For example, obesity among Finnish children has risen from 9.5 percent in the mid-1980s to 20 percent currently.
More information
For more about diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases.
Thursday, May 15, 2008
Vitamin D may help curb breast cancer, study finds
Breast cancer patients with low levels of vitamin D were much more likely to die of the disease or have it spread than patients getting enough of the nutrient, a study found — adding to evidence the "sunshine vitamin" has anti-cancer benefits. The results are sure to renew arguments about whether a little more sunshine is a good thing.
The skin makes vitamin D from ultraviolet light. Too much sunlight can raise the risk of skin cancer, but small amounts — 15 minutes or so a few times a week without sunscreen — may be beneficial, many doctors believe.
While the vitamin is found in certain foods and supplements, most don't contain the best form, D-3, and have only a modest effect on blood levels of the nutrient. That's what matters, the Canadian study found.
Only 24 percent of women in the study had sufficient blood levels of D at the time they were first diagnosed with breast cancer. Those who were deficient were nearly twice as likely to have their cancer recur or spread over the next 10 years, and 73 percent more likely to die of the disease.
"These are pretty big differences," said study leader Dr. Pamela Goodwin of Mount Sinai Hospital in Toronto. "It's the first time that vitamin D has been linked to breast cancer progression."
But people shouldn't start downing supplements, she warned. Experts don't agree on how much vitamin D people need or the best way to get it, and too much can be harmful. They also don't know whether getting more vitamin D can help when someone already has cancer.
"We have no idea whether correcting a vitamin D deficiency will in any way alter these outcomes," said Dr. Julie Gralow, a cancer specialist at the University of Washington in Seattle.
The study was released Thursday by the American Society of Clinical Oncology and will be presented at the group's annual meeting later this month.
Lots of earlier research suggests vitamin D may help prevent prostate, breast and especially colon cancer. In lab and animal tests, vitamin D stifles abnormal cell growth, curbs formation of blood vessels that feed tumors and has many other anti-cancer effects.
Other evidence: People who live in northern regions of the world have higher cancer rates than those living closer to the equator, possibly because of less sunshine and vitamin D.
The Canadian researchers wanted to see whether it made a difference in survival. They took blood from 512 women at three University of Toronto hospitals between 1989 and 1995, when the women were first diagnosed with early-stage breast cancer.
A decade later, 83 percent of those who had had adequate vitamin D blood levels were alive without extensive spread of their cancer, versus 79 percent of those whose vitamin D levels were insufficient and 69 percent of those who were deficient, as defined by widely used medical standards for measuring intake.
One red flag: The few women with the very highest levels of vitamin D seemed to have worse survival.
Though the study was too small and those results were not conclusive, "there may be an optimal level of vitamin D in women with breast cancer and it may be possible to take too much," Goodwin said.
The federal government says up to 2,000 international units of vitamin D a day seems OK. Taking 800 units per day will, on average, raise blood levels to the middle of the range that seems best for bone and general health, Goodwin said.
Vitamin D is in salmon and other oily fish, and milk is routinely fortified with it, but dietary sources account for little of the amount of D circulating in the blood, experts say.
"It's very hard to make a recommendation" because how much difference a supplement makes depends on someone's baseline level, which also can be affected by sunlight, skin type and time of year, she explained.
Doctors do suggest breast cancer patients get their vitamin D levels checked to see whether they are deficient. The simple blood test is available in many hospitals and labs for about $25, Goodwin said.
Dr. Nancy Davidson, a Johns Hopkins University cancer specialist who is president of the oncology society, said those tests are growing in popularity, even in ordinary medical care.
"Rightly or wrongly, I'm increasingly seeing physicians who are measuring this," she said.
The Canadian study was paid for by the Breast Cancer Research Foundation in New York, established by cosmetics magnate Evelyn Lauder.
"It's a very provocative paper. It's confirmatory of a tremendous amount of evidence that vitamin D is an important component of health," said Dr. Larry Norton, chief of breast cancer programs at Memorial Sloan-Kettering Cancer Center in New York and a medical adviser to the foundation.
Breast cancer is the most common cancer in women. About 184,450 cases and 40,930 deaths from the disease are expected in the United States this year.
___
On the Net:
Government vitamin information:
http://ods.od.nih.gov/factsheets/vitamind.asp
Cancer conference: http://www.asco.org
The skin makes vitamin D from ultraviolet light. Too much sunlight can raise the risk of skin cancer, but small amounts — 15 minutes or so a few times a week without sunscreen — may be beneficial, many doctors believe.
While the vitamin is found in certain foods and supplements, most don't contain the best form, D-3, and have only a modest effect on blood levels of the nutrient. That's what matters, the Canadian study found.
Only 24 percent of women in the study had sufficient blood levels of D at the time they were first diagnosed with breast cancer. Those who were deficient were nearly twice as likely to have their cancer recur or spread over the next 10 years, and 73 percent more likely to die of the disease.
"These are pretty big differences," said study leader Dr. Pamela Goodwin of Mount Sinai Hospital in Toronto. "It's the first time that vitamin D has been linked to breast cancer progression."
But people shouldn't start downing supplements, she warned. Experts don't agree on how much vitamin D people need or the best way to get it, and too much can be harmful. They also don't know whether getting more vitamin D can help when someone already has cancer.
"We have no idea whether correcting a vitamin D deficiency will in any way alter these outcomes," said Dr. Julie Gralow, a cancer specialist at the University of Washington in Seattle.
The study was released Thursday by the American Society of Clinical Oncology and will be presented at the group's annual meeting later this month.
Lots of earlier research suggests vitamin D may help prevent prostate, breast and especially colon cancer. In lab and animal tests, vitamin D stifles abnormal cell growth, curbs formation of blood vessels that feed tumors and has many other anti-cancer effects.
Other evidence: People who live in northern regions of the world have higher cancer rates than those living closer to the equator, possibly because of less sunshine and vitamin D.
The Canadian researchers wanted to see whether it made a difference in survival. They took blood from 512 women at three University of Toronto hospitals between 1989 and 1995, when the women were first diagnosed with early-stage breast cancer.
A decade later, 83 percent of those who had had adequate vitamin D blood levels were alive without extensive spread of their cancer, versus 79 percent of those whose vitamin D levels were insufficient and 69 percent of those who were deficient, as defined by widely used medical standards for measuring intake.
One red flag: The few women with the very highest levels of vitamin D seemed to have worse survival.
Though the study was too small and those results were not conclusive, "there may be an optimal level of vitamin D in women with breast cancer and it may be possible to take too much," Goodwin said.
The federal government says up to 2,000 international units of vitamin D a day seems OK. Taking 800 units per day will, on average, raise blood levels to the middle of the range that seems best for bone and general health, Goodwin said.
Vitamin D is in salmon and other oily fish, and milk is routinely fortified with it, but dietary sources account for little of the amount of D circulating in the blood, experts say.
"It's very hard to make a recommendation" because how much difference a supplement makes depends on someone's baseline level, which also can be affected by sunlight, skin type and time of year, she explained.
Doctors do suggest breast cancer patients get their vitamin D levels checked to see whether they are deficient. The simple blood test is available in many hospitals and labs for about $25, Goodwin said.
Dr. Nancy Davidson, a Johns Hopkins University cancer specialist who is president of the oncology society, said those tests are growing in popularity, even in ordinary medical care.
"Rightly or wrongly, I'm increasingly seeing physicians who are measuring this," she said.
The Canadian study was paid for by the Breast Cancer Research Foundation in New York, established by cosmetics magnate Evelyn Lauder.
"It's a very provocative paper. It's confirmatory of a tremendous amount of evidence that vitamin D is an important component of health," said Dr. Larry Norton, chief of breast cancer programs at Memorial Sloan-Kettering Cancer Center in New York and a medical adviser to the foundation.
Breast cancer is the most common cancer in women. About 184,450 cases and 40,930 deaths from the disease are expected in the United States this year.
___
On the Net:
Government vitamin information:
http://ods.od.nih.gov/factsheets/vitamind.asp
Cancer conference: http://www.asco.org
Tuesday, May 6, 2008
Food Facts That Restaurants Hide From You
What does the restaurant industry have to hide? One of the true issues behind obesity is the fact that many chain restaurants — which provide one-third of all restaurant meals, according to the New York Department of Health — obfuscate the fat and calorie counts of their menu items, and fight any attempt to shed light on what, exactly, is going on between their buns and inside their taco shells.
Through scientific testing, consultations with nutrition experts, and good old-fashioned snooping, we uncovered some of the secrets these mega-restaurateurs have been keeping.
It's no wonder . . .
1) T.G.I. Friday’s
. . . doesn’t want you to know the nutritional impact of any of its dishes, which they have made a policy of not revealing to customers for years, despite the fact that major competitors such as Chili’s and Ruby Tuesday’s do just that. Thankfully, new legislation in New York City forces restaurants with 15 or more branches nationwide to provide calorie counts for all dishes and drinks on their menus.
We popped by T.G.I. Friday’s the day the law went into effect and saw some real shockers: 2,270 calories for Potato Skins, 1,670 calories for Double-Stack Quesadillas, and, most appalling of all, a Pecan Crusted Chicken Salad with 1,360 calories! Now we see why they worked so hard to keep these numbers hidden.
2) Burger King
. . . doesn't want you to know that its French Toast Sticks (which deliver more than 4 grams of fat per stick) share a deep fryer with the pork sausage, pork fritters, Chicken Tenders, Chicken Fries, Big Fish patties, hash browns, onion rings, and Cheesy Tots — and that all of those items contain harmful trans fats.
But there is hope: After the company was sued by the Center for Science in the Public Interest for moving too slowly to remove trans fats from its menu, Burger King promised to phase them out by the end of this year.
3) Red Robin
. . . doesn't want you to know the nutritional impact of its gourmet burgers. "A gourmet burger starts by being an honest burger," Red Robin's Web site declares — but not, apparently, a burger that will come clean about its nutrition facts.
When contacted, Red Robin's senior vice president responded that nutritional information for the menu would be available in October 2007. As of May 2008, however, nutrition facts were still not posted on the site.
4 ) Maggiano's Little Italy
. . . doesn't want you to know just how many calories and carbs you're consuming in those massive pasta portions. (As the menu puts it, "Family-style service or individual entrees are available . . . Whichever you choose, you'll have plenty to share or take home.")
In Italy, a standard pasta serving means 4 ounces of noodles with a few tablespoons of sauce. At Maggiano's, a large order of pasta translates into 2 pounds of noodles piled high on a hubcap-size dinner plate (15 1/2 inches in diameter). A Maggiano's PR rep responded to our request for nutritional information a week later: "Sorry for the delay. I had to wait for corporate's approval. Unfortunately, they have declined to participate."
5) Sit-down chains
. . . don't want you to know that their food is actually considerably worse for you than the often-maligned fast-food fare. In fact, our menu analysis of 24 national chains revealed that the average entree at a sit-down restaurant contains 867 calories, compared with 522 calories in the average fast-food entree. And that's before appetizers, sides, or desserts — selections that can easily double your total calorie intake.
For more reasons to insist on nutritional transparency from the food industry, check out these shocking secrets they don’t want you to know.
Through scientific testing, consultations with nutrition experts, and good old-fashioned snooping, we uncovered some of the secrets these mega-restaurateurs have been keeping.
It's no wonder . . .
1) T.G.I. Friday’s
. . . doesn’t want you to know the nutritional impact of any of its dishes, which they have made a policy of not revealing to customers for years, despite the fact that major competitors such as Chili’s and Ruby Tuesday’s do just that. Thankfully, new legislation in New York City forces restaurants with 15 or more branches nationwide to provide calorie counts for all dishes and drinks on their menus.
We popped by T.G.I. Friday’s the day the law went into effect and saw some real shockers: 2,270 calories for Potato Skins, 1,670 calories for Double-Stack Quesadillas, and, most appalling of all, a Pecan Crusted Chicken Salad with 1,360 calories! Now we see why they worked so hard to keep these numbers hidden.
2) Burger King
. . . doesn't want you to know that its French Toast Sticks (which deliver more than 4 grams of fat per stick) share a deep fryer with the pork sausage, pork fritters, Chicken Tenders, Chicken Fries, Big Fish patties, hash browns, onion rings, and Cheesy Tots — and that all of those items contain harmful trans fats.
But there is hope: After the company was sued by the Center for Science in the Public Interest for moving too slowly to remove trans fats from its menu, Burger King promised to phase them out by the end of this year.
3) Red Robin
. . . doesn't want you to know the nutritional impact of its gourmet burgers. "A gourmet burger starts by being an honest burger," Red Robin's Web site declares — but not, apparently, a burger that will come clean about its nutrition facts.
When contacted, Red Robin's senior vice president responded that nutritional information for the menu would be available in October 2007. As of May 2008, however, nutrition facts were still not posted on the site.
4 ) Maggiano's Little Italy
. . . doesn't want you to know just how many calories and carbs you're consuming in those massive pasta portions. (As the menu puts it, "Family-style service or individual entrees are available . . . Whichever you choose, you'll have plenty to share or take home.")
In Italy, a standard pasta serving means 4 ounces of noodles with a few tablespoons of sauce. At Maggiano's, a large order of pasta translates into 2 pounds of noodles piled high on a hubcap-size dinner plate (15 1/2 inches in diameter). A Maggiano's PR rep responded to our request for nutritional information a week later: "Sorry for the delay. I had to wait for corporate's approval. Unfortunately, they have declined to participate."
5) Sit-down chains
. . . don't want you to know that their food is actually considerably worse for you than the often-maligned fast-food fare. In fact, our menu analysis of 24 national chains revealed that the average entree at a sit-down restaurant contains 867 calories, compared with 522 calories in the average fast-food entree. And that's before appetizers, sides, or desserts — selections that can easily double your total calorie intake.
For more reasons to insist on nutritional transparency from the food industry, check out these shocking secrets they don’t want you to know.
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