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Health News from NHS Choices

Constantly updated health news across a range of subjects.

NHS Choices News

  • Exercise in middle-age 'stops your brain shrinking'

    "A new study has suggested that exercising in your 40s could stop the brain shrinking," The Daily Telegraph reports.

    A study found people with good fitness levels in their 40s had larger brains than their unfit peers when measured 20 years later. The concern is that people with smaller brains may be more likely to develop dementia.

    The study, part of a big ongoing research project in the US (the landmark Framingham Heart Study) measured people's exercise capacity and heart and blood pressure reactions to exercise during a treadmill test, at an average age of 40.

    The same people were assessed about 20 years later, with a repeat exercise test and an MRI scan to determine brain volume.

    People with 20% less fitness compared to the average, had smaller brains by the equivalent of one additional year of ageing. A similar effect was seen for higher blood pressure or heart rate in response to exercise.

    However, we don't know the importance of the brain size differences measured and as this was only done once, it is not clear whether the size had actually changed.

    So we cannot be sure fitness levels directly caused the differences in brain size. But the research does add to the growing evidence that physical fitness and better mental capacity in older age go hand-in-hand. 

    What is good for the heart tends to also be good for the brain. Read more about how exercise may reduce your dementia risk.


    Where did the story come from?

    The study was carried out by researchers from Boston University School of Medicine, Framingham Heart Study, Harvard Medical School, Broad Institute of MIT and Harvard and the University of California. It was funded by the National Institutes for Health and the American Heart Association. 

    The study was published in the peer-reviewed journal Neurology.

    Reports in the UK media overstated the certainty of the study. The Daily Mail's headline: "Being a couch potato shrinks the brain," makes the results sound more definite than they are. The report says that "failing to exercise" was the cause of smaller brains. 

    The Daily Telegraph says the study "revealed … exercising when aged between 40 and 50 could help prevent the brain shrinking". However, the study did not look at whether people exercised, how much they exercised or at what age. It only included information about their fitness levels, blood pressure and heart rate.


    What kind of research was this?

    This is a prospective cohort study, which tracks people over a long period of time and compares information taken at different time points. It's a good way to look for links between factors – in this case between fitness and later brain size. However, it cannot prove that one thing causes another.


    What did the research involve?

    Researchers took a large group of people, average age 40, and tested their fitness levels using a treadmill. They recalled them 20 years later to repeat a fitness test and have an MRI brain scan and cognitive tests. They looked for links between fitness at the first test and brain size and cognitive skills 20 years later.

    The fitness tests involved people exercising on a treadmill until they reached 85% of their maximum heart rate, calculated by age and sex. Fitter people are able to exercise for longer before reaching this level. This time was used to calculate people's total exercise capacity. People's heart rate and blood pressure were also monitored before and during the test.

    The researchers excluded people from their first analysis if they already had cardiovascular disease, had been taking beta blockers (drugs that slow heart rate) or if they had dementia or any condition that could affect the brain scan or cognitive tests. They were also excluded if they were unable to complete the exercise test.

    In their analyses, the researchers adjusted their figures to take account of the following confounders:

    • age
    • sex
    • the time between examinations
    • whether they smoked
    • whether they had diabetes
    • whether they had a gene linked to Alzheimer's disease
    • whether they took medicine to treat high blood pressure


    What were the basic results?

    People who had 20% lower fitness levels based on the exercise capacity test had smaller brain volumes when assessed in later life. Those with a higher heart rate and diastolic blood pressure while exercising also had smaller brain volumes. Higher systolic blood pressure was also linked to smaller brain volumes, but only when the researchers looked at the subset of people with high blood pressure.

    There was no link between lower exercise capacity in mid-life and any measures of cognitive function (thinking ability) in later life.


    How did the researchers interpret the results?

    The researchers say their findings: "provide new evidence that lower cardiovascular fitness and elevated exercise blood pressure and heart rate responses in early to midlife are associated with smaller brain volumes nearly two decades later, thereby linking fitness over the life course to brain health in later life".

    They say that encouraging people to be fit in middle age could improve healthy brain ageing, especially for people with raised blood pressure.



    We already know that high blood pressure in mid-life is linked to increased chances of getting dementia in older age. Also, taking regular exercise in middle age has been linked to a lower chance of dementia.

    This study adds to what we already know about links between having a healthy heart and circulation, and a healthy brain.

    The study found that people who did well in fitness tests at around 40 years of age had fewer signs of brain shrinkage at around 60. However, this did not translate into signs that the brain was working less well – perhaps because people were not old enough to have shown signs of slowed cognitive function.

    We don't know from the study whether fitness levels are directly linked to brain shrinkage in a causal fashion. Therefore we can't say whether any particular amount of exercise protects against brain shrinkage. However, the researchers suggest that better cardiovascular fitness provides better blood flow and oxygen delivery to the brain, helping to keep it healthy.

    The study has some limitations; importantly, brain volume was only assessed once, at the end of life, so we don’t know how much people's total brain volume had changed over time. We don't know the likely effect of the differences in brain volume measured. Also, the researchers did not calculate the possible effects of carrying out many different calculations on one set of data, which can increase the likelihood of some findings being down to chance.

    Exercise has so many benefits that it can be confidently recommended, despite any questions about this particular study. However, there is no 100% guarantee that healthy lifestyles, including exercise, can prevent dementia in later life.  

    Links To The Headlines

    Exercising in your forties could stop brain shrinking. The Daily Telegraph, February 11 2016

    Being a couch potato SHRINKS the brain: Failing to exercise in your 30s and 40s is linked with dementia and early death. Daily Mail, February 11 2016

    Links To Science

    Spartano NL, Himali JJ, Beiser AS, et al. Midlife exercise blood pressure, heart rate, and fitness relate to brain volume 2 decades later. Neurology. Published online February 10 2016

  • Scientists look at what puts the 'junk' into junk foods

    "Scientists say they have cracked what makes processed foods… harmful,"  the Daily Mail reports. A small study suggests that processed foods that are high in "PAMPs" – pathogen-associated molecular patterns – may trigger inflammation inside the body.

    PAMPs are molecules that are associated with infectious bacteria, so in the same way as an infection, they can trigger an immune response in the way of inflammation. And some experts suspect that prolonged inflammation can increase the risk of chronic diseases such as high blood pressure and type 2 diabetes.

    This new study attempted to assess the relative benefits of a high-PAMP diet compared to a low-PAMP diet on a number of biomarkers associated with immune response.

    The study, involving 24 healthy men over 11 days, tentatively suggested that PAMPs did act to trigger some biomarkers linked to an immune response – although the results weren't consistent.

    Due to the size and shortness of the study its immediate implications are unclear.

    There are also other limitations to consider. For example, the study didn't measure new cases of diabetes or cardiovascular disease, or any disease.

    The assumption that the signs of raised inflammation seen in those given a high-PAMP diet are big enough to cause disease in the future is currently unproven.

    The results of this study are intriguing, but represent points of interest for further study, not established facts or guidance.

    Processed foods often have a high salt, sugar and fat content, so it is not a good idea to let them become a staple of your diet.

    Where did the story come from?

    The study was carried out by researchers from the University of Leicester (England) and was funded by University of Leicester Campbell Immunology Fund and the Higher Committee for Education Development in Iraq.

    The study was published in the peer-reviewed medical journal Nutrition, Metabolism & Cardiovascular Diseases.

    The Daily Mail's headline "Scientists say they have cracked what makes processed foods like burgers and ready meals harmful", seems to imply that the reason processed foods are unhealthy is some sort of mystery.

    This downplays the many existing reasons why foods like burgers and ready meals are bad for your health; they are called "junk food" after all. Many ready meals contain lots of added sugar and salt to make them taste better, and can be high in fat. The fat and sugar can contribute to weight gain, which in turn increases your risk of many diseases.

    A high-salt diet can raise your blood pressure, which elevates your risk of heart attacks and strokes. 

    The added issue is that you might not be aware of the high levels of fat, salt and sugar in the foods, as not everyone pays attention to food labels.

    This means you might be consuming levels likely to be harmful to health in the long run and not even know.


    What kind of research was this?

    This small study looked at the effects of dietary PAMPs on indicators of inflammation in a small group of healthy adult men over the course of just over a week.

    Small and short studies like this do not set out to provide solid answers, or provide weighty proof. Instead they attempt to scratch the surface of a new research area, present new theories and kick up questions that bigger and better studies might be able to answer. As such, the results represent points of interest for further study, rather than established facts.


    What did the research involve?

    The research had two main parts.

    The first part fed 11 healthy adult men (average age 38) two high-PAMP meals a day for four consecutive days while testing their blood before and after for signs of immune response changes. For the seven days before all men received diet advice to eat lower PAMP. This was because most men regularly consumed high-PAMP diets outside of the study so the researcher wanted to get everyone to a lower starting point. The rationale is that the impact of PAMP levels going from high to very high might be harder to detect than if it went from low to high. The men filled in food diaries to see if they were taking the advice.

    The second part fed a group of 13 different healthy men (average age 28) onion bhajis made from freshly chopped onion and monitored the impact on blood inflammation measures for 24 hours. Two weeks of normal eating passed before the same men were asked to eat a nutritionally identical meal made from pre-chopped onions – high in PAMPs.

    Any changes in weight circumference, blood cholesterol and blood fats were also measured.


    What were the basic results?

    The study team found that PAMPs were high in many processed foods such as lasagne and spaghetti bolognese ready meals, as well as baked pies, pasties and rolls.

    Encouraging men to follow a low-PAMP diet for seven days appeared to reduce some signs of inflammation (their white blood cell count reduced by 12%), lowered their cholesterol (-0.69 mmol/l), and they managed to lose weight (-0.7kg), including averaging 1.6cm less around the waist. Their insulin sensitivity – as risk factor for diabetes – was unaffected. The four-day high-PAMP diet largely reversed these effects, expect the weight loss, which didn't fully return to starting levels. For example, the white blood cell count went back up by 14% and men put back around 1.2cm around their waists.

    The study of nutritionally identical foods, differing only in their PAMP levels, showed high-PAMP foods made little difference to inflammatory markers 24 hours after eating. There were, however, signs the low-PAMP foods lowered inflammatory markers, for example, there were fewer white blood cells.


    How did the researchers interpret the results?

    The study team concluded that: "A low-PAMP diet is associated with reduced levels of several cardiometabolic risk factors, while a high-PAMP diet reverses these effects. These findings suggest a novel potential mechanistic explanation for the observed association between processed food consumption and risk of cardiometabolic diseases."



    This small study tentatively suggests that processed foods high in PAMPs act to trigger an immune response in people that ultimately may raise the risks of type 2 diabetes and cardiovascular disease later in life.

    At present these conclusions are very shaky. The study was small (just 24 healthy men took part) and short term (11 days), so gives us only the first loose threads of evidence about what's going on, rather than a more solid, clear picture.

    For example, the study didn't measure new cases of diabetes or cardiovascular disease, or any disease. The link to disease rests on the assumption that the raised levels of inflammation seen in those given a high-PAMP diet will be big enough to cause disease in the future. This could be right or wrong, and needs testing to see if it holds true.

    The first part of the study was also not controlled for other foods, which probably biased the results. The second part was much more controlled, and found very little immune impact after a high-PAMP meal – at least over 24 hours. More changes happened in the low-PAMP scenario.

    The weight change might also be a red herring. It's not surprising that men who ate lots of junk food before the study lost a bit of weight after a week following advice to eat healthier (less than 1% of their body weights overall). But we certainly can't pin this weight change on the PAMPs, there were far too many other variables involved.

    The results of this study are intriguing and represent points of interest for further study, not established facts.

    Hopefully a larger study will follow to look further at this issue.

    Links To The Headlines

    Revealed, the REAL reason junk food is so bad for us: Harmful molecules in chopped and refrigerated products raise the risk of heart disease and diabetes. Daily Mail, February 9 2016

    Links To Science

    Herieka M, Faraj TA, Erridge C. Reduced dietary intake of pro-inflammatory Toll-like receptor stimulants favourably modifies markers of cardiometabolic risk in healthy men. Nutrition, Metabolism & Cardiovascular Diseases. Published online December 18 2015

  • Zika virus: your questions answered

    The World Health Organization (WHO) reports that the Zika virus has now spread through both South and Central America and expects 3-4 million people to be infected in 2016.

    So what is the Zika virus and what steps can you take to protect yourself? Answers below.


    What is the Zika virus?

    The Zika virus is a mosquito-borne infection, which isn't harmful in most cases. However, it may be harmful for pregnancies, as it's been potentially linked to birth defects – specifically, abnormally small heads (microcephaly).

    It was first detected in the Zika forest of Uganda in 1947, and has circulated in Africa and South and South East Asia without many documented outbreaks reported. In the last few years, Zika outbreaks have been reported in the Pacific region, and the virus has now spread to South and Central America, and the Caribbean. WHO has warned that Zika virus is likely to spread to all countries in the Americas where the climate is suitable for the affected mosquitoes. Currently, this is thought to be all the countries in the Americas (including the Caribbean) with the exception of Chile and Canada. 

    ZIKV does not occur naturally in the UK. However, as of 10 February 2016, a total of 7 cases have been diagnosed in UK travellers.

    What symptoms does the virus cause?

    Most people don't have any symptoms. If symptoms do occur, they are usually mild and last around two to seven days. Commonly reported symptoms include:

    • a low-grade fever
    • joint pain (with possible swelling, mainly in the smaller joints of the hands and feet)
    • itching
    • rash, which is sometimes itchy
    • conjunctivitis (red eyes)
    • headache
    • eye pain


    How does the Zika virus spread?

    Most cases of the Zika virus are spread by infected mosquitoes biting humans. Unlike the mosquitoes that spread malaria, affected mosquitoes (the Aedes mosquito) are most active during the day (but especially during mid-morning and late afternoon to dusk).

    There has been one case where Zika virus may have occurred through sexual intercourse and a small number of cases have occurred by transmission from an expectant mother to her unborn child via the placenta.


    How do I reduce my risk of contracting the Zika virus?

    Before travelling, seek travel health advice from your GP/practice nurse or a travel clinic ideally six to eight weeks before you go. Detailed travel health advice for your destination is also available from the National Travel Health Network and Centre (NaTHNaC) website or the Scottish travel health service fitfortravel.

    To reduce your risk of infection with Zika virus, you should avoid being bitten by an Aedes mosquito. The most effective bite prevention methods, which should be used during daytime and nighttime hours, include:

    • using insect repellent that contains N, N-diethyl-meta-toluamide (DEET) on exposed skin – the repellent is safe to use during pregnancy and should be applied to skin after sunscreen is applied
    • wearing loose clothing that covers your arms and legs
    • sleeping under a mosquito net in areas where malaria is also risk

    The NaTHNaC and fitfortravel websites have further information on insect bite avoidance and travelling while pregnant.


    What risks does the Zika virus pose in pregnancy?

    There is evidence to suggest that pregnant women who contract the virus during pregnancy (at any trimester) may have an increased risk of giving birth to a baby with microcephaly (this means an abnormally small head and can be associated with abnormal brain development).

    Current advice is that women who are pregnant or planning to become pregnant should discuss their travel plans with their doctor and if already pregnant to consider postponing travel to any region where a known outbreak of the Zika virus is occurring. If travel is unavoidable then they should take scrupulous insect bite avoidance measures.

    Public Health England (PHE) provides regular updates about the current spread of the disease.


    I am pregnant and have visited a country where there is an ongoing Zika virus outbreak. What should I do?

    If you are pregnant and have a history of travel to a country where there is an ongoing Zika virus outbreak, see your GP or midwife and mention your travel history even if you have not been unwell. Your midwife or hospital doctor will discuss the risk with you and will arrange an ultrasound scan of your baby to monitor growth.

    If you have experienced Zika symptoms either during or within two weeks of returning home, see your GP or midwife or mention your travel history. Your midwife or hospital doctor will discuss the risk with you and will arrange an ultrasound scan to measure your baby’s growth and brain development. If there are any problems you will be referred to a specialist fetal medicine service for further monitoring. If you are still experiencing Zika symptoms your GP will arrange for you to have a blood test to check for Zika virus.


    I am trying to get pregnant and have visited a country where there is an ongoing Zika virus outbreak. What should I do?

    If you are trying to get pregnant and have a history of travel to a country where there is an ongoing Zika virus outbreak, see your GP or midwife and mention your travel history even if you have not been unwell. It is recommended that you take folic acid supplements for 28 days before trying to conceive.

    If you have experienced Zika symptoms either during or within two weeks of returning home it is recommended that you wait at least six months after full recovery before you try to conceive.

    Even if you have not been unwell, it is recommended that you wait at least 28 days after you return home from a country where there is an ongoing Zika virus outbreak before you try to conceive.


    My partner has visited a country where there is an ongoing Zika virus outbreak. What should I do?

    Sexual transmission of Zika virus has occurred in a small number of cases, but the risk of sexual transmission of Zika virus is thought to be very low. If your partner has travelled to a country where there is an ongoing Zika virus outbreak, condom use is advised:

    • for 28 days after his return home if he had no Zika symptoms
    • for six months following recovery if he experienced Zika symptoms or a Zika virus infection has been confirmed by a doctor

    For advice on the options available to you on other methods of contraception, speak to your GP or community sexual health clinic.

    What if I am worried that my baby has been affected by the Zika virus?

    Speak to your midwife or doctor for advice. If you are still concerned after receiving assurances from your healthcare professional and feel anxious or stressed more than usual, you can ask your GP or midwife for referral to further counselling.        


    How is the Zika virus diagnosed and treated?

    The Zika virus can be diagnosed with a blood test in people who are currently/actively displaying symptoms of Zika virus infection.

    There is no specific treatment for the symptoms of the Zika virus. Drinking plenty of water and taking paracetamol may help relieve symptoms. The use of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen is not recommended, as there is a potential risk they could trigger excessive bleeding.

    If you feel unwell on return form a country with an ongoing outbreak of Zika virus, but which also has malaria, you should seek urgent (same day) advice to help rule out a diagnosis of malaria.

    If you remain unwell and malaria has been shown not to be the cause, seek medical advice. 

  • Paracetamol use in pregnancy and infancy linked to child asthma

    "Babies given paracetamol are nearly a third more likely to develop asthma," the Mail Online reports. 

    The study the news is based on also found a link between maternal use of the painkiller in pregnancy, and childhood asthma.

    Pregnant women are advised not to take medicines if possible, but paracetamol is recommended as the best option if painkillers are needed to reduce a fever, because there is little evidence it can cause harm to the baby. Paracetamol is also recommended if painkilling or temperature reduction medicines are needed for babies.

    However, recent research has found a potential link between paracetamol and asthma. This study set out to investigate the link further.

    The researchers found paracetamol was linked to childhood asthma, both in cases when it had been taken by the pregnant woman and by the young baby (less than six months old). The study estimated that infant exposure to paracetamol increased the asthma risk by 29% and exposure in pregnancy led to a 13% increase; though this estimate was borderline significant.

    They also found that the reason for taking the medication did not affect the chances of asthma. This suggests the increased chance of asthma may be due to paracetamol, not to the illness it is used to treat.

    The results of this study will probably need to be replicated in larger populations before official advice on paracetamol use in pregnancy and infancy are changed. 

    Where did the story come from?

    The study was carried out by researchers from the Norwegian Institute of Public Health, the University of Oslo and the University of Bristol and was funded by the National Institutes of Health, the Norwegian Research Council and the Norwegian Extra Foundation for Health and Rehabilitation. 

    The study was published in the peer-reviewed International Journal of Epidemiology, on an open-access basis, meaning it is free to read online.

    Most of the UK media reported the study's findings accurately, but as is so often the case, the headline writers overstated the findings. A link between paracetamol use and asthma has only been suggested, not proven.


    What kind of research was this?

    This is a cohort study, which is a good type of study for investigating links between factors – in this case, between taking paracetamol in pregnancy or infancy, and children developing asthma. However, cohort studies cannot prove that one thing causes another. They can only show there is a link, and investigate factors that may or may not have affected the results.


    What did the research involve?

    Researchers took information about 114,761 children born in Norway between 1999 and 2008, and analysed it to look for links between paracetamol use and childhood asthma at the ages of three and seven. 

    They adjusted their figures to take account of the illnesses that paracetamol had been used to treat, and other factors that might have affected the results. They then calculated the relative risk (RR) of the child having developed asthma.

    The researchers included data on:

    • 53,169 children who had information on asthma at age three
    • 25,394 at age seven
    • 45,607 who had records of whether or not they had been given asthma medications by age seven

    Women in the study were asked about their own paracetamol use, and the reasons for it, at 18 and 30 weeks of pregnancy. When the child was six months old, the women were asked whether they had given paracetamol to the child, and if so what for.

    The researchers checked whether the type of illness people took paracetamol for – pain, high temperature or chest infection/flu – had an effect on the child's chances of getting asthma. They also adjusted figures to take account of the mother's age, whether she had asthma, whether she smoked during pregnancy, antibiotic use, weight, education level and number of children.

    They also looked for any effect from the father having taken paracetamol, or the mother having taken paracetamol when not pregnant. This is to see whether something else, such as the parents' attitudes to health and medicines, might affect the results.


    What were the basic results?

    About 28% of the children were born to mothers who had used paracetamol during pregnancy only, and 15% had taken paracetamol in the first six months of life only. A further 19% had been exposed to paracetamol both in the womb and in the first six months of life. A total of 5.7% of children had asthma at three years of age.

    The researchers found "modest associations" between the use of paracetamol and childhood asthma, both for use during pregnancy and use by the child during the first six months of life.

    Women who used paracetamol during pregnancy but did not give it to their infant were 13% more likely to have a child with asthma by age three (relative risk (RR) 1.13, 95% confidence interval (CI) 1.02 to 1.25).

    A child was 29% more likely to have asthma at age three if the child had been given paracetamol before six months of age but was not exposed to it during the pregnancy (RR 1.29, 95% CI 1.16 to 1.45). While they were 27% more likely to have asthma with exposure during pregnancy and the first six months of life (RR 1.29, 95% CI 1.14 to 1.41). Results were similar for asthma at age seven.

    The researchers said their results did not change when they adjusted them to take account of the reason for the medication. They found no link between the father's use of paracetamol or mother's use outside of pregnancy, and asthma in the child.


    How did the researchers interpret the results?

    The researchers say their study "is by far the largest study to provide evidence that prenatal and infant paracetamol exposures have independent positive associations with asthma development" – in other words, that the study found paracetamol was linked to a higher chance of getting asthma. 

    They go on to say their findings "suggest that the associations cannot be fully explained" by other factors, such as the illness that the mother or baby was taking paracetamol for.

    "Paracetamol is the most commonly used analgesic among pregnant women and infants, and uncovering potential adverse events is of public health importance," they say.



    This study tells us more about a potential link between paracetamol and childhood asthma. Other studies have suggested that taking paracetamol in pregnancy, or giving it to babies, might increase the risk of the child getting asthma, but this study gives more detail.

    One strong possibility before this study was published was that the problem was not paracetamol, but the reason for taking it – for example, that the baby's asthma was linked to the mother or baby having a chest infection, not to the medicine they took to relieve it. However, this study tests that possibility and finds that it cannot completely explain the link to paracetamol.

    There are some weaknesses in the study. It relies on the mother's report of paracetamol use and whether their child has asthma, which might not be reliable. It is possible that women who decided to take paracetamol while pregnant might have been more ill than women who had that illness but didn't take medication, which might have affected the results. Another major limitation is that the study did not determine the amount or frequency that paracetamol was taken either by the mother or the infant, so we do not know how this might affect the risk.

    However, it is a large study and the researchers carried out checks to make their findings as reliable as possible. While a cohort study can never confirm that one thing causes another, it does seem likely that there is a link between asthma and paracetamol.

    It's important to remember that the relative increase in risk of asthma, especially for women taking paracetamol during pregnancy, is quite low. The researchers say that advice on paracetamol use for pregnant women and babies does not need to change as a result of their study.

    Women in the UK are advised that paracetamol is the preferred choice to treat mild or moderate pain, or high temperature. They are advised to take paracetamol at the lowest effective dose, for the shortest possible time.

    Babies can be given paracetamol to treat high temperature or pain if they are over two months' old. Check the packet or information leaflet for information about the correct dose.

    Ibuprofen can be given for pain and fever in children of three months and over who weigh more than 5kg (11lbs) and, again, check the recommended dosage.

    Links To The Headlines

    Babies given paracetamol are nearly a THIRD more likely to develop asthma. Mail Online, February 10 2016

    Pregnancy health warning: Paracetamol could cause asthma in unborn babies. The Sun, February 10 2016

    Pregnant women who take paracetamol more likely to have babies with asthma. Daily Mirror, February 10 2016

    Links To Science

    Magnus MC,  Karlstad Ø, Håberg SE, et al. Prenatal and infant paracetamol exposure and development of asthma: the Norwegian Mother and Child Cohort Study. International Journal of Epidemiology. Published online February 9 2016

  • New NICE guidelines on sun exposure warn 'tanning is unsafe'

    "No safe way to suntan, new NICE guidance warns," BBC News reports. The guidelines, produced by the National Institute for Health and Care Excellence (NICE), also stresses the benefits of moderate sun exposure.

    This will help prevent vitamin D deficiency; which is more common in the UK than many people realise. It is estimated that around one in five adults and older children (aged between 11 and 18) have low vitamin D status. The figure is around one in seven for younger children.


    What are the risks of overexposure?

    Sunlight contains ultraviolet A (UVA) and ultraviolet B (UVB) radiation, both of which can be harmful to the skin. (The guidelines do not discuss artificial sources of UV light, such as sunbeds, but these are also thought to be harmful).

    Risks of overexposure to sunlight include:

    Non-melanoma is a leading cause of disfigurement, with an estimated quarter of a million cases occurring each year in the UK. Melanoma is a leading cause of cancer deaths in younger adults. More than 2,000 people die every year in the UK from melanoma.

    Overexposure can also cause premature ageing of the skin, which can lead to signs and symptoms, such as :

    • dryness
    • itching
    • wrinkling
    • enlarged blackheads
    • loss of skin elasticity


    At-risk groups

    Groups of people particularly vulnerable to overexposure include:

    • children (particularly babies) and young people
    • people who tend to burn rather than tan
    • people with lighter skin, fair or red hair, blue or green eyes, or who have lots of freckles
    • people with many moles
    • people who are immunosuppressed (that is, they have less resistance to skin problems as a result of a disease or use of particular drugs)
    • people with a personal or family history of skin cancer (even if their natural skin colour is darker than that of the family member who had cancer)
    • outdoor workers
    • those with outdoor hobbies, for example, sailing or golf
    • people who sunbathe
    • people who take holidays in sunny countries


    Preventing overexposure

    Avoid strong sunlight

    Avoid spending long periods of time in strong sunlight. The sun is at its strongest from 11am to 3pm from March to October. It can also be very strong and have potentially damaging effects at other times. Even if it is cool or cloudy, it is possible to burn in the middle of the day in summer.

    Wear suitable clothing

    Skin should be protected from strong sunlight by covering up with suitable clothing, finding shade and applying sunscreen.

    Suitable clothing includes:

    • a wide-brimmed hat that shades the face, neck and ears
    • a long-sleeved top
    • trousers or long skirts in close-weave fabrics that do not allow sunlight through
    • sunglasses with wraparound lenses or wide arms with the CE Mark and European Standard EN 1836:2005

    Use sunscreen

    When buying sunscreen, make sure it's suitable for your skin and blocks both ultraviolet A (UVA) and ultraviolet B (UVB) radiation.

    The sunscreen label should have:

    • the letters "UVA" in a circle logo and at least 4-star UVA protection
    • at least SPF15 sunscreen to protect against UVB

    Most people do not apply enough sunscreen. The amount of sunscreen needed for the body of an average adult to achieve the stated sun protection factor (SPF) is around 35ml or six to eight teaspoons of lotion.

    If sunscreen is applied too thinly, the amount of protection it gives is reduced. If you're worried you might not be applying enough SPF15, you could use a stronger SPF30 sunscreen.

    If you plan to be out in the sun long enough to risk burning, sunscreen needs to be applied twice:

    • 30 minutes before you go out
    • just before going out

    Sunscreen should be applied to all exposed skin, including the face, neck and ears (and head if you have thinning or no hair), but a wide-brimmed hat is better.

    Water-resistant sunscreen is needed if sweating or contact with water is likely.

    Sunscreen needs to be reapplied liberally, frequently and according to the manufacturer's instructions. This includes applying straight after you've been in water (even if it is "water-resistant") and after towel drying, sweating or when it may have rubbed off.

    Advice for babies and children

    Take extra care to protect babies and children. Their skin is much more sensitive than adult skin, and repeated exposure to sunlight could lead to skin cancer developing in later life.

    Children aged under six months should be kept out of direct strong sunlight.

    From March to October in the UK, children should:

    • cover up with suitable clothing
    • spend time in the shade (particularly from 11am to 3pm)
    • wear at least SPF15 sunscreen

    To ensure they get enough vitamin D, children aged under five are advised to take vitamin D supplements even if they do get out in the sun. Find out about vitamin D supplements for children.

    Avoid tanning

    There is no healthy way to tan. Any tan can increase your risk of developing skin cancer. Getting a tan does very little to protect your skin from the harmful effects of the sun. The idea that there is such a thing as a healthy tan is a myth.

    The British Association of Dermatologists advises that people should not use sunbeds or sunlamps.

    Sunbeds and lamps can be more dangerous than natural sunlight, because they use a concentrated source of ultraviolet (UV) radiation.

    UV radiation can increase your risk of developing melanomas. Sunbeds and sunlamps can also cause premature skin ageing.

    If you do want browner looking skin then fake tan is the way to go.


    Sunlight and vitamin D

    Vitamin D is essential for healthy bones, and we get most of ours from sunlight exposure.

    We need vitamin D to help the body absorb calcium and phosphorus from our diet. These minerals are important for healthy bones and teeth.

    A lack of vitamin D – known as vitamin D deficiency – can cause bones to become soft and weak, which can lead to bone deformities. In children, for example, a lack of vitamin D can lead to rickets. In adults, it can lead to osteomalacia, which causes bone pain and tenderness as well as muscle weakness.

    Most people can make enough vitamin D from being out in the sun daily for short periods with their forearms, hands or lower legs uncovered and without sunscreen from March to October, especially from 11am to 3pm.

    A short period of time in the sun means just a few minutes – about 10 to 15 minutes is enough for most lighter-skinned people – and is less than the time it takes you to start going red or burn. Exposing yourself for longer is unlikely to provide any additional benefits.

    People with darker skin will need to spend longer in the sun to produce the same amount of vitamin D.

    Groups of people who have little or no exposure to the sun for cultural reasons or because they are housebound or otherwise confined indoors for long periods, may be vitamin D deficient and may benefit from vitamin D supplements.

    How long it takes for your skin to go red or burn varies from person to person. Cancer Research UK has a useful tool where you can find out your skin type, to see when you might be at risk of burning.

    Vitamin D and pregnancy

    Pregnant and breastfeeding women should take a vitamin D supplement to make sure their own needs for vitamin D are met, and their baby is born with enough stores of vitamin D for the first few months of its life.

    You can get vitamin supplements containing vitamin D free of charge if you are pregnant or breastfeeding, or have a child under four years of age and qualify for the Healthy Start scheme.

    Read more about vitamins and supplements in pregnancy

    Links To The Headlines

    No safe way to suntan, new NICE guidance warns. BBC News, February 9 2016

    Don't go out in the sun for over 10 minutes warn health chiefs: Sunseekers told there is no such thing as a healthy tan as they are urged to slap on EIGHT teaspoons of sunscreen. Daily Mail, February 9 2016

    No such thing as a safe tan, warn health officials. The Daily Telegraph, February 9 2016

    Millions of British sun-worshippers warned there is "no safe way" to get a tan. Daily Mirror, February 9 2016

    There's no safe way to get a natural sun tan, says official health guidelines. The Independent, February 9 2016