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NHS Direct Health News

NHS Choices: Behind the headlines   + / -  
last updated: Fri, 26 Aug 2016 01:56:57 GMT

 Thu, 25 Aug 2016 17:30:00 GMT Excess body fat now linked to 13 different types of cancer

"Experts have linked eight more cancers to being overweight or obese, nearly tripling the list from five to 13," the Daily Mail reports.

This is the latest finding of the International Agency for Research on Cancer (IARC), a group of cancer experts from around the world that look at risk factors for cancer. 

What is the basis for these reports?

The headlines are based on a report published in the peer-reviewed New England Journal of Medicine.

The report is not exactly new research, but a review of previously published studies that looked at the link between weight and cancers.

It is the result of a working group of international cancer researchers who met to review the evidence in April this year.

They reviewed studies in humans, animals and basic science to see whether the group's previous conclusions, published in 2002, needed to be updated.

The group's new report concludes that, "the absence of excess body fatness lowers the risk of most cancers", also saying that losing weight intentionally may help prevent cancer.

They list 13 cancers where they say there is "sufficient" evidence to conclude that being a healthy weight reduces the risk of cancer, three where there is "limited" evidence, and eight where the evidence is "inadequate".

The cancers they identify as having sufficient evidence to link them to weight are:

The degree of increased risk ranged from an almost fivefold increase for oesophageal cancer in the highest BMI category compared with people with a normal weight (relative risk [RR] 4.8; 95% confidence interval [CI] 3.0 to 7.7), to a 10% increased risk of postmenopausal breast cancer (RR 1.1, 95% CI 1.1 to 1.2).

What is the link between cancer and weight?

Scientists have known for some time that people who are overweight have an increased risk of certain cancers compared with people of a healthy weight.

A healthy weight is usually defined as having a body mass index (BMI) of 18.5 to 24.9. People are classed as overweight if their BMI is 25 to 29.9 and obese if their BMI is 30 or over. BMI is calculated from weight and height.

Almost all of the evidence linking being overweight and cancer is from epidemiological studies, which look at large groups of people and then calculate how likely people of different weights are to have been diagnosed with cancer, compared with people of a healthy weight.

Many of these studies also try to take account of other factors that can affect cancer risk, such as whether people smoke, whether they exercise, and how healthy their diet is.

But it's hard to account for all other factors, so individual studies can't really show whether being overweight causes cancer.

When reviewed together, however, and when studies show that the more overweight someone is, the more likely they are to get cancer, the chances are higher that the research is showing that weight has a causal effect.

A report by the IARC in 2002 said there was enough evidence to say being overweight increased the risk of eight cancers, all of which are included in the new list of 13.

Since then other studies have strengthened the evidence, so the IARC now feels it has enough evidence to list these 13 cancers.

How does weight and cancer affect you?

Carrying excess body weight has a number of health risks, including a greater chance of having a heart attack or stroke, as well as being linked to a raised risk of the cancers listed above.

The easiest way to keep to a healthy weight is to avoid putting weight on, but if you already weigh more than you like, diet and exercise can help you achieve a healthier weight.

Talk to your GP or see our 12-week plan to lose weight through healthy eating and physical activity.

Weight is not the only factor that affects the risk of cancer. Although there's no proven way to avoid cancer altogether, you can lower your risk of getting cancer if you:

Links To The Headlines

The big fat cancer curse: Scientists link obesity to thirteen types of disease including the ovaries, stomach and liver. Daily Mail, August 24 2016

Putting on weight can increase risk of 13 different cancers new study claims. Daily Mirror, August 24 2016

Fat cancer threat: obesity found to trigger 8 more types of cancer. The Sun, August 25 2016

Obesity is linked to more cancers. The Times, August 25 2016 (subscription required)

Links To Science

Lauby-Secretan B, Scoccianti C, Loomis D, et al. Body Fatness and Cancer — Viewpoint of the IARC Working Group. The New England Journal of Medicine. Published online August 25 2016

 Wed, 24 Aug 2016 16:40:00 GMT Being sick of the daily commute could be affecting your health

"Why your commute is killing you: stressful rush-hour journeys are shortening commuters' lifespans," The Sun reports after the Royal Society for Public Health published a report arguing that commuting can negatively impact both physical and mental health.

The report highlights research that suggests non-active commuting – not walking or cycling to work – is detrimental to our health.

The research indicates it can increase how many unhealthy foods we eat, impact our mental health and raise blood pressure, among other things.

The issue of commuter health is arguably more important than ever because of the increasing number of people who have to commute.

As the report points out, there are now 24 million regular commuters in England and Wales, with the average commute lasting 56 minutes a day.

Not only does commuting increase snacking habits, it also means we have less free time available to lead an active, healthy lifestyle.

To combat this trend, the report calls for the public to cycle or walk to work where possible. They recommend employers adopt a flexible working policy to allow more people to work from home or travel to and from work at different times.

Transport companies are also called upon to increase healthier food options in stations, put on more trains, get rid of first class carriages to increase seating capacity, and advise travellers of train capacity to enable them to plan their journeys at less stressful times.

Who produced the report?

The report was produced by the Royal Society for Public Health (RSPH) in recognition of the substantial increase in the number of workers with long daily commutes to work.

The society is an independent charity dedicated to the improvement of public health and wellbeing.

In England and Wales 90% of the workforce commutes to work, spending an average of 56 minutes travelling, rising to 79 minutes in London.

The benefits of active travel, such as cycling and walking to work, are well known, yet the majority of commuters opt for passive travel, commuting by car, bus or train – often out of necessity rather than choice.

The report is not a systematic review, so there may have been evidence that contradicted its views that was overlooked. That said, it would be surprising if there was a large body of evidence outlining how rush hour commuting is good for us.

What evidence did they look at?

Evidence was gathered from a variety of sources, including the Office for National Statistics, examining wellbeing, length of commute and type of commute.

The British Household Panel Survey similarly looked at commuting information and measured self-reported health status.

Opinion polls were undertaken by the Royal Society for Public Health themselves, and The Work Foundation surveyed respondents on their work pattern preferences.

What were the main findings?

The main findings were that health status, level of happiness and satisfaction were lower for people who had longer commutes. These people were also more likely to go to their GP.

People who travel by bus or coach had lower levels of life satisfaction and less sense that their daily activities are worthwhile than those travelling by car, while those taking the train had higher levels of anxiety.

In a poll of 1,500 people, 55% said they felt more stressed as a result of their commute and 41% did less physical activity.

Commuters felt their journey contributed an average additional 767 calories – the equivalent of around three Big Macs – to their diet each week from food and drink outside regular meals, and 33% said they snacked more.

The factors impacting health the most were found to be:

  • length of commute
  • uncomfortable temperatures
  • anti-social behaviour
  • overcrowding
  • journey delays

What recommendations did the report make?

The report recommends that commuters engage in active travel where possible, enabling them to build physical activity into their daily routine.

One way of increasing the time workers spend on health-promoting activities is to move towards a flexible home working culture, away from the nine to five.

In recent years the number of organisations allowing employees to work from home has hugely increased, and it's estimated this will be the norm for more than half the workforce by 2017.

This trend needs to continue, says the report, as research shows it is beneficial for both the health and wellbeing of staff, as well as productivity.

But for some workers, flexible working may not be possible – for example, those who work in people-facing roles.

For those who still have to travel at rush hour, transport companies have a role to play in improving the health and wellbeing of their customers and decreasing stress, the report states.

The report says station design guidelines should introduce health and wellbeing as a key consideration for their retail and catering facilities. This could help cut down the extra calories consumed by commuters.

It advises that overcrowding must be tackled to minimise commuters' stress levels. The report recommends publishing crowding levels on train and bus services, empowering commuters to plan their journeys.

The report also calls for longer platforms and more frequent services. And it argues that first class carriages should be abolished, as these are often half empty while the rest of the train is full.

Conclusion

The report does make for interesting reading, especially as more of us are commuting than ever before.

There are steps you can take to factor in a DIY fitness programme as part of your daily routine:

  • Get off a bus or tube stop before your destination.
  • If you need to drive, try to park further away from your office and walk the rest of the way.
  • Discuss project ideas with a colleague while taking a walk.
  • Stand while talking on the telephone.
  • Walk over to someone's desk at work rather than calling them on the phone or sending an email.
  • Take the stairs instead of the lift, or get out of the lift a few floors early and use the stairs.
  • Walk up escalators or travelators rather than standing still.
  • Go for a walk during your lunch break – use a pedometer to keep track of how many steps you take.

And downloading some podcasts on to your smartphone ahead of time can keep you distracted during your commute, which may help reduce your stress levels.

Links To The Headlines

Why your commute is killing you: stressful rush-hour journeys are shortening commuters' lifespans. The Sun, August 24 2016

What's the downside of commuting? An extra 767 calories, report finds. The Daily Telegraph, August 24 2016

UK workers consume 800 extra calories a week while commuting. The Guardian, August 24 2016

Commuting adds 800 calories a week to our diet turning the rat race into the fat race. Mail Online, August 24 2016

Links To Science

Royal Society for Public Health. Health in a hurry. August 2016

 Wed, 24 Aug 2016 15:28:00 GMT Childhood head injury linked to range of adult health problems

"Millions of Brits face dying early because of something they did when they were children," says the Daily Mirror's needlessly alarming headline.

The newspaper reports on a study which found that a head injury causing concussion (known as a traumatic brain injury or TBI) may increase the chances of a range of health problems in later life.

The study used Swedish databases to follow more than a million people for up to 41 years. Nine percent of them had been treated in hospital for a TBI before they were 25.

After adjusting their figures to account for family circumstances, the researchers found those who'd had a head injury were slightly more likely to:

  • be receiving a disability pension
  • have been treated for psychiatric illness
  • not have secondary school qualifications
  • have died before the age of 41

Older children, those with more severe head injuries, and those who had more than one head injury were more likely to be affected.

The study doesn't prove that the head injuries caused the problems.

It's possible that factors the researchers didn't measure had an effect. For example, children with behavioural problems may be both prone to childhood accidents as well as more likely to experience difficulties in adulthood.

When it comes to head injuries, prevention is better than any cure. But it is also important not to discourage your child from taking part in physical activity, as this brings a much greater risk of health problems in adulthood.

 

Where did the story come from?

The study was carried out by researchers from Oxford University, Imperial College London, Indiana University, and the Karolinska Institute in Sweden. It was funded by the Wellcome Trust, the Swedish Research Council and National Institute for Child Health and Human Development.

The study was published in the peer-reviewed journal PLOS Medicine on an open-access basis, so it is free to read online.

The Times, Mirror and Daily Mail headlines all focused on the increased risk of early death after childhood concussion, although this outcome had the lowest absolute risk of all those studied. The researchers analysed their figures three ways, with different levels of accounting for confounding factors, including family circumstances. Perhaps unsurprisingly, the newspapers used the figures which showed the biggest increase in risk, not the ones that took full account of this confounding.

However, the newspapers did quote experts who cautioned there is a need to balance the risks of injury from sports such as rugby and football against the benefits of taking part in sport. The Mirror's extrapolation that "millions of Britons" are at risk of early death seems a bit over-done, although up to 700,000 children are apparently treated for head injury in the UK each year.

 

What kind of research was this?

This was a cohort study, using a national database of births in Sweden. These studies are good ways to find links between factors, in this case head injury in childhood or early adulthood, and a range of outcomes including poor educational achievement, inability to work on health grounds, and early death. However, they cannot prove that one causes the other.

 

What did the research involve?

Researchers followed up 1,143,470 people born between 1973 and 1985 in Sweden. They used Sweden's database system to check whether they'd been treated for a brain injury that caused concussion, before the age of 25. They then looked at a range of outcomes in adulthood, including poor educational achievement and early death. After adjusting their figures to take account of people's family circumstances, they looked to see whether people who'd had a head injury were more likely to have one of these outcomes.

Family circumstances, including deprivation, parental education level and environment, can affect both the chances of having a head injury and the chances of one of the long-term outcomes being measured. Therefore the researchers also looked at what happened to the brothers or sisters of children with head injury, to see whether they were more or less likely to have had one of these outcomes.

They calculated the risk of the outcomes for people with and without head injury in early life using three models. First they just adjusted for sex, year of birth and order in which children were born. In the second model they also adjusted for family circumstances such as income and parental education. Finally, they performed further adjustments to take account of what happened to siblings of children with head injuries. The figures we report in the results section below are the third set of figures, as they are likely to be the least affected by confounding factors.

Researchers also calculated the absolute risks of the different outcomes, and looked at the effects of the severity of injury, age of injury and repeated injury. 

 

What were the basic results?

Of more than a million people studied, 104,290 (9.1%) had been treated for a head injury. Looking at the people injured compared to 55,831 siblings who had not had head injuries:

  • 6.3% received a disability pension, compared to 5.5% of unaffected siblings
  • 20% had an outpatient psychiatric visit (10.4% were admitted to psychiatric hospital), compared to 18.4% of unaffected siblings (9% were admitted to psychiatric hospital)
  • 1.6% had died before age 41, compared to 1.4% of unaffected siblings
  • 13.9% didn't pass secondary school qualifications, compared to 12.5% of unaffected siblings

These figures translate into increased relative risks which look high, though the overall difference between people with and without head injury is small, as shown above. For each outcome, the results are:

  • 49% increased risk of disability pension (relative risk (RR) 1.49, 95% confidence interval (CI) 1.38 to 1.6)
  • 31% increased risk of outpatient psychiatric visit (RR 1.31, 95% CI 1.26 to 1.37)
  • 57% increased risk of admission to psychiatric hospital (RR 1.57, 95% CI 1.47 to 1.67)
  • 40% increased risk of death before age 41 (95% CI 1.16 to 1.68)
  • 28% increased risk of low educational achievement (95% CI 1.23 to 1.33)

In addition, the results showed that having a severe head injury increased the risk of any of these outcomes, as did having more than one head injury.

 

How did the researchers interpret the results?

The researchers say their results "indicate potentially causal effects" between head injury in childhood and problems later in life. They say this implies a need to prevent head injury, through better parental supervision of young children and prevention of sports-related concussion for older children. This "could focus on changes to rules so that risks of players colliding their heads with each other or with equipment", including heading footballs, is reduced, they say.

Less controversially, they call for age-appropriate follow-up of children who've had head injuries, to try to prevent them from falling behind at school, and to take action on signs of health or social problems.

 

Conclusion

This is an important study, but the more alarming headlines over-state the absolute risks of problems in adulthood following on from a childhood head injury. The majority of people who'd had a head injury didn't have any of the problems studied, and the overall risk of death by age 41 – the outcome that got most press attention – was 1.6% – only 0.2 percentage points higher than for the unaffected siblings of children with head injury.

The study has a number of strengths:

  • it is very large
  • has a long follow-up period
  • the Swedish database records are thought to be accurate
  • it includes figures about siblings of children with head injury, helping to account for some of the differences seen with family upbringing, although they can't account for everything

Some experts questioned whether neurodevelopmental disorders such as attention deficit hyperactivity disorder (ADHD) might increase both the risk of head injury and of the adverse outcomes in adulthood. However, the researchers say they took account of psychiatric and neurological conditions that occurred before age 25, and that this did not affect the results.

As various experts have warned, the risk of head injury should not be used as a reason for children not to take part in activities such as sports. We don't know from the study whether the injuries were sports-related, and we do know that physical activity has many benefits, including in the fight against childhood obesity.

Perhaps the most important conclusion from the study is that children and young people who've had a concussion should be monitored for signs of problems later in life, so that they can be helped to avoid some of the potential consequences.  

Links To The Headlines

Childhood concussion warning: Even a minor bang to the head can raise the risk of an early death. Daily Mail, August 24 2016

Millions of Brits face dying early because of something they did when they were children. Daily Mirror, August 24 2016

Child head injuries linked to early death. The Times, August 24 2019 (subscription required)

Links To Science

Sariaslan A, Sharp DJ, D’Onofrio BM, et al. Long-Term Outcomes Associated with Traumatic Brain Injury in Childhood and Adolescence: A Nationwide Swedish Cohort Study of a Wide Range of Medical and Social Outcomes. PLOS Medicine. Published online August 23 2016


 

 
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