Lunar rhythms of the meal and alcohol intake of humans

Moonlight surgery: no influence of moon phase or Friday 13th on outcomes of total knee arthroplasty

OBJECTIVES

The purpose of the present study was to investigate associations between revision-free survival and functional scores of total knee arthroplasty (TKA) and moon phase on the day of surgery, as well as operations performed on a Friday 13th.

PARTICIPANTS

The data of all patients that received TKA between 2003 and 2019 were extracted from the Tyrol arthroplasty registry. Patients that had undergone previous total or partial knee arthroplasty as well as patients that had missing pre- or post-operative WOMAC were excluded. Patients were allocated to one of the following four groups according to moon phase on the day of surgery: new, waxing, full and waning. Patients operated on a Friday 13th were also identified and compared to patients operated on any other days/dates. A total of 5923 patients met the inclusion criteria, with mean age of 69 ± 9 years, and comprising 62% women.

RESULTS

There were no significant differences in revision-free survival among the four moon phase groups (p = 0.479), and no significant differences in preoperative and postoperative total WOMAC (p = 0.260, p = 0.122), There were no significant differences in revision-free survival patients operated on Friday 13th vs. other days/dates (p = 0.440). The preoperative total WOMAC was significantly worse for patients operated on a Friday 13th (p = 0.013), which was observed in the pain (p = 0.032) and function (p = 0.010) subscales. There were no significant differences in postoperative total WOMAC at 1 year follow-up (p = 0.122).

CONCLUSIONS

Neither moon phase on the day of surgery nor Friday 13th were associated with revision-free survival or clinical scores of TKA. Patients operated on a Friday 13th had significantly worse preoperative total WOMAC but similar postoperative total WOMAC at 1-year follow-up. These findings could help reassure patients that TKA renders consistent outcomes regardless of the preoperative pain or function, and in spite of bad omens or moon phases.

Lunar cycle in homicides: a population-based time series study in Finland

OBJECTIVE

To test whether homicides in Finland vary according to moon phases.

DESIGN

A time series study.

SETTING

Finland.

PARTICIPANTS

6808 homicides committed in 1961-2014.

OUTCOME

Daily numbers of homicides.

METHOD

The daily numbers of homicides were related to eight moon phases and the illuminated percentage of the moon disc using negative binomial regression. To identify lunar patterns, piecewise linear terms of lunar days were used, together with changes from one moon phase to another. Homicides were similarly regressed on quintiles of the illuminated percentage of the moon disc. A periodic term of length 29.53 days was included to detect cyclic patterns. The results were adjusted for sex, age, secular trend, distance from the moon, seasons, weekday, major holidays and temperature.

RESULTS

During the full moon, 15% less homicides were committed than during the new moon (RR 0.85; 95% CI 0.77 to 0.94) and 86% less during the lightest quintile of illumination compared with the darkest quintile (RR 0.14; 95% CI 0.04 to 0.50). Adjustments did not change the results. Piecewise linear regressions showed a significant decline in homicides at the full moon and a rise thereafter. The full moon drop in homicides was directionally similar for seasons, weekdays, sex, age and time periods, and it was particularly pronounced in the early part of period studied (1961-1974). Periodic regression showed a regular cyclic pattern of length 29.53 days (p~0.035).

CONCLUSIONS

Contrary to current scientific opinion, an association exists between moon phases and homicides, and contrary to what has been previously assumed, homicides declined during the full moon, especially in earlier decades. However, the causality of the association remains elusive.

Moon phases and moon signs do not influence morbidity, mortality and long-term survival, after living donor kidney transplantation

Background

Approximately 11% of the German population are convinced that certain moon phases and moon signs may impact their health and the onset and clinical course of diseases. Before elective surgery, a considerable number of patients look to optimize the timing of the procedure based on the lunar cycle. Especially patients awaiting living donor kidney transplantation (LDKT) commonly look for an adjustment of the date of transplantation according to the moon calendar. This study therefore investigated the perioperative and long-term outcome of LDKT dependent on moon phases and zodiac signs.

Methods

Patient data were prospectively collected in a continuously updated kidney transplant database. Two hundred and seventy-eight consecutive patients who underwent LDKT between 1994 and December 2009 were selected for the study and retrospectively assigned to the four moon phases (new-moon, waxing-moon, full-moon, and waning-moon) and the corresponding zodiac sign (moon sign Libra), based on the date of transplantation. Preexisting comorbidities, perioperative mortality, surgical outcome, and long-term survival data were analyzed.

Results

Of all LDKT procedures, 11.9, 39.9, 11.5, and 36.5% were performed during the new, waxing, full, and waning moon, respectively, and 6.2% during the moon sign Libra, which is believed to interfere with renal surgery. Survival rates at 1, 5, and 10 years after transplantation were 98.9, 92, and 88.7% (patient survival) and 97.4, 91.6, and 80.6% (graft survival) without any differences between all groups of lunar phases and moon signs. Overall perioperative complications and early graft loss occurred in 21.2 and 1.4%, without statistical difference (p > 0.05) between groups.

Conclusion

Moon phases and the moon sign Libra had no impact on early and long-term outcome measures following LDKT in our study. Thus, concerns of patients awaiting LDKT regarding the ideal time of surgery can be allayed, and surgery may be scheduled independently of the lunar phases.

Howling at the moon? The effect of lunar phases on post-surgical pain outcome

OBJECTIVE

Many people are convinced that lunar phases influence their lives - despite the fact that a lot of studies have shown that this belief is wrong. In this article, we investigate the effect of lunar phases on acute post-surgical pain and on treatment-related side effects. We hypothesize that there is no influence.

METHODS

The data for the study were collected in 2010 and 2011 in 10 international hospitals participating in the research project PAIN OUT. Hospitalized patients were asked for their pain after surgery and pain treatment side effects using numerical ratings scales from 0 to 10. We applied Kurskal-Wallis H-tests to find out if the four moon phases show significant differences in 14 outcome variables. Afterwards, we adjusted for age, gender and three tracer surgeries.

RESULTS

A total of 12,224 patient data sets were assessed. For most variables and sub-groups, there is no lunar effect on the observed outcome variables. The only items that show statistically significant differences are pain interference with sleep (p = 0.01) and drowsiness (p = 0.01). The only sub-groups that show statistically significant connections to lunar phases in some variables are men (7 out of 14 variables significant) and elderly people (4 out of 14 variables significant).

DISCUSSION

Even in the statistically significant sub-groups, the differences are small and only show up in some variables. We conclude that lunar phases have no effect on post-surgical pain or its side effects. The hypothesis holds. Thus, there is no reason for patients to postpone surgeries or to fear surgeries on any given date.

Association of food form with self-reported 24-h energy intake and meal patterns in US adults: NHANES 2003-2008

BACKGROUND

Laboratory studies suggest that food form (beverages compared with solid foods) evokes behavioral and physiologic responses that modify short-term appetite and food intake. Beverage energy may be less satiating and poorly compensated, which leads to higher energy intake.

OBJECTIVE

We examined associations between 24-h energy consumed in beverages and a variety of meal and dietary attributes to quantify the contribution of beverage consumption to the energy content of diets in free-living individuals consuming their self-selected diets.

DESIGN

We used dietary recall data for adults (n = 13,704) in NHANES 2003-2008 to examine the multiple covariate-adjusted associations between 24-h energy from beverages and nonbeverages and associations between beverage intake, eating behaviors, and the energy density of beverage and nonbeverage foods.

RESULTS

In the highest tertile of 24-h beverage energy intake, beverages provided >30% of energy. Total 24-h energy and nonbeverage energy consumption and energy density (kcal/g) of both beverage and nonbeverage foods increased with increasing energy from beverages (P < 0.0001). With increasing 24-h beverage energy consumption, the reported frequency of all, snack, and beverage-only ingestive episodes and length of the ingestive period increased, whereas the percentage of energy from main meals decreased (P < 0.0001).

CONCLUSIONS

Higher 24-h beverage energy intake was related to higher energy intake from nonbeverage foods, quality of food selections, and distribution of 24-h energy into main meal and snack episodes. Moderation of beverage-only ingestive episodes and curtailing the length of the ingestion period may hold potential to lower uncompensated beverage energy consumption in the US population.

The epidemiology and chronobiology of epistaxis: an investigation of Scottish hospital admissions 1995-2004

OBJECTIVES

This study aimed at investigating aspects of the epidemiology and chronobiology of emergency admissions with epistaxis in Scotland between 1995 and 2004. In particular, we sought to examine the epidemiology of hospital admission with epistaxis and effects of factors such as day of week, time of year and lunar cycle.

DESIGN

A statistical analysis, in terms of descriptive statistics, logistical regression and linear regression, was carried out on data obtained from the Scottish Morbidity Records related to emergency Ear, Nose and Throat (ENT) admissions.

SETTING AND PARTICIPANTS

All emergency inpatient admissions for Scottish residents to ENT wards in Scottish NHS hospitals during the 10-year period, between 1st January 1995 and December 31st 2004 were studied. This study only looked at admissions and thus excludes Accident and Emergency attendances caused by epistaxis.

MAIN OUTCOME MEASURES

Age, gender, year, month and day of the week of admission were considered, as was relationship to the moon phase.

RESULTS

During the study period, the mean daily admission rate with epistaxis was six. Epistaxis accounted for 33% of all ENT emergency admissions. The average age of non-epistaxis ENT emergency admission was 31 years. For epistaxis emergency admissions the median age was 70 years. There were fewer admissions in the summer months [August RR: 0.59 (95% CI: 0.54-0.65) P < 0.001]. There were more admissions at the weekends and on non-weekend public holidays [RR: -0.115 (95% CI -0.160-0.071) P < 0.001]. There was a trend towards a reduction in admission rates from the year 2001. Despite the fluctuations with season and weekday, there was no relationship with phase of the moon [RR: 0.98 (95% CI: 0.88-1.09) for day of the full moon compared with non-full moon weekday].

CONCLUSIONS

This study underlines the importance of epistaxis as the single most frequent emergency diagnosis in ENT. The frequency and patterns of admission show pronounced fluctuations. The observed increase in winter admissions confirms earlier work and may have implications for health resource allocation. Relationships between weekends/public holidays and increased admissions with epistaxis may correspond with social patterns of alcohol use (a known aetiological factor). The lunar cycle does not have an effect on the frequency of epistaxis admissions.

The influence of the full moon on the number of admissions related to gastrointestinal bleeding

The objective of this study was to analyse whether the number of admissions for gastrointestinal bleeding to our bleeding unit increases during the full moon. In a prospective study, we included 447 consecutive patients with gastrointestinal haemorrhage admitted to our bleeding unit during a period of two years. The number of admissions was allocated to the corresponding day of the lunar cycle, and full moon and non-full moon days were compared. A wide variation in the number of admissions throughout the lunar cycle was observed. There were 26 admissions on the 25 days of full moon and 421 admissions in the remaining 713 days of non-full moon. This difference was mainly related to a higher incidence of haemorrhage in men and variceal haemorrhage at full moon. The results of this study suggest an increase in the number of admissions related to gastrointestinal haemorrhage in our bleeding unit during the full moon, especially in men and in patients experiencing variceal haemorrhage. However, the wide variation in the number of admissions throughout the lunar cycle could limit interpretation of the results. Therefore, further studies are needed to clarify the possible influence of the moon on gastrointestinal haemorrhage.

Cyclic time patterns of death from suicide in northern Finland

BACKGROUND

Time patterns of suicide have been attributed not only to social and psychological factors but also to direct geophysical effects. Seasonal variations in day length and temperature seem likely to contribute to the timing of the suicide process.

METHODS

We analysed all suicides (n=1658) committed in a northern province of Finland during a period of 153 months. Daily data on the number of suicides, local weather conditions and geomagnetic storms were compiled and modelled with Poisson regression using the province population as the denominator, and with the means of harmonic series for seasonal variation. Time series analysis of monthly numbers of suicides was carried out using the seasonal-trend decomposition procedure based on loess.

RESULTS

Marked fluctuations in the number of suicides occurred during the study period (P=0.01). There was significant seasonal variation in death from suicide (P=0.01), but analysis of the meteorological data showed no evidence of effect on the risk of suicide.

LIMITATIONS

Assessment of mental disorder or alcohol consumption was missing, since only data derived from death certificate was available for each case.

CONCLUSIONS

The seasonal effect was significant, but remained modest compared to sex and age as risk factors for suicide. Preventive measures need to be tailored according to time of the year.

Food intake in the real world: implications for nutrition and aging

Nutrient intakes are affected by two classes of factors, physiological and environmental. In the real world, environmental variables such as social factors, palatability, and the time of eating appear to have large influences on amounts ingested in the short-term. Physiological control mechanisms also operate to regulate intake, and they induce compensatory responses to deviations from the norm. These physiological influences only appear to have weak influences on short-term intake unless there are large deviations from the normal state, but over the long-term they act patiently and persistently to rectify the excesses produced by environmental fluctuations and thereby tend to maintain a relative balance between energy intake and expenditure. As individuals age there is a progressive decline in physiological function including the mechanisms that act to control intake in the young. This should not produce a problem in a healthy individual in a stable environment: however, if that situation should change due to illness or an environmental change such as the death of a spouse, which produces decline in intake, elderly individuals would not have the physiological mechanisms present to compensate. Thus, the deficit in energy intake would not be replaced, and the lower level of intake would be maintained as long as the new health condition or environment remains stable. Hence, the decline in the effectiveness of the physiological systems with age makes the elderly particularly vulnerable and unable to rebound from deficits. Although the elderly have difficulty compensating for deficits automatically by physiologically-induced adjustments, the studies of real world intake reviewed in this article suggest that compensation can be produced by adjustments to the environment. The elderly appear to be as responsive to environmental factors as younger individuals. In particular, they appear to increase intake in response to social facilitation, diurnal rhythms, the eating environment, and palatability to the same extent as their juniors. These data suggest that alterations in the social, temporal, environmental, or hedonic conditions of eating could induce desired alterations in the nutrient intakes of the elderly. The study of real world eating behavior has produced evidence that suggests that this strategy can work. It remains for future applied investigations to ascertain whether or not this strategy is effective in treating undernutrition in the elderly.

A general model of intake regulation

Previously proposed models of intake regulation focus on specific variables thought to influence overall intake, and include factors involved in negative feedback loops with intake as well as genetic influences on intake. Recent evidence, however, suggests that these models although informative, are incomplete. They cannot account for the observations of prolonged and increasing deviations from defended levels, weakness and transitoriness of compensatory responses, the presence of powerful factors that are not compensated, and behavioral genetic data suggesting that there are a wide variety of independent genetic influences on numerous factors that influence intake. As a result we propose a new general model of intake regulation in which intake is influenced by both a set of uncompensated factors that are not influenced by intake and by a set of compensated factors that are. The preferred levels of intake and both sets of factors are specified as influenced by heredity. Further, the model includes impact factors, weights, which specify the magnitude of the effect each factor has on intake. The weights are assumed to be different for different individuals and their values are determined by heredity. A computer simulation of the new model demonstrated that it maintains different levels depending upon the external and internal environments, that changes in these environments result in new levels, and that inherited individual differences in responsiveness to these factors can markedly influence the levels obtained. The proposed general model appears to fit existing knowledge and is parsimonious and widely applicable. Future work should be directed to testing the general model and further developing specific models within the conceptual framework employing known physiological systems and uncompensated stimuli.

Do animals bite more during a full moon? Retrospective observational analysis

OBJECTIVE

To test the hypothesis that the incidence of animal bites increases at the time of a full moon.

DESIGN

Retrospective observational analysis.

SETTING

Accident and emergency department at a general hospital in an English city.

SUBJECTS

1621 consecutive patients, irrespective of age and sex.

MAIN OUTCOME MEASURES

Number of patients who attended an accident and emergency department during 1997 to 1999 after being bitten by an animal. The number of bites in each day was compared with the lunar phase in each month.

RESULTS

The incidence of animal bites rose significantly at the time of a full moon. With the period of the full moon as the reference period, the incidence rate ratio of the bites for all other periods of the lunar cycle was significantly lower (P <0.001).

CONCLUSIONS

The full moon is associated with a significant increase in animal bites to humans.

Barking mad? another lunatic hypothesis bites the dust

OBJECTIVE

To assess whether dog bites requiring hospital admission occur more at the full moon.

DESIGN

Review of dates of admission for dog bites to accident and emergency departments, June 1997 to June 1998, compared with dates of the full moon.

SETTING

All public hospitals in Australia.

MAIN OUTCOME MEASURES

Admissions for dog bites.

RESULTS

12 peak clusters of admissions were unrelated to the time of the full moon.

CONCLUSION

Dog bites are no more frequent on full moons than at any other time of the month. Sceptics rejoice.

What are the major correlates of macronutrient selection in Western populations?

In order to better understand the factors that may influence and regulate the intake of the macronutrients carbohydrate, fat and protein a 7 d diet diary technique was employed to study eating behaviour in the natural environment of free-living human subjects. In general, factors that promote energy intake tend to promote fat and protein intake to a greater extent than carbohydrate intake. This increased intake occurs as the result of: environmental factors such as social facilitation and the time of day, week or lunar phase; subjective factors such as hunger and elation; individual difference factors such as obesity, restraint and ageing. There are indications that the intake of macronutrients is regulated by negative feedback systems. In the short term, the amount of protein remaining in the stomach at the onset of a meal appears to have a restraining effect on intake, especially protein intake. Over several days, macronutrient intake appears to be affected by a nutrient-specific delayed negative feedback. Protein intake during 1 d is negatively associated with protein intake 2 and 3 d later, while carbohydrate intake is negatively related to later carbohydrate intake, and fat intake to later fat intake; both peaking after a 2 d delay. Studies of the intakes of twins suggested that many aspects of the control of macronutrient intake are influenced by inheritance; these factors include the overall amounts ingested, the before-meal stomach contents and the responsiveness of the subject to the negative impact of the stomach contents. The results indicate that macronutrient intakes are regulated by multiple persistent processes that are to a large extent inherited.

Inheritance of premeal stomach content influences on food intake in free living humans

The heritability of the before-meal stomach content effects on food intake was investigated with 110 identical and 102 fraternal same-sex and 53 fraternal mixed-gender adult twin pairs who were paid to maintain 7-day food intake diaries. From the diary reports, the total and meal intakes of food energy and the amounts of the macronutrients ingested were estimated. A simple computer model of stomach emptying was used to estimate the contents of the stomach at the beginning and end of the meals. Linear structural modeling was applied to investigate the nature and degree of genetic and environmental influences and revealed significant genetic influences on the amount of food energy and macronutrients estimated to be present in the stomach at the beginning and end of meals. However, these influences were found to be secondary to genetic influences on overall intake and meal size such that when these were considered in the model the heritabilities for stomach contents vanished. The genes were also found to affect the magnitude of the negative correlations between the before meal stomach contents and the amounts of nutrients ingested, and the magnitude of the negative slope of the best-fitting regression line between before meal stomach contents and meal size. These results suggest that although the amount in the stomach found at meal time is only affected indirectly by the genes, the impact of the content of the stomach on the amount ingested is to some extent inherited. This suggests that responses to internal stimuli are influenced by the genes and become part of the total package of genetically determined physiological and psychological processes that regulate energy balance.

Prior day's intake has macronutrient-specific delayed negative feedback effects on the spontaneous food intake of free-living humans

A fundamental issue in understanding how energy balance is accomplished involves comprehending how changes in intake affect subsequent intake. This was investigated in free-living humans by reanalyzing the data previously collected from 733 adults who were paid to maintain a 7-d diary of everything they ate and when they ate it. Food energy intake during a day was found to only mildly affect intake on the subsequent day (mean r = -0.07, P < 0.001), but was more strongly negatively related to intake occurring on the second (mean r = -0.18, P < 0.001) and third day (mean r = -0.10, P < 0.001) afterward. Each macronutrient was shown to have a maximal negative relationship with subsequent intake of that same macronutrient, with 2-d lag mean autocorrelations equal to -0.11, P < 0.001 for carbohydrate, equal to -0.18, P < 0.001 for fat, and equal to -0.13, P < 0.001 for protein. These effects on daily intake were found to result from separate negative feedback effects on meal size and frequency. The results suggest that intake affects subsequent intake by persistently setting a long-term bias that, integrated over time, produces a net shift in intake.

How can eating behavior be regulated in the complex environments of free-living humans?

The eating behavior of humans in their natural environments is complexly affected by a myriad of nutritional, physiological, psychological, sociological and cultural factors. We have employed the diet diary technique to document the influence of: the subjective states of hunger, the amount of food or fluid remaining in the stomach at the onset of ingestion, and its composition, the time of day, day of the week, phase of the moon, month of the year, the location, the number of people present, the relationship of eating companions to the subject, dietary restraint, and eating disorders. Recently we have demonstrated, with twins, significant heritabilities for the amounts of foods and fluids ingested, independent of body size. By viewing behavior in free-living conditions the relative importance of these factors in the determination of the amounts and timing of intake can be discerned and measured. The analysis indicates that immediate environmental, psychological, social, and cultural stimuli exert powerful but short-lived effects on intake. Physiological stimuli, on the other hand, appear to influence intake subtly but persistently. Their influences are difficult to document on the short-term, but clear over long periods of time. Short-term intake for the most part would appear to be unregulated and allow to vary spontaneously within a relatively wide range. Physiological variables appear to feed back after a delay of at least a day and usually longer to alter the overall level of intake of bias. The persistent bias continues to shift intake, producing a cumulative net alteration of intake, while the effects of random short-term influences average over tome, and result in no effect on intake.