Health Report:

Super-Size Me:  Fast Food's Effects on Your Liver

Exercise, Weight & Coronary Artery Disease

Contamination of Surgical Instruments in the Operating Room

"A critical weekly review of important new research findings for health-conscious readers..."

By, Robert A. Wascher, MD, FACS

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Last Updated: 5/4/2008

The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author.  Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.


Obesity is an epidemic in America, and in many societies around the world.  The plentiful availability of relatively inexpensive fat- and calorie-packed foods, along with a plethora of “effort-saving” devices, has helped to make us the fattest civilization in recorded human history. 

In addition to its adverse effects upon the cardiovascular system, joints and other important organs, excess calories can also induce fatty changes in the liver.  This condition, referred to as hepatic steatosis, if severe enough, can cause liver inflammation and dysfunction similar to chronic cirrhosis. A new study, from Sweden, published in the journal Gut, suggests that binging on fast food for as little as a few weeks can, in fact, lead to measurable signs of liver injury.

In this study, 12 healthy men and 6 healthy women volunteered to eat at least two fast food meals a day, and to adopt a sedentary lifestyle, for a period of 4 weeks.  An equal number of “control” volunteers continued with their regular diets and levels of physical activity.  On a weekly basis, all study volunteers underwent testing to measure the level of liver enzymes in the blood that become elevated in the presence of liver inflammation and injury.  Additionally, the subjects underwent weekly scans of their livers in order to estimate the extent of fat deposition within their livers. 

On average, the volunteers who agreed to be “super-sized” gained nearly 15 pounds over the 4 week duration of this clinical study.  Blood levels of ALT, a liver enzyme that rises with injury to the liver, were normal in all study volunteers at the beginning of the study.  At the end of the 4 week study, however, 11 of the 18 (61%) “super-sized” volunteers had abnormally elevated levels of ALT in their blood, signaling the presence of inflammatory changes within their livers.  When they had their livers scanned for fat content, these heavy eaters had nearly 3 times as much fat in their livers at the end of the study as they did when they entered the study only 4 weeks earlier. 

Taken together, this study nicely shows how rapidly the binge-eating of fast food can lead to measurable signs of liver injury and inflammation.  The same injurious effects on the liver are often seen in alcoholics, partly due to the great excess of calories associated with high levels of alcohol intake.  In fact, the authors of this study, citing the results of their research, suggest that physicians consider overeating as another potential cause of liver inflammation and injury in patients with abnormal ALT levels in the blood, in addition to the usual suspects of alcohol abuse, hepatitis caused by viruses, and liver injury caused by other substances that are known to be toxic to the liver.  Based upon the results of this intriguing little clinical study, it would appear that “super-sizing” your diet may potentially lead to rapid and significant harm to your liver.


It is well known that obesity is linked to an increased risk of high blood pressure, coronary artery disease, heart attack, and congestive heart failure.  There continues to be a great deal of debate, however, regarding the subgroup of people often referred to as the “fit fat.”  Some studies have purported to show that overweight people who nonetheless exercise regularly, and who appear to be otherwise healthy, may have approximately the same risk of heart attack, and death due to cardiovascular disease, as their leaner compatriots.  Other studies have shown that even vigorous and regular exercise fails to completely erase the added health risks associated with increasing levels of obesity.

A new study has evaluated the effects of physical activity and body weight, in women, on the risk of coronary artery disease.  This study was conducted by researchers at the Beth Deaconess Medical Center and the Brigham and Women’s Hospital in Boston, and is featured in the current issue of the Archives of Internal Medicine.  The data for this research study was derived from a very large study of clinically healthy women.  Nearly 40,000 women have been participating in the Women’s Healthy Study, for an average of 11 years now; and all of them were without clinical evidence of cardiovascular disease, cancer or diabetes when they first entered the study.  This study was designed to assess the impact of both body weight and level of physical activity as risk factors for coronary artery disease (CAD).

A total of 948 cases of new CAD were diagnosed in this huge cohort of women during the study (most of these 948 women experienced a heart attack, or required either coronary artery bypass surgery or stenting of their coronary arteries).  The researchers then calculated the risk of developing CAD for subgroups of study volunteers, based upon body mass (e.g., normal weight, overweight and obese) and average level of physical activity (physically active women who were not overweight served as the basis for comparison with these other subgroups).

Not surprisingly, the women who were both obese and physically inactive had the greatest risk of developing CAD (more than 2.5 times the risk of the physically active women with a normal body weight).  The women who were at the next highest level of risk for CAD were those who were obese but physically active, and those who were overweight but physically inactive.  In fact, the risk of CAD was essentially identical in these two subgroups of women (nearly 2 times the risk of CAD, when compared to the active women with a normal body weight).  The third highest risk category for CAD was found in women who were overweight but physically active (1.5 times the CAD risk as normal weight women who were active).  Next to the physically active women with a normal body weight, the lowest risk category for CAD was observed in the group of women with normal body weight who were physically inactive.  In this particular subgroup, the added risk of CAD was a rather modest 1.08 times the risk observed in the physically active women with normal weight.

The results of this study, essentially, confirm the well known increased risk of CAD associated with either increased body mass or physical inactivity.  In this study, women with both risk factors had the highest overall incidence of CAD.  This study also reveals that increased levels of physical activity do appear to reduce the risk of CAD, but not to the levels observed among women with normal body mass.  That is to say that it appears that the increased risk of CAD brought about by being overweight or obese cannot be completely eliminated by increased levels of exercise and physical activity.  Previous suggestions that being “fit and fat” can bring the risk of CAD down to levels observed in lean individuals appear not to be correct, based upon this large and very high quality prospective public health study. 

Whether or not the findings of this study also apply equally to men as well is unclear.  However, based upon other epidemiological studies, it is reasonable to assume that both women and men can reduce their risk of CAD significantly by maintaining their body mass in the normal range and by engaging in regular, frequent and vigorous exercise.


In most cases, operating rooms are completely set up before the patient is wheeled in.  The OR technicians and nurses bring all of the necessary surgical instruments and supplies into the room, and open them up so that surgery can begin promptly once the patient is anesthetized.  In some cases, delays in getting the patient into the operating room, or under anesthesia, may expand the amount of time that sterilized surgical instruments are left exposed to the open air in the OR.  An innovative new study from Wright State University, in Dayton, Ohio, and just published in The Journal of Bone & Joint Surgery, evaluated the incidence of bacterial contamination in trays of surgical instruments after varying durations of exposure to the ambient air in the operating room.

In this study, 45 sterile trays, used to hold sterilized surgical instruments, were opened within a standard operating room.  The exposed surfaces of these trays were then cultured, in standard fashion with sterile swabs, to identify the presence of viable bacteria on them.  Serial cultures were obtained, initially upon opening the trays, and then at 30 minute intervals, for a total of 4 hours.  The trays were divided into three groups, each with 15 sterile trays.  In the first group, the sterile instrument trays were opened and left within a locked OR, and nobody was allowed in except for the person who intermittently swabbed the trays to perform cultures.  In the second group, a single person went into and out of the OR every 10 minutes, for 4 hours.  Finally, in the third group, all opened sterile instrument trays were initially covered with sterile towels, and were then subsequently uncovered, and nobody was allowed to enter this particular operating room except for the person performing the cultures.

Among the 30 trays left uncovered throughout the experiment, 3 of them (10%) were found to be contaminated with bacteria immediately after they were opened!  Of the remaining 27 trays that were left uncovered, a whopping 30% were found to have bacterial contamination after 4 hours of being left open to the air within the operating room (even after only 1 hour of being left open, 15% of these uncovered instrument trays had culture-proven evidence of bacterial contamination).  There was no significant difference in the likelihood of bacterial contamination among the uncovered trays in the OR where no entry was allowed versus the OR where one person was permitted to enter and leave the room every 10 minutes.  On the other hand, none of the 15 instrument trays that were initially covered immediately upon opening were found to have evidence of bacterial contamination 4 hours after being opened. 

To summarize, this study determined that sterile surgical instrument trays were increasingly likely to develop bacterial contamination over time if they were left uncovered after being opened.  Light human traffic into and out of the OR did not appear to have any impact on the risk of bacterial contamination of the uncovered instrument trays, however.  On the other hand, covering the instrument trays until it was time to actually begin the surgical procedure appeared to eliminate this time-dependent risk of environmental bacterial contamination.  The authors concluded, therefore, that sterile surgical instrument trays should be immediately covered until they are ready to be used.  (Seems like a good idea to me.)

Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity.

Dr. Wascher is an oncologic surgeon, professor of surgery, a widely published author, and the Director of the Division of Surgical Oncology at Newark Beth Israel Medical Center


Send your feedback to Dr. Wascher at rwascher@doctorwascher.net

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Copyright 2008.  Robert A. Wascher, MD, FACS.  All rights reserved.

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