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Health News from NHS Choices

Constantly updated health news across a range of subjects.

NHS Choices News

  • Body clock may have effect on sporting peak performance

    "Our internal body clock has such a dramatic impact on sporting ability that it could alter the chances of Olympic gold," BBC News reports.

    This headline comes from a study of 20 female athletes, which showed their peak performance on a fitness test was strongly linked to what are described as "circadian phenotypes".

    These phenotypes were assessed using a questionnaire that looked at issues such as the time people tended to wake up and what times of the day they felt most active.

    Depending on the results of the questionnaire, they were then classified into one of three groups: morning types (larks), intermediate types (let's call them "afternooners"), and evening types (owls).

    They were then asked to take part in a fitness test known as the bleep test at different times of the day to see if there was a pattern in terms of peak performances.

    And there was: the larks peaked around 12:00, the afternooners peaked around 16:00, and the owls peaked around 20:00.

    Despite media reports to the contrary, this study wasn't saying anything about whether exercising at different times of the day is better for your health.

    As an aside, there is a theory these results could explain the historical underachievement of the England football team.

    Their body clocks have been set to play at 15:00 on a Saturday afternoon, but most World Cup games take place around 17:00 or 20:00. This is pure speculation at this stage, but good ammunition for post-match punditry.

    Any form of exercise, whatever time of the day, brings important health benefits.

     

    Where did the story come from?

    The study was carried out by researchers from the University of Birmingham. No funding source was mentioned in the publication.

    It was published in the peer-reviewed science journal, Current Biology.

    The reporting on the BBC and Mail Online websites was generally accurate, and included a lot of comment from the study authors about the possible wider implications of their research, such as how Spanish footballers may have an advantage in the UEFA Championship League because they are more used to playing in the evening.

    However, both of the news sources' headlines were misleading. The BBC said that, "Bedtime 'has huge impact on sport'," but the research wasn't concerned with when people went to bed: it focused on whether people were generally morning or evening types.

    The Mail, on the other hand, said: "Morning jog? Leave it until noon" – but this advice only applies to larks, and only really if they are aiming to set a new personal best.

     

    What kind of research was this?

    This was an experimental study looking at how peak athletic performance is related to the time of day and people's individual circadian rhythms.

    Circadian rhythms are biological cycles in the body related to the time of day. They are sometimes referred to as "the body clock", or as the body's "individual biological timing".

    Historically, people have been categorised as "larks" or "owls". Larks – morning people – rise early, are most active in the morning, and feel awake shortly after they get up. However, they feel tired come late afternoon or early evening.

    By contrast, owls – or evening types – don't feel fully awake until many hours after they get up. They remain somewhat tired during the morning hours, but become active and switched on in the evenings.

    The researchers tell us circadian rhythms have been linked to athletic performance in past research, alongside many other factors.

    They also tell us athletes appear to perform at their best in the evening. They wanted to explore whether this held true if you took account of whether people were larks or owls, or somewhere in the middle.

    The study was small and designed to test a new hypothesis: a proof of concept study. It was not designed to provide definitive proof athletic performance is affected by the time of day, or is related to a person's biological clock. It was not large enough or diverse enough to achieve these aims.

     

    What did the research involve?

    The Birmingham study team recruited 20 competition-level female hockey players and asked them to perform their best at the bleep test.

    This is a test of cardiovascular fitness involving a series of 20m runs in shorter and shorter times. Researchers performed the test at six different times of day between 07:00 and 22:00 to see how their performance varied.

    Meanwhile, the women completed a new questionnaire specifically designed to study sleep/wake-related parameters, training, competition, and performance variables in athletes.

    The team used the answers to categorise the women into:

    • early circadian phenotype – "larks"
    • late circadian phenotype – "owls"
    • intermediate circadian phenotype – people more in the middle ("afternooners")

    The analysis was pretty straightforward and appropriate.

     

    What were the basic results?

    Analysis by time of day, ignoring circadian phenotype

    Overall, the results showed peak performance on the bleep test was in the late afternoon, around 16:00 and 19:00. Performance was lowest at 07:00. The variation between the best and worst performance throughout the day was 11.2%.

    Analysis by time of day, taking circadian phenotype into account

    When the team looked more closely at peak performance, they found it was significantly influenced by circadian phenotype. They found:

    • larks peaked around 12:00
    • intermediate types peaked around 16:00
    • owls peaked around 20:00

    The gap between the best and worst performance, when separated out by circadian phenotype, was 26% in the owls. It was less in larks (7.6% variation) and intermediates (10.0%)

    To put this into context, the researchers reported the variation in time performance between first and seventh place at the 2012 London Olympic Games 100m sprint men's final was less than 5%.

    They found peak performance was more related to the time people got up – specifically, the delay between that and competition – than the actual time of day.

    Again, this varied a lot by circadian phenotype. Owls needed much longer after waking (around 11 hours) than larks before peak performance could be produced.

     

    How did the researchers interpret the results?

    The researchers stated the highlights of the research were findings that:

    • athlete performance shows significant daytime variation
    • personal best performance times differ significantly between circadian phenotypes
    • internal biological time is the most reliable predictor of peak performance time
    • daytime performance variations can be as pronounced as 26% in the course of a day

    They concluded circadian rhythms, or internal biological time, are major determinants of athletic performance at different times of the day.

     

    Conclusion

    This study of 20 female athletes showed peak performance on a fitness test was linked to underlying biological timing, or what is called circadian phenotype. This was a better predictor of peak performance than the actual time of day.

    The possible implications of the results were discussed widely in the media. Opinions ranged from a possible explanation for why Spanish teams do well in the Champions League (they must be full of evening types, which helps them perform best in the evening matches), to advice not to jog in the morning. A lot of this was speculative, so should be taken with a pinch of salt for now. 

    There is also potential confusion about what this means for people currently exercising and wanting to keep healthy. For clarity: this study didn't say exercising at different times of day is better for your health and fitness.

    It says if you are competing, you may perform your best at different times of day, and this depends on whether you are more of a morning or an evening person.

    Advice to ditch the morning jog until noon espoused in the Daily Mail doesn't really follow from this research, unless the aim of your morning jog is to break a personal best.

    Similarly, this study isn't particularly relevant for people exercising to lose weight. It's more useful for athletes and coaches looking to optimise competitive performance.

    The study authors advise internal biological time is more important than time of day, and we should listen to and understand the body clock more.

    It would be interesting to know whether the circadian phenotype can be changed so, for example, athletes can prepare their bodies better for competition at a set time of day, even if this doesn't naturally fit with their lark/owl status. This study didn't address this question, but other related research might.

    The study was small, only included women, and was designed mainly to show proof of concept. A larger, more diverse group (including men, for example) would need to be studied for us to be confident these results are applicable to the majority of athletes.

    Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

    Links To The Headlines

    Bedtime 'has huge impact on sport'. BBC News, January 30 2015

    Morning jog? Leave it until noon: Performance does not peak until several hours after a person has woken up. Mail Online, January 30 2015

    Links To Science

    Facher-Childs E, Brandstaetter R. The Impact of Circadian Phenotype and Time since Awakening on Diurnal Performance in Athletes. Current Biology. Published online January 29 2015



  • Child obesity rates are 'stabilising'

    "The rise in childhood obesity … may be beginning to level off," BBC News reports. Researchers examined trends in child and adolescent rates of overweight and obesity using electronic GP records from 1994 to 2013.

    The data shows there was a significant increase in child and adolescent overweight and obesity rates every year during the first decade from 1994 to 2003. Overall, annual rates did not increase significantly during the second decade, 2004 to 2013.

    However, when split by age category, the results showed there was still a significant upward trend in overweight and obesity rates for the oldest age group (11 to 15 years) – albeit with less of an increase than there was in the first decade. At its maximum in recent years, overweight and obesity has affected almost two-fifths of adolescents in this age group.

    As the researchers used GP records, it is possible children who have problems with their weight and were assessed by their GP are over-represented. This could then lead to an overestimate of prevalence. However, it is hard to think of another method of analysis that would provide a more reliable estimate.

    While it is encouraging to see that the child obesity epidemic is not getting worse, there are also no clear signs as yet that it's getting any better. Underlying factors, such as low activity levels and easy access to calorie-rich, nutrient-poor foods, still remain to be addressed.

     

    Where did the story come from?

    The study was carried out by researchers from King's College London, and was funded by the National Institute of Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London.

    It was published in the peer-reviewed BMJ group publication, Archives of Disease in Childhood. The article is available on an open access basis, so it is free to read online or download.

    Overall, the UK media coverage is generally accurate, though sources have a different take on the research – some pointing out the good news, others the bad.

    The Daily Mail's statement that the "crisis at its worse among 11 to 15-year-olds" is not wholly accurate. While overweight and obesity rates in this age group have still increased in the past decade, it has been to a lesser extent than previously. It is also difficult to say that now is the "crisis point" as such, as we don't know what's going to happen in the future.

     

    What kind of research was this?

    This was a population-based cohort study that aimed to use GP electronic health records in England to examine the prevalence of overweight and obesity in children and adolescents aged 2 to 15 years. Researchers looked at data from 1994 to 2013 to see how trends have changed over the past two decades.

    Obesity has become a significant public health issue in both adults and children, with rates in children known to have increased dramatically over past decades.

    However, the researchers say there have been recent reports suggesting that obesity levels in children may have levelled off. That is what this study aimed to look at.

    The main limitation of such a study is being able to sample a group of children that represent a fair picture of the child population as a whole.

    Being based on database records, the study is not going to have information, or up-to-date information, on all children and adolescents. However, it should give a good representation of general trends.

     

    What did the research involve?

    The research used information from the Clinical Practice Research Datalink (CPRD), a large database holding the electronic health records of about 7% of general practices in the UK – about 5.5 million people. The coverage of GPs in the database was reported to be broadly representative of geographic distribution in the UK.

    The CPRD contains information on weight, height and body mass index (BMI) where this has been collected. Only the first BMI recording for a child was taken for any given year, though an individual child could contribute several years' worth of data.

    The final analysis included data from 370,544 children who contributed 507,483 BMI observations across the two study decades (average 1.4 BMI observations per child).

    The researchers analysed BMI by sex and by three different age groups (2 to 5 years, 6 to 10 years, and 11 to 15 years). They looked at trends over the two decades 1994 to 2003, and 2004 to 2013. Thirty-nine per cent of the collected data came from the first decade, 61% from the second.

     

    What were the basic results?

    The prevalence of children who were either overweight or obese ranged as follows:

    For boys:

    • 2-5-year-old boys – minimum 19.5% prevalence in 1995, to maximum prevalence 26.0% in 2007
    • 6-10-year-old boys – minimum 22.6% in 1994, to maximum 33.0% in 2011
    • 11-15-year-old boys – minimum 26.7% in 1996, to 37.8% in 2013

    For girls:

    • 2-5-year-old girls – minimum 18.3% in 1995, to maximum 24.4% in 2008
    • 6-10-year-old girls – minimum 22.5% in 1996, to maximum 32.2% in 2005
    • 11-15-year-old girls – minimum 28.3% in 1995, to maximum 36.7% in both 2004 and 2012

    Looking at annual trends, there was a clear year by year increase in prevalence of overweight and obesity in the first decade (1994 to 2003), with less of an annual increase in the second decade (2004 to 2013).

    Looking at the odds of a child being overweight or obese, the annual increase in risk across every year of the study was 4.2%.

    However, when broken down by decade, the annual risk increase was 8.1% between 1994 and 2003, but only 0.4% between 2004 and 2013.

    The increase in risk of overweight or obesity each year was significant in the first decade, but not in the second. The researchers say this indicates overweight and obesity rates are stabilising. These trends were similar with separate analyses for both boys and girls.

    When looking at trends per age category, the risk of overweight and obesity increased significantly every year for all age groups in the first decade between 1994 and 2003.

    During the second decade, the risk of overweight and obesity did not increase significantly each year for the two younger age groups.

    However, for the oldest age group (11 to 15 years), there was still a significant annual increase in risk of overweight and obesity during the second decade (by 2.6%), though this was still much smaller than the annual increase in the first decade (12%).  

    When looking specifically at obesity, all trends were comparable to those for the combined category of overweight and obesity as outlined above.

     

    How did the researchers interpret the results?

    The researchers say the use of GP electronic health records in England may provide a valuable resource for monitoring trends in obesity.

    They say that, "More than a third of UK children are overweight or obese, but the prevalence of overweight and obesity may have stabilised between 2004 and 2013."

     

    Conclusion

    This research shows how trends in child and adolescent overweight and obesity have changed over the two decades from 1994 to 2013, as indicated by GP records.

    As the results show, for both boys and girls, the prevalence of overweight and obesity increases with increasing age category, with the highest prevalence recorded in the 11 to 15-year-old age group, which at its maximum has affected almost two-fifths of adolescents in recent years.

    However, it is encouraging to see that while there were significant annual increases in child overweight and obesity rates in the first decade between 1994 and 2003, the overall annual increase was not significant during the second decade, 2004 to 2013.

    But when split by age category, it does show there was still a significant upward trend in overweight and obesity rates for the oldest age group (11 to 15 years), albeit with less of an increase than there was in the first decade.

    Therefore, as the researchers say, this still highlights the need for interventions to address overweight and obesity, particularly for this adolescent age group.

    An important limitation to be aware of for this study, though, is the possibility of selection bias. The study has used a large GP electronic database holding height and weight information for more than 350,000 children in the UK. It needs to be considered how representative this sample may be of the general child and adolescent population the UK.

    While the database does contain a representative sample of GP practices and their registered population, not all UK children in these age groups will have been to the GP and had their height and weight measured.

    There is the possibility a child may have been more likely to have their height and weight measured (particularly in successive years) if there have been problems with their weight.

    As such, it is possible the database could be over-representative of children with weight issues, and so give an overestimate of the prevalence of overweight and obesity in the general child and adolescent population of the UK.

    But accessing reliable data that is representative of every person is clearly not feasible, and using a reliable GP electronic database should give us a reasonable indication of the likely prevalence in the UK.

    Such a study also can only provide us information on trends. It can't tell us the reasons that may be behind these changing trends, or tell us of future ones.

    While the results suggest overweight and obesity levels may be levelling off (at least among the younger age groups), this is not to say they will now start to decrease. There have been annual decreases in the past, for example, that weren't sustained.

    Overweight and obesity levels could still remain at these relatively high levels of around a third of all children and adolescents, or increase further again unless things change.

    These results may give some encouragement, but childhood overweight and obesity remains an important public health issue. The various possible influences of overweight and obesity, such as low activity levels and consumption of calorie-dense food and drink, still need to be addressed. 

    The study is likely to lead to further calls by public health campaigners for the introduction of legislation designed to tackle childhood obesity, such as a curb on advertising and a tax on unhealthy foods.

    Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

    Links To The Headlines

    Child obesity rates 'levelling off' among under-10s. BBC News, January 30 2015

    Fat Britain: A third of children are now officially overweight with crisis at its worse among 11 to 15-years-olds. Daily Mail, January 30 2015

    Childhood obesity epidemic may be 'levelling out,' claims new study. The Independent, January 30 2015

    Child Obesity 'Levelling Off' But Concerns Remain. Sky News, January 30 2015

    One in four teens now obese by 15. The Daily Telegraph, January 30 2015

    More than a THIRD of children are obese but the problem is FINALLY slowing down. Daily Mirror, January 30 2015

    Over a third of children in England overweight. ITV News, January 30 2015

    Links To Science

    van Jaarsveld CHM, Gulliford MC. Childhood obesity trends from primary care electronic health records in England between 1994 and 2013: population-based cohort study. Archives of Disease in Childhood. Published online January 29 2015



  • Thousands of UK women could benefit from 'three-person' IVF

    "Thousands of women could benefit from 'three-parent' baby technique," The Independent reports. A modelling study estimated the technique, which is currently illegal, could be used for thousands of women with genes linked to serious mitochondrial DNA diseases.

    The news is especially topical as it was announced today that parliament is set to vote in February about whether to make the technique legal.

    "Three-parent" IVF is designed to prevent babies being born with mitochondrial conditions. Mitochondria are the "powerhouses" within our cells that convert sugar into energy.

    A baby inherits its mitochondria from its mother, and women with mutations in their mitochondrial DNA are at risk of passing on a mitochondrial genetic disorder to their offspring.

    Mutations in mitochondrial DNA can cause a range of disorders affecting the muscles, heart, brain and eyes. Some children can be severely affected and have a reduced life expectancy. There is currently no cure.

    The new techniques use healthy mitochondria from a donor egg to replace the mitochondria in the mother's egg, either before fertilisation or just after, to prevent passing on mutations.

    While on a technical level a baby conceived in this way would have three "parents", in practice only 1% of genetic information would come from the third "parent" (the egg donor).

    The modelling study attempted to estimate the number of women in the UK and US who could benefit from such techniques. This aims to help inform decisions around whether the technique should be allowed.

    The study estimated 2,473 women in the UK could benefit from the new IVF technique. This was based on the proportion of women known to be at risk in the north east of England, so does not take into account variations across the UK or US in terms of ethnic diversity or average maternal age.

    As this technique is untried, it is currently unknown how effective it may be, or what the short- or long-term consequences are.

     

    Where did the story come from?

    The study was carried out by researchers from Newcastle University.

    It was funded by the Wellcome Trust Centre for Mitochondrial Research, the Newcastle University Centre for Ageing and Vitality, the Medical Research Council, the Lily Foundation, the UK National Institute for Health Research, and the UK NHS Specialist Commissioners Rare Mitochondrial Disorders of Adults and Children Service.

    The study was published as a letter in the peer-reviewed New England Journal of Medicine on an open-access basis, so it is free to read online.

    The UK media reporting was accurate, though it wasn't pointed out we still do not know how effective or safe the techniques might be.

     

    What kind of research was this?

    This study aimed to estimate how many women in the UK and US might benefit from new IVF techniques that use donor mitochondria (sometimes referred to as "three-parent" IVF). These techniques aim to prevent women passing mitochondrial mutations on to their offspring.

    The researchers based these estimations on data on how many women have a mitochondrial DNA (mtDNA) mutation and whether this affects their fertility.

    As these techniques are not currently legal, before they can be used they require new regulations to be passed in parliament regarding the Human Fertilisation and Embryology Act (1990).

    In simple terms, the new techniques involve either:

    • taking the DNA from the nucleus of the egg that has just been fertilised (most of our DNA is found in the nucleus) and transferring it to a donor egg that has had the nuclear DNA removed, but still has the healthy mitochondria and mtDNA
    • taking the mother's DNA from the nucleus of her egg and inserting it into a donor egg that has had its nuclear DNA removed, but still has healthy mtDNA intact – fertilisation would then take place using the donor egg and father's sperm

    Behind the Headlines discussed these techniques in more detail back in June 2014.

    These techniques are controversial – at present, it is against the law to modify DNA before or after fertilisation because of concerns about the ethics of changing people's DNA in a way that will be inherited in generations to come.

    Indeed, no country in the world has passed regulations for these techniques to be used. Because of this, it is important that the health, social, ethical and legal implications are considered fully before any decisions are made.

    Still, it is worth considering that similar concerns were raised when IVF was first introduced in the late 1970s, and it is now considered standard practice.

    As this technique looks like a promising way to avoid certain diseases, the Department of Health put out a public consultation in February 2014 on whether these techniques should be allowed to be used. Following the responses received, parliament is set to vote on the issue in February 2015.

     

    What did the research involve?

    The number of women in the UK and US who have the potential to pass on an mtDNA mutation was first estimated. This was based on the percentage of women of childbearing age who have been identified in the north east of England as having mtDNA mutations, as well as their fertility rate.

    The researchers used data from the UK Office for National Statistics to calculate fertility rate in the general population. They then compared this with data on women who are carriers of a disease-causing mtDNA mutation from the MRC Mitochondrial Disease Cohort UK to see if fertility is affected by these mutations.

    They also had local data from the north east of England on the proportion of women who had an mtDNA mutation. They used these figures to estimate the likely number of women affected in the rest of the UK and US.

     

    What were the basic results?

    Fertility rates were not reduced in women with a disease-causing mtDNA mutation. The researchers identified 154 women with such mutations from the MRC Mitochondrial Disease Cohort, and found their fertility rate was 63.2 live births per 1,000 person-years, compared with 67.2 in the general population.

    They say that in women most severely affected, the rate was 50.6 live births per 1,000, compared with a similar group of women in the general population with a rate of 52.6 live births per 1,000.

    Based on this, the estimated number of childbearing-age women at risk of passing on a mitochondrial disease was:

    • 2,473 women in the UK
    • 12,423 women in the US

     

    How did the researchers interpret the results?

    The researchers concluded if all women in the UK estimated to have an mtDNA mutation wanted to have a child and had the new IVF procedure, this could benefit 150 births per year.

     

    Conclusion

    This study has provided an estimate of the number of women of childbearing age who might pass on an mtDNA mutation to their offspring. The researchers say this is nearly 2,500 women in the UK and could affect 150 births per year.

    However, as the authors point out, the estimates do not take into account the following factors, which vary across the UK and US, compared with the north east of England:

    • average age of women giving birth
    • ethnic diversity
    • actual number of women with a mitochondrial DNA mutation

    The researchers also acknowledged that even if the new regulations are passed, not all women would necessarily have access to the new IVF technique, or would want it.

    As these new IVF techniques are not currently legal, they have not resulted in the birth of any babies conceived using them. It is therefore not known how effective the techniques might be, or what the short- or long-term consequences are.  

    The Department of Health put out a public consultation on whether these two techniques should be allowed to be used in February 2014. Following the responses, parliament is set to vote on the issue in February this year.

    It is difficult to predict the outcome of the vote. At the time of writing, there has been no official party whip announced by the various political parties on how their MPs should vote.

    Most commentators expect it to be a free vote, where MPs are left to vote according to their own personal beliefs, which makes it even harder to predict.

    Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

    Links To The Headlines

    Thousands of women could benefit from 'three-parent' baby technique. The Independent, January 28 2015

    150 babies a year could be born to three-parent families: Children with DNA from two eggs and one sperm could be saved from potentially lethal genetic diseases. Mail Online, January 28 2015

    Legalise three-parent babies, say Nobel winners. The Times, January 29 2015

    Links To Science

    Gorman GS, Grady JP, Ng Y, et al. Mitochondrial Donation  How Many Women Could Benefit? New England Journal of Medicine. Published online January 28 2015



  • A third of over-70s report 'frequent sexual activity'

    “A third of pensioners have sex at least twice a month,” the Daily Mail reports. A new UK study reinforces the point that sex doesn’t automatically stop once a person gets their free bus pass.

    The study looked at sexual activity and sexual health among more than 6,000 men and women aged 50 to 90. It showed that a sizeable minority of older people – including those over the age of 80 – continue to have active sex lives, although sex became less frequent as people got older.

    Men were particularly concerned about their sexual health as they got older, while women became less so. Men were worried about erection problems and women about lack of desire.

    This is an interesting study of sexuality among older people. It relies on self-reporting, which might undermine its reliability, as some people may find it hard to be honest about such a sensitive topic.

    A final important point is that sexually transmitted infection (STIs) don’t stop being a problem once you have retired. Recent data has shown that rates of common STIs in the 65 and over category have risen in England during the past decade. You should always practise safe sex whatever your age. 

     

    Where did the story come from?

    The study was carried out by researchers from the University of Manchester, University of Leeds and NatCen Social Research. It was funded by the National Institute on Aging and a consortium of UK government departments.

    The study was published in the peer-reviewed journal Archives of Sexual Behavior.

    The Daily Mail’s report that one third of pensioners have sex at least twice a month was accurate, but the results of this study were more complex than the Mail’s report implied as it was not all good news.

    Many participants expressed concerns about sex, not just the frequency of their sexual activity. Also, the study did not cover only “pensioners” but people aged 50 and over.

     

    What kind of research was this?

    This was an observational study of sexual activity, problems with sexual functioning and concerns about sexual health among 6,201 older adults in England. The authors point out that stereotypes of older people often ignore the significance of sexual activity. Specifically how sexual activity, or lack of it, can affect fulfilment in relation to quality of life and emotional wellbeing. Also little is known about how sexuality relates to the ageing process generally.

     

    What did the research involve?

    The researchers used data from a nationally representative survey of men and women in England aged 50 years and older, who were taking part in an ongoing longitudinal study of ageing (the English Longitudinal Study of Ageing). All participants were living in the community, in private households, so the study did not cover older people in residential care.

    In 2012/13, 7,079 participants had a face-to-face interview and completed a comprehensive questionnaire on their sexual relationships and activities. Partners under 50 were excluded and 6,201 participants, 56% of them women, were included in the final sample.

    The questionnaire included detailed questions on attitudes to sex, frequency of sexual activities, problems with sexual activities and function, concerns and worries about sex, and details about current sexual partnerships. 

    Participants were also asked about their current living arrangements and general health and lifestyle factors during the face-to-face interview. They were asked if they had ever been diagnosed with any of several common conditions, including high blood pressure, arthritis, cardiovascular diseasediabetes and asthma.

    They were also asked to rate their:

    • health on a five point scale (ranging from excellent to poor),
    • smoking status (current or non-smoker)
    • frequency of alcohol consumption over the past year (ranging from never or rarely, to frequently – three days a week to almost every day)

    Depressive symptoms were also assessed using a validated depression scale.

    The researchers analysed their results, looking specifically at any association between sexual activity, reported chronic conditions and self-rated general health. They adjusted results for age, partner status, smoking status and frequency of alcohol consumption.

     

    What were the basic results?

    Below are the main findings of the study:

    • At all ages, men reported more frequent sexual activity and thinking about sex more often than women. Likewise, sexually active men reported higher levels of concern with their sexual health and sexual dissatisfaction than women at all ages.
    • Levels of sexual activity declined with increasing age, although a sizable minority of men and women remain sexually active until the eighth and ninth decades of life.
    • Poorer health was associated with lower levels of sexual activity and a higher prevalence of problems with sexual functioning, particularly among men.
    • The difficulties most frequently reported by sexually active women related to becoming sexually aroused (32%) and achieving orgasm (27%), while for men the main difficulty was erectile function (39%).
    • The sexual health concerns most commonly reported by women related to their level of sexual desire (11%) and frequency of sexual activities (8%). Among men common concerns were level of sexual desire (15%) and erectile difficulties (14%).
    • While the likelihood of reporting sexual health concerns tended to decrease with age in women, the opposite was seen in men.
    • Poor sexual functioning and disagreements with a partner about initiating and/or feeling obligated to have sex were associated with greater concerns about and dissatisfaction with overall sex life.

     

    How did the researchers interpret the results?

    The researchers say that their study shows many older people, including those over 80, continue to have active sex lives, although the frequency of sexual activities declines with increasing age.

    Women appeared less dissatisfied with their overall sex life than men and reported decreasing levels of dissatisfaction with increasing age.

    They say that older people’s sexual health should be “managed” not just in the context of their age, gender and general health, but also within their existing sexual relationship.

     

    Conclusion

    This study suggests not only that many older people are still sexually active, but that, like every other age group, they have worries and concerns about sex and relationships. Not surprisingly, ageing and failing health affect sexual activity.

    Older men report worrying about getting erections, while women are more concerned with lack of desire. The study also reminds us that sexual problems have to be seen in the context of a relationship.

    The study is, by definition, based on people self reporting on sex, which might undermine its reliability. It is possible that some people find it hard to be honest about such a sensitive area, even in a confidential questionnaire.

    If you are an older adult and you are having problems with your sex life then there may be treatment options available. Read more about how you could have a fulfilling sex life as you get older.

    Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

    Links To The Headlines

    Sex in your 70s? Absolutely! A third of pensioners have sex at least twice a month, study finds. Daily Mail, January 29 2015

    Links To Science

    Lee DM, Nazroo J, O’Connor DB, et al. Sexual Health and Well-being Among Older Men and Women in England: Findings from the English Longitudinal Study of Ageing. Archives of Sexual Behavior. Published online January 27 2015



  • Sugary soft drinks linked to earlier periods in girls

    “Sugary drinks may cause menstruation to start earlier, study suggests,” reports The Guardian, reporting on a US study looking at the consumption of sugar-sweetened beverages (SSBs) in teenage girls.

    This study included over 5,000 girls. It first assessed them when they were aged 9-14 years, asking them whether they had started their periods and assessing their consumption of SSBs. The girls were followed up annually.

    The study found that girls in the highest consumption category (more than 1.5 SSB servings per day) were 22% more likely to start their period in the next month than girls in the lowest consumption category (two or fewer SSB servings per week). Girls in this highest consumption category started their periods at an average age of 12.8 years, which was 2.7 months earlier than girls in the lowest consumption category.

    However, this study does not prove that SSB consumption is the direct cause of this difference, as many unmeasured health and lifestyle factors may be influencing the relationship.

    One potential concern is that an early onset of menstruation (menarche) has been linked to an increased risk of some types of cancer, such as breast cancer. However, even if SSBs have a direct effect on menarche, cancer outcomes were not assessed by this study. It is uncertain whether the small difference seen, which is just a few months, would have any meaningful effect on later risk of breast cancer.

    Overall, people should not be overly concerned, though the limitations of this study do not take away from the fact that SSBs are high in sugar and calories. Sugar can lead to tooth decay, and a high intake of sugar and calories can lead to obesity.

     

    Where did the story come from?

    The study was carried out by researchers from Harvard School of Public Health and Harvard Medical School, and was funded by the Breast Cancer Research Foundation, the National Institute of Environmental Health Sciences and National Institutes of Health, among other sources. The study was published in the peer-reviewed medical journal Human Reproduction on an open-access basis, so it is free to read online or download as a PDF.

    The media correctly reported the association between fizzy drinks and earlier age of starting periods, but some headlines, such as The Daily Telegraph’s suggestion that such drinks “cause early puberty”, are unproven.

    In addition, The Telegraph’s and the Daily Mirror’s headlines that the drinks “increase [sic] cancer risk in girls” may cause undue alarm. It is important to highlight that the study has not looked at cancer outcomes, either in girls or when they grow into women. This headline purely relates to the fact that the earlier age of starting periods is recognised as a risk factor – among many others – for cancers such as breast and endometrial (womb) cancer.

     

    What kind of research was this?

    This was an analysis of data collected in a prospective cohort study that aimed to see whether SSB consumption in girls is associated with the age when their periods start (menarche).

    The researchers used participants of “The Growingup Today Study”, a prospective cohort study of children of participants in the US Nurses’ Health Study II. The researchers say how age at menarche is known to have decreased considerably in the Western world over the past couple of centuries. They say that the association of later menarche with calorie restriction and earlier menarche in children with a higher body mass index (BMI) supports the importance of nutritional factors. Previous studies are said to have investigated the link between protein intake and menarche, but the link with many other food groups remains unstudied. The researchers were interested in SSBs due to increase in popularity over the same time period in which age at menarche has decreased.

    The main limitation of an analysis such as this is the potential for other health and lifestyle factors to be affecting age at menarche. In addition, The Growingup Today Study was not designed specifically to answer the current question, so may not have been able to measure all factors that might have been considered, if this was the main aim.

     

    What did the research involve?

    The Growingup Today Study included 9,033 girls, 5,227 of whom had data available for inclusion in this study.

    A baseline questionnaire was given in 1996 when the girls were aged 9-14 years, with annual follow-up questionnaires up until 2001. In 1996, ‘97 and ’98, a 132-item questionnaire for young people and adolescents assessing what they ate and drank (a food frequency questionnaire) was given to the participants. They were asked how often they consumed a typical serving size of specified foods and drinks during the past year. For drinks, the serving size was one can/glass for soda and diet soda, one glass for non-carbonated fruit drinks (including Hawaiian Punch, lemonade, Koolaid and other non-carbonated fruit drinks), and one glass/can/bottle for sweetened iced tea. Total consumption of SSBs were calculated as the sum of these drinks. The total did not include diet soda or non-fizzy fruit juice, which were assessed separately.

    Each follow-up questionnaire asked whether the girls had started their periods, and when.

    The researchers calculated how the likelihood of menarche over time for girls in each category of SSB consumption compared with girls who drank the least SSBs (two or fewer servings per week). They adjusted for total energy intake and various other potential confounders, including physical activity, BMI, birthweight, ethnicity, mother’s age at menarche, family composition, and eating meals together as a family.

     

    What were the basic results?

    The average (median) age at menarche in this study was 13.1 years. Girls who drank more SSBs were more likely to have an earlier menarche.

    After adjustment for all confounders, girls at any age between 9 and 18.5 years who had not yet started their periods were on average 22% more likely to start their periods in the following month if they drank the most SSBs (more than 1.5 SSB servings per day, equivalent to more than 10.5 servings per week) than girls who drank the least SSBs (2 or fewer SSB servings per week; hazard ratio (HR) 1.22, 95% confidence interval (CI) 1.11 to 1.35).

    Girls who drank the most SSBs started their period at an average age of 12.8 years of age, which was 2.7 months earlier than girls who drank the least SSBs.

    Looking at individual drinks, drinking the highest amounts of non-fizzy fruit drinks and sugar-sweetened fizzy drinks were associated with increased risk of starting menarche compared to the lowest consumption of these drinks. However, consumption of fruit juice or diet fizzy drinks did not affect age at menarche.

     

    How did the researchers interpret the results?

    The researchers conclude that, “more frequent SSB consumption was associated with earlier menarche in a population of US girls”. They acknowledge that though they adjusted for a variety of possible confounders, there is still the chance that factors other than SSB consumption are influencing the results. They also say that they did not measure SSB consumption during early childhood, which may also affect age at menarche.

     

    Conclusion

    People should not be overly concerned by this study’s findings, as they cannot prove that drinking SSBs directly causes earlier puberty in girls – they can only show a link.

    Also, the difference between girls who drank the most SSBs in terms of when they started their period was an average of just 2.7 months earlier than girls who drank the least, which seems a relatively small difference.

    There are various limitations to this study – not least the possibility that the results are being influenced by confounding, which the researchers acknowledge. Nutrition is already known to play a role in the timing of first periods, with higher BMI and calorie intake linked to earlier periods. Though they have tried to adjust for these and other factors that could be having an effect (including physical activity), there is still the possibility that their effect or those of other factors have not been removed. It is difficult to know how much of a direct and independent effect – if any – SSBs could be having.

    Other points of limitation include that the possibility of inaccurate recall of SSB consumption and that the assessments may not be representative of longer-term consumption patterns. The first assessments were taken when the girls were around the age of 9-14 years – a time when many girls will be starting their periods anyway. This also makes it difficult to establish any cause and effect relationship. As the researchers say, SSB consumption during earlier childhood may be an important time period that they have not measured.

    The study results are also for a US population who may differ from the UK, both in terms of their SSB consumption, and other factors that may influence age at menarche.

    Even if SSB consumption does cause earlier menarche, it is difficult to know what health effects, if any, this would have. While it is true that earlier menarche is recognised as one possible risk factor for breast cancer, for example, this study did not assess any health outcomes other than menarche.

    It is uncertain how much of an impact the small time difference in age of menarche seen in this study could have on breast cancer risk. The authors state that previous research has suggested that a one year decrease in the age at menarche is thought to increase breast cancer risk by around 5%. Therefore, they consider the 2.7 month reduction in age to be only “modest”. There are also a wide range of other health and lifestyle factors associated with breast cancer risk, some of which (alone or in combination) may have a greater influence than age at menarche.

    Nevertheless, whatever the limitations of this study, SSBs are by their nature high in sugar and calories. High intake could contribute to an increase in risk of overweight and obesity if the calories are not burned off. Overweight and obesity are associated with many detrimental effects upon health, and sugar can also lead to tooth decay in later life.

    There is normally a non-sugar alternative available to the most popular SSBs.

    Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

    Links To The Headlines

    Sugary drinks may cause menstruation to start earlier, study suggests. The Guardian, January 28 2015

    Sugary drinks 'can bring on a girl's periods earlier': Youngsters who drink more than one a day begin puberty at younger age. Daily Mail, January 28 2015

    Fizzy drinks cause early puberty and increases cancer risk in girls, study finds. The Daily Telegraph, January 28 2015

    Soft drinks may cause girls to start their periods early, scientists say. Metro, January 27 2015

    One and a half cans of fizzy drink a day raises breast cancer risk. Daily Mirror, January 28 2015

    Links To Science

    Carwile JL, Willett WC, Spiegelman D, et al. Sugar-sweetened beverage consumption and age at menarche in a prospective study of US girls. Human Reproduction. Published online January 27 2015