One of the most significant studies in health has just celebrated 65 years since it started, and it’s still going strong.

Over those 65 years, residents of the small town of Framingham in Massachusetts, USA, have been participating in long-term studies looking at heart disease and its causes.

By the mid-1950s, the number of middle-aged men succumbing to coronary heart disease was causing serious concern – not least when several world leaders developed it. The disease had been on the rise since the start of the 20th century and the Framingham Heart Study set out in 1958 to establish what was behind this.

The study initially recruited more than 5,000 men and women, nearly a fifth of the whole population of Framingham. The researchers collected data about each of the participants every two years using interviews, clinical examinations and laboratory tests. The data covered participants’ lifestyle and environment as well as looking at their health and genetic profiles. This helped to show the importance of not smoking, taking enough physical activity, treating high blood pressure, avoiding obesity and the importance of blood fats in preventing coronary heart disease.

By 1971 the study had recruited a second generation of participants and in 1994 it extended its recruitment to reflect the changing population resulting from an influx of South Americans. 2002 saw the recruitment of a third generation. Over time, the study was widened to include other diseases, notably type 2 diabetes and dementia.

There were similar studies going on elsewhere but none was quite so comprehensive or prolonged. The Framingham study resulted in many papers published in leading scientific journals, and the work was widely discussed in scientific societies worldwide, greatly influencing research, debate and health policy.

Indeed, the findings in this and the other studies changed the way doctors looked at illness. Previously, most doctors thought of an illness as being caused by germs. If the germs could be killed or prevented from spreading, the illness would be eliminated. The Framingham discoveries required a rethink. This resulted in the concept of ‘non-communicable disease’ to explain much of modern illness and highlighted the importance of what we as individuals could do to prevent these diseases, as well as transforming the public health agenda.

There are questions over the future of this study, and whether it will continue to bring sufficient returns on the cost now that its primary objectives have been achieved. The US government has cut substantially its share of the funding.

But the fact remains that this study generated a novel way of looking at all disease and increased phenomenally our understanding of coronary heart disease.

About the study:  http://www.framinghamheartstudy.org/about/

 

Almost everyone likes sugar. Many people like it a lot – a fact that hasn’t escaped food manufacturers.

No longer is sugar simply something to be added at table or used in cakes, biscuits and jams. It has become ubiquitous: you now find it in all sorts of unexpected places – sauces and salad dressings, cured meats, breakfast cereals, curries and ready meals. And, of course, large quantities are added to many fizzy drinks.

There is currently a debate about how much sugar people consume in the industrialised nations. The sugar industry would like us to think it is modest; but – based on the amount of raw and refined sugar produced per year, supported by surveys of populations – it seems that over the past 45 years there has been at least a threefold increase in sugar consumption. In recent years, the increase has been even faster at about 4 to 5 percent per year.

Bangladesh appears to be the country with the lowest sugar consumption at 8 kg per person per year and Israel the highest with an astonishing 66 kg per person per year. Given that this is an average figure, some Israelis must be consuming considerably more – virtually the equivalent of their entire body weight in sugar!

With rising levels of obesity in industrialised and emerging nations alike, and an alarming increase in type 2 diabetes around the world, the question arises of whether these alarming health trends have anything to do with our bodies becoming swamped by sugar.

Recent studies have been examining this. In one*, data from 175 countries showed that levels of diabetes increased with increased availability of sugar, even after taking into account body weight and physical activity levels. The researchers therefore concluded that there was a probable relationship between diabetes levels and sugar consumption, but stressed that their methodology could not prove it. (Reaching secure conclusions about cause and effect requires vast long-term studies.)

In an unrelated study**, the American Heart Association has estimated that sugar-sweetened drinks are responsible worldwide for around 180,000 deaths per year: 133,000 from diabetes, 44,000 from heart disease and 6,000 from cancer. The researchers expressed concern; but again commentators have cautioned about drawing premature conclusions about cause and effect.

Evidence is certainly mounting that sugar consumption at today’s levels may be a major contributor to poor health. Indeed, some communities in the United States are already considering ways of reducing sales of sugary drinks through taxation or banning large portion sizes. Perhaps we should be doing the same on this side of the Atlantic.

Certainly, though, we could each do with a hard look at the stunning amount of sugar we may be consuming. Cutting down will do us no harm, and may prove to be great for our health.

 

*Link to the diabetes and sugar study: http://dx.doi.org/10.1371/journal.pone.0057873

**Multimedia resources, including taped interviews with an AHA expert offering perspective on the science, are available on the right column of this link http://newsroom.heart.org/news/180-000-deaths-worldwide-may-be-associated-with-sugary-soft-drinks?preview=b39f71c47418e98ba6ebd2660b859f96

 

 

Over recent years, there’s been an increase in magazine advertising and direct mailing to the public about tests to screen for a range of diseases. Assuming you can afford these tests, should you go for them? Is this advertising helping people to control their own health or is it simply exploiting deep-seated fears?

It’s true that early detection of a disease often offers the best chance for effective treatment. Cervical cancer provides a good example: detecting the earliest signs of the cancer itself – or of its precursor – has saved many lives. But screening for diseases can raise some tricky issues.

Even with cervical cancer – for which there is good epidemiological data and wide agreement over diagnosis and treatment – not everything is as straightforward as you might expect. For example, there are differences between the four UK countries about the age at which screening should start.

The complexity of screening more generally is illustrated by some major questions about the value of mammography screening for breast cancer, where ‘false positive’ results can cause unnecessary distress for women. There are also doubts about using the blood test PSA in screening for prostate cancer – and, indeed, in the best way to treat this cancer if detected. There’s no point in detecting a condition if it’s uncertain what should be done about it.

A range of other conditions can be screened for and it’s likely the range of tests will continue to expand. For example, checking blood glucose levels can reveal type 2 diabetes, and checking cholesterol levels may show a liability to heart disease. Lifestyle advice and, where appropriate, medication can then significantly reduce the risk of the disease; but even with these there is continuing debate. For something like an ultrasound scan of the carotid arteries in the neck, which is now available, it is far from established that there are benefits for the patient if an abnormality is discovered.

Within the NHS there is a process, aided by independent authorities, for evaluating such tests and giving the best guidance on their use. To establish the usefulness of a screening programme takes detailed scientific work extending over several years. Even then, doubts can arise.

Scans – such as CT, MRI and ultrasound – are now widely used in clinical practice where they have revolutionised diagnosis in a way that was unimaginable 50 years ago. These work best when the clinician has an idea of what’s being looked for. For example, using CT to scan smokers for lung cancer has been shown to detect early cancer and there’s some evidence it improves the outcome for the patient.

But it’s probably not worth investing in a whole-body scan – as is now available at a price – especially if you have no symptoms of disease. No one has shown any clear overall benefit for this. Indeed, it would take a very large study of several years duration to establish efficacy, and this hasn’t been done. It’s worth noting that CT scanning exposes the body to significant irradiation and, if repeated, the cumulative dosage can rise to a dangerous level. MRI scanning is often unpleasant for those with claustrophobia.

More important, though, is the question of what you might want to do with an unexpected finding? Do you seek out further tests or proceed to treatment? The cascade of further investigations may not be without hazard, and there is the fear and uncertainty even when nothing abnormal is found in the end.

There is also an issue with scans that don’t show any problems. This is not the same as proving the scanned person is free from all disease, but it can potentially lead to them believing they are and ignoring symptoms they might otherwise have told their doctor about.

Normally a scan or test is planned with a medical adviser who can explain it, why it’s being done and what is proposed if it turns out abnormal. Doing tests blindly is different. Purveyors of directly marketed tests talk about referring on to another practitioner without clear indication of who this might be. Many of them will do no more than send results to your usual doctor.

Some people are bound to benefit occasionally from tests such as these bringing something to light, but overall is it worth paying to have these tests if you don’t have any symptoms? Probably not. Even in the United States, with their very different medical care system, doubts have been expressed about the sense of these commercially provided tests. In the UK your money would be better spent elsewhere.

If you have symptoms then it’s best to talk to your doctor about them. He or she can then arrange investigation through the NHS – or privately – with the advantage that there will be someone who can interpret for you what any findings mean and can arrange whatever further care or observation you might need.

 

Link to a discussion of the ethics of commercial screening tests:  http://annals.org/article.aspx?articleid=1355172

 

Do you eat breakfast? Many people don’t, but they could be putting themselves at greater risk of diabetes, heart disease and increased body fat.

Surveys vary in the number of people who don’t eat breakfast. Part of the problem, of course, is defining what counts as a ‘breakfast’. Assuming it to be a meal rather than a snack taken on the run to work, then somewhere between 30% and 40% regularly skip it.

Thankfully, parents and teachers – whatever they do themselves – usually insist that children eat something. Past studies have shown the importance of breakfast for learning, and some schools even provide breakfast for pupils.

Two recent studies have now reinforced the benefits of breakfast for adolescents and adults.

In a study of nearly 3,000 European adolescents*, those that ate breakfast regularly had less body fat, were fitter and showed fewer of the risk factors for heart disease – especially in the boys.

The other study** looked at more than 29,000 adult men, following them for 16 years. After taking account of other factors, those who regularly skipped breakfast were 21% more likely to get type 2 diabetes, a serious disease that is increasing rapidly among adults and young people.

These findings have considerable significance in confirming and adding to earlier work.

Nutritionists have long suggested that we should eat something at the beginning of the day. Food that releases energy slowly can stave off feelings of hunger and reduce the amount of snacking through the morning. Debate will continue about what makes the ideal breakfast – although most nutritionists won’t be suggesting a daily fry-up!

 

Professor Brian Kirby, Author of How to Live to 110: Your comprehensive guide to a healthy life

 

*Link to the study of adolescents: http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8536196

**Link to the study of adult men: http://www.ajcn.org/content/early/2012/03/27/ajcn.111.028209.abstract

 

 

 

Charles Booth, manufacturer and philanthropist, lived at the end of the 19th century. He investigated poverty in London, mapping out streets of overcrowding and poverty, as well as areas that were wealthier.

What he found was that the poorest were the sickest.

His maps still exist and the streets are still there. Recently, researchers carried out a similar study in the same areas. This time around they focused on a serious long-term disease: Type 2 diabetes.

Diabetes is associated with a higher risk of heart disease; and if untreated it can lead to damage of the kidneys, eyes and blood vessels. Over recent decades it has become increasingly common. The people most at risk are those with a large waistline who do little physical activity. The risk is also higher in Asian people.

The study showed that the same areas mapped by Booth still have the least wealth and the highest levels of the disease.

The reasons for the similarity may be complex, bearing in mind the changes in the population in those streets over the past 100 years.

But it is a sobering thought that all this time later we may not be that much further forward.

(Link to BBC article about the study)

 

Professor Brian Kirby, author of How to Live to 110: Your comprehensive guide to a healthy life.

 

 

These days, when you have a book to sell you need a website. But when we were building our site, we realised it could be much more than a boring old marketing tool.

So what we’ve done is put together a site full of information we hope will be of value to everyone, whether or not you buy our book How to Live to 110. It outlines what to do now to keep yourself healthy, so you live longer and end up in great shape throughout your later years.

We’ve given an overview of all the main diseases covered in the book – heart disease, cancer, high blood pressure, diabetes, lung disease, infections, dementia and so on – and suggested some of the steps you can take to avoid these. We also give advice and suggestions on physical activity, burning calories, foods that help protect you from disease, avoiding hunger, losing weight permanently and giving up smoking.

People are living longer these days. Everyone really should be taking steps to make sure their old age is rewarding and healthy rather than years of illness and frailty. The website can’t go into depth on this, like our book does, but we hope it will still prove helpful. And, unlike some websites, all the suggestions we make are based on scientific studies

Of course, we’d love it if people buy our book. After all, we spent two hard years researching and putting it together, and we’re really proud of how it turned out! But if our website gets some people thinking about their future health – and perhaps contributes to a reduction in the diseases caused by modern living – then that’s great too.

(Our website is www.how-to-live-to-110.com – or click on the tab at the top of the blog.)

 

Professor Brian Kirby, author of How to Live to 110: Your comprehensive guide to a healthy life.

 

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