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The biochemistry of vitamin B6 is basic to the cause of the Chinese restaurant syndrome.

The concept of this basic research was that monosodium L-glutamate could reveal a deficiency of vitamin B6 by the neurological reactions known as the Chinese Restaurant Syndrome. An other amino acid, tryptophan, administered to subjects, is known to reveal a deficiency of vitamin B6 by the excretory xanthurenic acid, etc. The presence and degree of a deficiency of vitamin B6 in 155 students on no supplemental B6 was determined by the differential assay of aspartate transaminase of erythrocytes which also allows each subject to be a control. Twenty-seven of 155 students had extraordinarily low basal specific activities of the transaminase, less than 0.26 mumol pyruvate/(h X 10(8) erythrocytes). These 27 were challenged with glutamate and a placebo. Twelve of 27 revealed the Chinese Restaurant Syndrome, and 15 did not. By double blind trials, the 12 "responders" were treated with pyridoxine and a placebo for twelve weeks, and then were rechallenged with glutamate and a placebo. Decoding showed 3 of 12 received placebo to pyridoxine and then revealed the symptoms of the syndrome again to glutamate; 9 of 12 received pyridoxine and then 8 of 9 failed to respond to glutamate. These results show, p less than 0.01, that the symptoms of the Chinese Restaurant Syndrome to oral glutamate fail to reoccur after treatment which pyridoxine, and that the biochemistry of vitamin B6 is basic to the cause of the Chinese Restaurant Syndrome.

Aspartate Aminotransferases↗

Deaths from nasopharyngeal cancer among waiters and waitresses in Chinese restaurants.

OBJECTIVE: Previous studies have shown that waiters have a high risk of developing cancers of the buccal cavity and pharynx, but nasopharyngeal cancer (NPC) has not been specifically studied. This study was carried out to investigate whether waiters/waitresses in Chinese restaurants have an increased risk of dying from NPC. METHODS: A mortality odds ratio study was used to estimate the relative risk of dying from NPC for waiters/waitresses working in Chinese restaurants in Hong Kong during the period 1986-1995, using the general population as the external comparison group and deceased kitchen workers as an internal comparison group. Cases were deaths from NPC and the controls were deaths from the selected sets of reference causes. RESULTS: Seventeen deaths from NPC were identified among 415 deceased waiters and four NPC deaths occurred among 140 deceased waitresses. The adjusted mortality odds ratio (aMOR) for NPC was increased among waiters, being 3.02 (95% CI 1.82-5.00) and 2.61 (95% CI 1.02-6.69) in the external and internal comparisons, respectively. For waitresses, the aMOR was 4.58 (95% CI 1.63-12.86) in the external comparison. Analysis by duration of union membership suggested a dose-response relationship. CONCLUSIONS: An increased risk of dying from NPC was observed among waiters/waitresses and could not be fully explained by bias or confounding factors. Possible risk factors related to poor indoor air quality in the service areas of Chinese restaurants in Hong Kong should be further investigated.

Case-Control Studies↗

The effect of enforcement upon service of alcohol to intoxicated patrons of bars and restaurants.

Laws prohibiting the service of alcohol to already intoxicated patrons of bars and restaurants are seldom enforced. Following introduction of an enforcement effort in Washtenaw County, Michigan, observed refusals of service to "pseudopatrons" simulating intoxication rose from 17.5% to 54.3%, declining eventually to 41.0%. At the same time, the percentage of those arrested drunk drivers coming from bars and restaurants declined from 31.7% to 23.3%. In a comparison county, refusals of service rose to a significantly smaller extent, from 11.5% to 32.7%, while the percentage of DWIs coming from bars and restaurants showed no significant changes. Service refusals were related to volume of business and numbers of intoxicated patrons in an establishment at the time of observation, while numbers of arrested DWIs was related to the nature of the establishment's clientele, policies, and practices. While enforcement of alcohol service laws offers a potentially cost beneficial means of reducing highway crashes, replication across additional jurisdictions is needed.

Accidents, Traffic↗

McDonald's restaurants and neighborhood deprivation in Scotland and England.

BACKGROUND: Features of the local fast food environment have been hypothesized to contribute to the greater prevalence of obesity in deprived neighborhoods. However, few studies have investigated whether fast food outlets are more likely to be found in poorer areas, and those that have are local case studies. In this paper, using national-level data, we examine the association between neighborhood deprivation and the density of McDonald's restaurants in small census areas (neighborhoods) in Scotland and England. METHODS: Data on population, deprivation, and the location of McDonald's Restaurants were obtained for 38,987 small areas in Scotland and England (6505 "data zones" in Scotland, and 32,482 "super output areas" in England) in January 2005. Measures of McDonald's restaurants per 1000 people for each area were calculated, and areas were divided into quintiles of deprivation. Associations between neighborhood deprivation and outlet density were examined during February 2005, using one-way analysis of variance in Scotland, England, and both countries combined. RESULTS: Statistically significant positive associations were found between neighborhood deprivation and the mean number of McDonald's outlets per 1000 people for Scotland (p<0.001), England (p<0.001), and both countries combined (p<0.001). These associations were broadly linear with greater mean numbers of outlets per 1000 people occurring as deprivation levels increased. CONCLUSIONS: Observed associations between presence or absence of fast food outlets and neighborhood deprivation may provide support for environmental explanations for the higher prevalence of obesity in poor neighborhoods.

England↗

Restaurant owner perceptions of the effects of a smoking ban.

In this paper business owner expectations regarding revenue changes due to a general smoking ban are analyzed using a survey mailed out to all restaurants, bars, cafés and nightclubs in Gothenburg, Sweden. A reasonable interpretation of the survey responses is that as many as 74% of the establishments do not expect to be severely hurt by a general smoking ban applying to the entire restaurant sector. The econometric results show that the owners are more likely to expect a decrease in revenues the larger their share of smoking customers. Moreover, establishments that are smoke-free are less likely to expect negative economic effects compared to those that currently allow smoking. Also, establishments with a non-smoking section are less likely to expect negative economic effects from a general smoking ban. No strong effect of the type of establishment (café, bar, or restaurant) on expected changes in revenues is detected, although establishments with late night hours are more likely to expect financial losses.

Air Pollution, Indoor↗

Consumers may not use or understand calorie labeling in restaurants.

This study was an investigation of the possible utility of calorie labeling legislation in restaurants in community (n=649) and college student (n=316) samples. Only 48% to 66% of participants presently looked at food labels, and 64% to 73% were able to report accurate knowledge of daily caloric needs. Furthermore, 44% to 57% reported that they were not likely to use food label information in restaurants if it were available. Therefore, public education campaigns focused on calorie requirements may need to precede restaurant labeling, and perhaps other possibilities in labeling formats should be considered (eg, defining foods as "low," "moderate," and "high" calorie).

Adult↗

Adolescent fast food and restaurant ordering behavior with and without calorie and fat content menu information.

PURPOSE: To determine whether adolescents will modify their ordering behavior if calorie and fat nutrition information is posted on the restaurant menu. METHODS: Adolescent volunteers (aged 11 to 18 years) were asked to order a dinner of their choice from three different restaurant menus (McDonald's, Panda Express, and Denny's) and then from a second set of modified menus with calorie and fat content information posted next to each menu item. Total reported consumed calories, fat, and the price of the meal ordered were calculated for each meal. RESULTS: For the first 106 adolescents enrolled, 75 did not change any of their orders after being shown the calorie and fat content information. For the 31 who did change some of their orders, 43 meals resulted in decreased calories and 11 meals resulted in increased calories (20 resulted in a more expensive meal, 23 resulted in a less expensive meal and 11 resulted in no change in the cost of the meal; average change 0.027 dollar increase). Of the 27 who rated themselves as too fat or slightly overweight, only 9 (33%) changed their orders. CONCLUSIONS: The provision of calorie and fat content information on the menus did not modify the food ordering behavior for the majority of adolescents. However, the provision of the nutrition information should still be encouraged because it resulted in some calorie/fat reduction by some of the adolescents and it did not adversely affect the restaurants' revenue.

Adolescent↗

Nasal carriage of enterotoxin-producing Staphylococcus aureus among restaurant workers in Kuwait City.

Enterotoxin-producing Staphylococcus aureus is a common cause of staphylococcal food poisoning. To determine the incidence of carriage of enterotoxin-producing S. aureus in a sample of the healthy population in Kuwait city, restaurant workers in the city were screened for nasal carriage of S. aureus. 26.6% of 500 workers studied carried S. aureus and 86.6% of the S. aureus produced staphylococcal enterotoxins. 28% produced enterotoxin A, 28.5% produced enterotoxin B, 16.4% produced enterotoxin C and 3.5% produced enterotoxin D. Ten isolates produced both enterotoxins A and B or A and C. 73% of the isolates were untypeable with standard phages. However, 17.1%, 3% and 6% belonged to phage groups I, II and III respectively. The results demonstrated a high level of enterotoxigenic S. aureus carriage among restaurant workers which although lower than that reported for the general population and hospital workers may be important in the restaurant industry.

Bacteriophage Typing↗

Risk factors for transmission of foodborne illness in restaurants and street vendors in Jakarta, Indonesia.

In a previous risk factor study in Jakarta we identified purchasing street food as an independent risk factor for paratyphoid. Eating from restaurants, however, was not associated with disease. To explain these findings we compared 128 street food-vendors with 74 food handlers from restaurants in a cross-sectional study in the same study area. Poor hand-washing hygiene and direct hand contact with foods, male sex and low educational level were independent characteristics of street vendors in a logistic regression analysis. Faecal contamination of drinking water (in 65 % of samples), dishwater (in 91 %) and ice cubes (in 100 %) was frequent. Directly transmittable pathogens including S. typhi (n = 1) and non-typhoidal Salmonella spp. (n = 6) were isolated in faecal samples in 13 (7 %) vendors; the groups did not differ, however, in contamination rates of drinking water and Salmonella isolation rates in stools. Poor hygiene of street vendors compared to restaurant vendors, in combination with faecal carriage of enteric pathogens including S. typhi, may help explain the association found between purchasing street food and foodborne illness, in particular Salmonella infections. Public health interventions to reduce transmission of foodborne illness should focus on general hygienic measures in street food trade, i.e. hand washing with soap, adequate food-handling hygiene, and frequent renewal of dishwater.

Adult↗

Fast food restaurant use among adolescents: associations with nutrient intake, food choices and behavioral and psychosocial variables.

OBJECTIVE: To examine demographic, behavioral and dietary correlates of frequency of fast food restaurant use in a community-based sample of 4746 adolescent students. DESIGN: A survey was administered to students in classrooms at 31 secondary schools in a large metropolitan area in Minnesota, United States. Height and body weight were measured. SUBJECTS: Students in grades 7-12 who were enrolled in participating schools, had parental consent and were in attendance on the day of data collection. MEASUREMENTS: Frequency of fast food restaurant use (FFFRU), dietary intake, and demographic and behavioral measures were self-reported. Dietary intake was assessed using a semi-quantitative food frequency questionnaire. Height and body weight were directly measured. RESULTS: FFFRU was positively associated with intake of total energy, percent energy from fat, daily servings of soft drinks, cheeseburgers, french fries and pizza, and was inversely associated with daily servings of fruit, vegetables and milk. FFFRU was positively associated with student employment, television viewing, home availability of unhealthy foods, and perceived barriers to healthy eating, and was inversely associated with students' own and perceived maternal and peer concerns about healthy eating. FFFRU was not associated with overweight status. CONCLUSIONS: FFFRU is associated with higher energy and fat intake among adolescents. Interventions to reduce reliance on fast food restaurants may need to address perceived importance of healthy eating as well as time and convenience barriers.

Adolescent↗

Airborne exposure and biological monitoring of bar and restaurant workers before and after the introduction of a smoking ban.

The aims were to assess the impact of a total smoking ban on the level of airborne contaminants and the urinary cotinine levels in the employees in bars and restaurants. In a follow up design, 13 bars and restaurants were visited before and after the implementation of a smoking ban. Ninety-three employees in the establishments were initially included into the study. The arithmetic mean concentration of nicotine and total dust declined from 28.3 microg m(-3) (range, 0.4-88.0) and 262 microg m(-3) (range, 52-662), respectively, to 0.6 microg m(-3) (range, not detected-3.7) and 77 microg m(-3) (range, not detected-261) after the smoking ban. The Pearson correlation coefficient between airborne nicotine and total dust was 0.86 (p < 0.001; n = 48). The post-shift geometric mean urinary cotinine concentration declined from 9.5 microg g(-1) creatinine (cr) (95% CI 6.5-13.7) to 1.4 microg g(-1) cr (95% CI 0.8-2.5) after the ban (p < 0.001) in 25 non-snuffing non-smokers. A reduction from 1444 microg g(-1) cr (95% CI 957-2180) to 688 microg g(-1) cr (95% CI 324-1458) was found (p < 0.05) in 29 non-snuffing smokers. The urinary cotinine levels increased from 11.7 microg g(-1) cr (95% CI 7.0-19.6) post-shift to 21.9 microg g(-1) cr (95% CI 13.3-36.3) (p < 0.01) in the next morning in 24 non-snuffing non-smokers before the smoking ban. A substantial reduction of airborne nicotine and total dust was observed after the introduction of a smoking ban in bars and restaurants. The urinary cotinine levels were reduced in non-smokers. The decline found in smokers may suggest a reduction in the amount of smoking after intervention. In non-smokers cotinine concentrations were higher based on urine sampled the morning after a shift than based on urine sampled immediately post-shift.

Adult↗

Evaluation of a novel integrated bioreactor--AOS system for treating oil-containing restaurant wastewater on site in Hong Kong.

AOS system is an anaerobic digestion reactor (A-section, UASB or UBF), oxidation degradation reactor (O-section, aerobic biofilm reactor), and physical sedimentation tank (S-section) 3-in-1 integrated reactor. The compact bioreactor was applied to treat oil-containing restaurant's wastewater on site in Hong Kong. The treatment efficiency was observed at different HRT. Experimental results indicated that the AOS system for treating oil-containing restaurant wastewater on site was feasible when HRT at 0.6 days above. During the running period, the net sludge generation rate of the AOS system was only about 0.08-0.09 g g(-1)removed COD, and the utmost COD specific volumetric removal rate (SVRR) of the system reached 2.77 gL(-1) d(-1). The utmost specific biomass substrate utilization rate (SBSUR) of COD in O-section and A-section reached 1.22 d(-1) and 0.128 d(-1), respectively. In addition, the experiment results showed that the AOS system with a filter in UASB (that is UBF's AOS system) could bear much more great HLR comparing with UASB's AOS and was more efficient for treating oil-containing restaurant's wastewater on site.

Biodegradation, Environmental↗

A large, multiple-restaurant outbreak of infection with Shigella flexneri serotype 2a traced to tomatoes.

BACKGROUND: Foodborne outbreaks of Shigella infection are uncommon and tomatoes are an unusual vehicle. We describe a large, multiple-restaurant outbreak of Shigella flexneri serotype 2a infection that was associated with tomatoes. METHODS: We conducted nationwide surveillance and a case-control study, collected fecal specimens for culture, and measured the survival of the outbreak strain of S. flexneri in tomatoes. RESULTS: We interviewed 306 of 886 ill restaurant patrons and 167 control subjects. Matched univariate analysis showed that several food items were associated with illness, but only tomatoes remained significant in multivariate models. Illness peaked at each restaurant within 24 h after the arrival of hand-sorted bruised and overripe tomatoes from a new distributor; all patient isolates that were tested were indistinguishable by PFGE. Sliced tomatoes from the distributor were inoculated with the outbreak strain, and viable S. flexneri were recovered for 72 h. CONCLUSION: To prevent such outbreaks, persons with shigellosis should be excluded from handling food at all points along the distribution chain.

Adult↗

Restaurant-associated outbreak of giardiasis.

An outbreak of giardiasis occurred among staff of a job training center after a meeting at a restaurant. Twenty-seven (75%) of 36 attendees became ill compared with 1 (3%) of 31 staff members not attending (relative risk, 23.3; 95% confidence interval, 3.4-161.4). Because most attendees ate all items on a fixed menu, no individual food item could be conclusively associated with illness. Circumstantial evidence suggests, however, that ice contaminated by a food handler may have been the vehicle. The restaurant had multiple sanitary violations, and 2 employees, 1 with asymptomatic giardiasis and the other with a Giardia-infected, diapered child, served ice to the attendees. This outbreak demonstrates the potential for restaurant-based giardiasis outbreaks.

Adolescent↗

Local restaurant smoking policy enactment in Massachusetts.

The objective of this study was to identify differences between communities that enact local restaurant smoking policies in Massachusetts and those that do not. Using data from 314 reporting cities and towns, the authors determined that communities with restaurant smoking policies were typically medium-sized towns and had a lower proportion of blue-collar workers than non-adopting communities. Highly restrictive communities had higher median incomes and educational attainment than non-adopting communities. Since the creation of the Massachusetts Tobacco Control Program, the number and strength of restaurant smoking policies have grown.

Demography↗

Multiple outbreaks of Norwalk-like virus gastro-enteritis associated with a Mediterranean-style restaurant.

The role of diverse infectious agents, particularly Norwalk-like viruses (NLV), in three successive gastro-enteritis outbreaks in one setting (a restaurant) was evaluated. Methods included standard bacteriological tests, specific tests for Escherichia coli, tests for verocytotoxins, electron microscopy (EM) for viruses and reverse transcription-PCR (RT-PCR) methodology for NLV. No pathogenic bacteria were detected. Verocytotoxin genes, although detected by PCR in the first outbreak, could not be confirmed in the E. coli isolated, so they did not appear to be of significance. NLV was the main agent detected in each of the three outbreaks. DNA sequencing and phylogenetic analysis of the amplified products obtained from the RT-PCR positive specimens indicated that only one NLV strain was involved in each outbreak, but the NLV strains responsible for the three outbreaks were different from each other. PCR technology for detection of NLV proved highly sensitive, but failed to detect one specimen which was positive by EM. The restaurant associated with the outbreaks is a Mediterranean-style restaurant where food from a common platter is typically eaten with fingers. The findings indicate that NLV was introduced by guests or staff and was not due to a long-term reservoir within the setting.

Caliciviridae Infections↗

Is household smoking status associated with expenditure on food at restaurants, alcohol, gambling and insurance? Results from the 1998-99 Household Expenditure Survey, Australia.

AIM: To examine how household expenditure on food at restaurants, alcohol, gambling and insurance vary between smoking and non-smoking households. DESIGN: Cross sectional survey of households from private dwellings, conducted by the Australian Bureau of Statistics (ABS), using a stratified multistage area sample design. SETTING: Australia, 1998-99. PARTICIPANTS: Nationally representative sample of households (n = 6892). MAIN OUTCOME MEASURES: Expenditure on meals at restaurants, alcohol, alcoholic beverages at licensed premises, gambling, and insurance. RESULTS: The odds of reporting expenditure on restaurant food and health insurance were 20% and 40% smaller for smoking than non-smoking households, respectively. The odds of reporting expenditure on alcohol (not including expenditure at licensed premises), drinking at licensed premises, and gambling were 100%, 50%, and 40% greater for smoking than for non-smoking households, respectively. CONCLUSIONS: The study suggests that smokers are more likely to engage in risky behaviour. Implementing smoking bans in licensed premises and gambling venues can provide an opportunity to reduce smoking prevalence. Quitting or cutting down smoking can provide opportunities for expenditure on other products or services, and enhance standards of living.

Alcohol Drinking↗

An outbreak of Salmonella enteritidis phage type 34a infection associated with a Chinese restaurant in Suffolk, United Kingdom.

BACKGROUND: On 30th July 2002, the Suffolk Communicable Disease Control Team received notifications of gastrointestinal illness due to Salmonella Enteritidis in subjects who had eaten food from a Chinese restaurant on 27th July. An Outbreak Control Team was formed resulting in extensive epidemiological, microbiological and environmental investigations. METHODS: Attempts were made to contact everybody who ate food from the restaurant on 27th July and a standard case definition was adopted. Using a pre-designed proforma information was gathered from both sick and well subjects. Food specific attack rates were calculated and two-tailed Fisher's exact test was used to test the difference between type of food consumed and the health status. Using a retrospective cohort design univariate Relative Risks and 95% Confidence Intervals were calculated for specific food items. RESULTS: Data was gathered on 52 people of whom 38 developed gastrointestinal symptoms; 16 male and 22 female. The mean age was 27 years. The mean incubation period was 30 hours with a range of 6 to 90 hours. Food attack rates were significantly higher for egg, special and chicken fried rice. Relative risk and the Confidence interval for these food items were 1.97 (1.11-3.48), 1.56 (1.23-1.97) and 1.48 (1.20-1.83) respectively. Interviews with the chef revealed that many eggs were used in the preparation of egg-fried rice, which was left at room temperature for seven hours and was used in the preparation of the other two rice dishes. Of the 31 submitted stool specimens 28 tested positive for S Enteritidis phage type 34a and one for S Enteritidis phage type 4. CONCLUSION: In the absence of left over food available for microbiological examination, epidemiological investigation strongly suggested the eggs used in the preparation of the egg-fried rice as the vehicle for this outbreak. This investigation highlights the importance of safe practices in cooking and handling of eggs in restaurants.

Adult↗