Changes to diet and exercise could avoid 26,000 cases of cancer a year in women

Around 500 cases of cancer in women every week in the UK could be prevented by keeping a healthy weight and increasing exercise | British Journal of Cancer | story via Cancer Research UK

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The latest figures, calculated from 2015 cancer data, found that whilst smoking remains the biggest preventable cause of cancer, everyday changes to live a little more healthily can have a large impact.

By keeping a healthy weight, drinking less alcohol, eating more fibre, cutting down on processed meat and being more active, more than 26,000 cancer cases in women could be avoided each year.

This equates to 15% of all cancers diagnosed in women each year in the UK. More than 24,000 cases of cancer in men could also be avoided with the same approach.

Full story at Cancer Research UK

Full reference: Brown, K. et al. | The fraction of cancer attributable to known risk factors in England, Wales, Scotland, Northern Ireland, and the UK overall in 2015 | British Journal of Cancer 2018 | Vol. 118 p1130–1141

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Preventing Type 2 diabetes

Guidance on how to optimise the NHS Diabetes Prevention Programme in order to identify those at risk of Type 2 diabetes and help lower their risk of developing the disease | Public Health England

NHS DPP
Image source: www.gov.uk

Healthier You: NHS Diabetes Prevention Programme (NHS DPP)

The NHS DPP is a joint commitment from Public Health England, NHS England and Diabetes UK. The Programme, launched in 2015, delivers evidence based behavioural interventions at scale for individuals identified as being at high risk of developing Type 2 diabetes.

The NHS DPP is underpinned by a strong evidence base. PHE has published a systematic review and meta-analysis examining the effectiveness of diabetes prevention programmes.

The goals of the NHS DPP are to:

  • reduce the incidence of Type 2 diabetes
  • reduce the incidence of complications associated with Type 2 diabetes – heart, stroke, kidney, eye and foot problems related to diabetes
  • reduce health inequalities associated with incidence of Type 2 diabetes, over the longer term

In the short-term, the Programme recognises that a stronger focus on identifying people who are at risk of diabetes is likely to increase recorded incidence of diabetes as more undiagnosed cases are uncovered. This is important to recognise as it is possible to live for some time with undiagnosed Type 2 diabetes; in 2015, an estimated 900,000 people had Type 2 diabetes but were undiagnosed.

There is strong international evidence that demonstrates how behavioural interventions, with a focus on supporting people to maintain a healthy weight and be more active, can significantly reduce the risk of developing Type 2 diabetes. The NHS DPP behavioural intervention reflects this evidence, as it is underpinned by 3 core goals:

  • achieving a healthy weight
  • achievement of dietary recommendations
  • achievement of the Chief Medical Officers’ (CMO) physical activity recommendations
Dr Jonathan Valabhji outlines the aims of NHS Diabetes Prevention Programme

Full detail: Health matters: preventing Type 2 Diabetes

Use of screens during leisure time linked to adverse health outcomes

A new study from the University of Glasgow has found a strong association between discretionary screen time, that is electing to spend leisure time on screens,  and adverse health outcomes, such as mortality and cardiovascular disease.  This is particularly true of  those with low fitness, low muscle strength or physical activity levels (via University of Glasgow).

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The researchers analysed the behaviour of almost 400,000 people and discovered that the association between a high level of discretionary screen time and unfavourable health outcomes, was almost twice as strong in those with low fitness levels or low grip strength.  More screen time was associated with an increased risk of all-cause mortality, as well as a higher risk of both heart disease and cancer.

Individuals who viewed screens for five or more hours each day (the highest screen category) had a higher prevalence of current smoking, obesity and comorbidities, including diabetes and hypertension as well as higher prevalence of being on medication for hypertension and higher cholesterol, when compared individuals who used screens during leisure time for fewer than two hours a day (the lowest screen-time group). They also had a higher BMI, waist circumference and percentage body fat,  consumed more processed meat and less fruit and vegetables, as well as lower levels of physical activity, fitness and grip strength in comparison to those in the lowest screen-time group.  While the researchers observed  similar patterns when participants were stratified by TV-viewing categories, this was not the case for PC screen-time categories.

Source: Celis-MoralesC. A., et al. (2018)

University of Glasgow Too much screen time associated with heart disease and cancer

 

The paper has been published in the BMC

Abstract

Background

Discretionary screen time (time spent viewing a television or computer screen during leisure time) is an important contributor to total sedentary behaviour, which is associated with increased risk of mortality and cardiovascular disease (CVD). The aim of this study was to determine whether the associations of screen time with cardiovascular disease and all-cause mortality were modified by levels of cardiorespiratory fitness, grip strength or physical activity.

Methods

In total, 390,089 participants (54% women) from the UK Biobank were included in this study. All-cause mortality, CVD and cancer incidence and mortality were the main outcomes. Discretionary television (TV) viewing, personal computer (PC) screen time and overall screen time (TV + PC time) were the exposure variables. Grip strength, fitness and physical activity were treated as potential effect modifiers.

Results

Altogether, 7420 participants died, and there were 22,210 CVD events, over a median of 5.0 years follow-up (interquartile range 4.3 to 5.7; after exclusion of the first 2 years from baseline in the landmark analysis). All discretionary screen-time exposures were significantly associated with all health outcomes. The associations of overall discretionary screen time with all-cause mortality and incidence of CVD and cancer were strongest amongst participants in the lowest tertile for grip strength and weakest amongst those in the highest grip-strength tertile (all-cause mortality 1.04, p = 0.198; CVD 1.05, p = 0.070; cancer 0.98, p = 0.771). Similar trends were found for fitness (lowest fitness tertile: all-cause mortality 1.23, p = 0.002 and CVD 1.10, p = 0.010; highest fitness tertile: all-cause mortality 1.12, p = 0.570). Similar findings were found for physical activity for all-cause mortality and cancer incidence.

Conclusions

The associations between discretionary screen time and adverse health outcomes were strongest in those with low grip strength, fitness and physical activity and markedly attenuated in those with the highest levels of grip strength, fitness and physical activity. Thus, if these associations are causal, the greatest benefits from health promotion interventions to reduce discretionary screen time may be seen in those with low levels of strength, fitness and physical activity.

Full reference:

Celis-MoralesC. A., et al|2018| Associations of discretionary screen time with mortality, cardiovascular disease and cancer are attenuated by strength, fitness and physical activity: findings from the UK Biobank study |BMC Medicine | https://doi.org/10.1186/s12916-018-1063-1

The article is available to download from BMC Medicine

In the media:

BBC High levels of screen time linked to cancer and heart disease

An introduction to the social determinants of health

What makes us Healthy? An An introduction to the social determinants of health | The Health Foundation

This report explores how a person’s opportunity for health is influenced by factors outside the health and social care system.

It also shows that many people don’t have the same opportunities to be as healthy as others. It contains suggestions for further reading and highlights how action can create improvements in the health of the whole population, for the lasting benefit of individuals, society and the economy.

Full document available here

Tackling multiple unhealthy risk factors

This report shares learning and insight from services that are using innovative ways to address the problem of multiple unhealthy risk factors in their populations | The King’s Fund

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Image source: http://www.kingsfund.org.uk/

This new report from the King’s Fund draws on interviews and information from eight case studies in local authorities and the NHS and updates the evidence base on tackling multiple unhealthy risk factors.

Previous research by The King’s Fund has shown that unhealthy behaviours cluster in the population. Around seven in ten adults do not follow guidelines on tobacco use, alcohol consumption, healthy diet or physical activity, yet most behaviour change services address these behaviours separately, not reflecting the reality of people’s lives.

Most services included in the report are local authority led and are integrated health and wellbeing services. These provide behavioural advice and support to people across a range of different behaviours, including smoking, weight management and physical activity.

Full report: Tackling multiple unhealthy risk factors: emerging lessons from practice

Summary available here

Key Data on Young People

Key Data on Young People 2017 | The Association for Young People’s Health (AYHP) | via OnMedica

This report looks at the living circumstances, education and employment, health behaviours and lifestyle, sexual health, mental health, physical health and long-term conditions, and use of health care services of children and young people.

The report  found evidence of a number of positive trends, with rates of drinking, smoking and teenage pregnancy all continuing to fall. However, authors explained the teens and early 20s remain a ‘risky period’ in health terms, for a range of issues that will have lifetime implications. These include: diet, activity and obesity; sexually transmitted infections; the peak age for diagnosis of a number of chronic conditions such as asthma and type 1 diabetes; the peak age for hospitalisation for challenging conditions such as eating disorders and self-harm; the most common age for concerns around child sexual exploitation.

The report also highlighted the impact of health inequalities, with young people living in the most deprived areas are more likely to be killed or seriously injured on roads, more likely to be obese, and more likely to have worse physical, mental and sexual health outcomes.

Full report: Key Data on Young  People 2017:  Latest information and statistics 

OnMedica News story: We are ‘sitting on a young people’s health time bomb’

New liver disease data shows major variation across England

The rate of people dying early from liver disease in some parts of England is almost 8 times higher than others. | Public Health England

New data published by Public Health England (PHE) shows a wide variation of premature mortality rates from liver disease across England.

Liver disease is almost entirely preventable with the major risk factors, alcohol, obesity and Hepatitis B and C, accounting for up to 90% of cases. The atlas will help health professionals to allocate their resources to improve patient outcomes.

The atlas shows premature mortality rates – dying before the age of 75 – ranged from 3.9 per 100,000 in South Norfolk clinical commissioning group (CCG) to 30.1 per 100,000 in Blackpool CCG, a 7.7 fold difference.

The atlas paints a mixed picture, with 10 indicators showing improvements including a reduction of premature deaths and fewer alcohol-specific hospital admissions for under 18s.

Nine of the indicators have become worse over time, including a doubling of hospital admission rates for cirrhosis from 54.8 per 100,000 to 108.4 per 100,000 people over the past decade. This indicator also varies significantly across the country with an 8.5 fold variation across CCGs and this gap has widened over the past decade.

The 2nd Atlas of Variation in risk factors and healthcare for liver disease in England will be published on the PHE fingertips website.