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Health News from NHS Choices

Constantly updated health news across a range of subjects.

NHS Choices News

  • Heart failure drug could 'cut deaths by a fifth'

    “A new drug believed to cause a 20 per cent reduction in heart failure deaths could present a 'major advance' in treatment,” The Independent reports.

    The drug, LCZ696, helps improve blood flow in heart failure patients. Heart failure is a syndrome caused by the heart not working properly, which can make people vulnerable to serious complications.

    A new study compared LCZ696 with an existing heart failure drug called enalapril, which is also used to treat high blood pressure.

    Researchers found that LCZ696 is better than enalapril for preventing death from cardiovascular causes and for preventing hospitalisation for heart failure. The results were so striking that they decided to halt the trial.

    During the 27 months of the study, compared to enalapril, LCZ696:

    • reduced the risk of death from cardiovascular disease by 20%
    • reduced the risk of hospitalisation for heart failure by 21%
    • reduced the risk of death from any cause by 16%

    The makers of LCZ696 must now apply for marketing authorisation before the drug can be sold. A press release from the developer of the drug, Novartis, states that it plans to file the application for marketing authorisation in the European Union in early 2015.

     

    Where did the story come from?

    The study was carried out by researchers from the University of Glasgow, the University of Texas Southwestern Medical Center and Novartis Pharmaceuticals, in collaboration with an international team of researchers from other universities and research institutes around the world. It was funded by Novartis, the pharmaceutical company that developed LCZ696.

    The study was published in the peer-reviewed New England Journal of Medicine and has been made available on an open-access basis, so it is free to read online.

    The results of the research were well covered by the UK media.

     

    What kind of research was this?

    This was a randomised controlled trial. It aimed to determine whether the new drug LCZ696 reduced the risk of death from cardiovascular causes or hospitalisation for heart failure in people who had heart failure with reduced ejection fraction, compared to enalapril.

    Heart failure is a syndrome caused by the heart not working properly. In heart failure with reduced ejection fraction, less blood than normal is pumped out of the heart with each beat.

    Enalapril is a drug already used to treat hypertension (high blood pressure) and heart failure. Enalapril is what is known as an angiotensin-converting enzyme (ACE) inhibitor, which improves heart failure by a number of different mechanisms. It inhibits an enzyme that is part of what is known as the renin-angiotensin-aldosterone system. One of the effects of this is to cause blood vessels to relax and widen.

    LCZ696 also inhibits the renin-angiotensin-aldosterone system but also inhibits another enzyme called neprilysin. It was hoped that it would be more effective in treating heart failure.

    A randomised controlled trial was deemed the best way of determining whether LCZ696 reduced the risk of death from cardiovascular causes or hospitalisation for heart failure compared to enalapril.

     

    What did the research involve?

    The researchers recruited 8,442 people with heart failure and an ejection fraction of 40% or less into the trial. Ejection fraction is a measure of how well your heart beats. A normal heart pumps a little more than half the heart’s blood volume with each beat. Normal ejection fractions range between 55% and 70%. To be included in the trial, patients had to be able to tolerate both enalapril and LCZ696; this was determined in a run-in phase before people were randomised. 

    People were randomly assigned to receive LCZ696 (200mg twice daily) or enalapril (at a dose of 10mg twice daily), in addition to recommended therapy.

    The researchers monitored how many people died from cardiovascular causes or were hospitalised for heart failure.

    The researchers compared outcomes for people receiving LCZ696 with people receiving enalapril. 

    43 of them were later excluded due to invalid randomisation, or if their hospital site had been closed.

     

    What were the basic results?

    The trial was stopped early because outcomes with LCZ696 were much better than outcomes with enalapril.

    After people had been followed for an average of 27 months:

    • 4.7% fewer people who received LCZ696 died from cardiovascular causes or had been hospitalised for heart failure: 914 patients (21.8%) in the LCZ696 group compared with 1,117 patients (26.5%) in the enalapril group. This was equivalent to a 20% reduction in risk with LCZ696 compared to with enalapril (hazard ratio [HR] 0.80; 95% confidence interval [CI] 0.73 to 0.87). If 21 people were treated with LCZ696, one less death from cardiovascular causes or hospitalisation for heart failure would be expected than if people received enalapril.
    • 3.2% fewer people who received LCZ696 died from cardiovascular causes: 558 patients (13.3%) in the LCZ696 group and 693 patients (16.5%) in the enalapril group. This was a 20% reduction in risk with LCZ696 compared to with enalapril (HR 0.80; 95% CI, 0.71 to 0.89). If 32 people were treated with LCZ696, one less death from cardiovascular causes would be expected than if people received enalapril.
    • 2.8% fewer people who received LCZ696 were hospitalised for worsening heart failure: 537 patients (12.8%) in the LCZ696 group compared to 658 (15.6%) in the enalapril group. This was a 21% reduction in risk with LCZ696 compared to with enalapril (HR 0.79; 95% CI 0.71 to 0.89).
    • 2.8% fewer people who received LCZ696 died: 711 patients (17.0%) in the LCZ696 group compared with 835 patients (19.8%) in the enalapril group. This was equivalent to a 16% reduction in risk with LCZ696 compared to with enalapril (HR 0.84; 95% CI 0.76 to 0.93).

    LCZ696 also significantly reduced the symptoms and physical limitations of heart failure.

    With regards to adverse effects, more people who received LCZ696 had low blood pressure (hypotension) and non-serious angioedema (swelling of the deeper layers of the skin due to a build up of fluid), but fewer people had kidney (renal) impairment, hyperkalemia (high levels of potassium in the blood) and cough than the people who received enalapril. Overall, fewer people in the LCZ696 group stopped their medication because of an adverse event than in the enalapril group.

     

    How did the researchers interpret the results?

    The researchers concluded that “LCZ696 was superior to enalapril in reducing the risks of death, and of hospitalisation for heart failure.”

     

    Conclusion

    This was a well conducted study that achieved impressive results.

    In this 27 month-long randomised controlled trial of 8,442 people with heart failure and an ejection fraction of 40% or less, compared to enalpril, the new drug LCZ696:

    • reduced the risk of death from cardiovascular disease or the risk of hospitalisation for heart failure by 20%
    • reduced the risk of death from cardiovascular disease by 20%
    • reduced the risk of hospitalisation for heart failure by 21%
    • reduced the risk of death from any cause by 16%

    Marketing authorisation is now required before it can be sold. The developer of the drug, Novartis, states that they plan to file the application for marketing authorisation in the European Union in early 2015.

    It is currently unclear how much LCZ696 will cost. Until this information becomes available, it is difficult to predict whether LCZ696 will be offered by the NHS.

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

    Links To The Headlines

    New heart drug LCZ696 could reduce heart failure deaths by 20%, scientists say. The Independent, August 30 2014

    'Remarkable' new heart drug will cut deaths by a fifth - and could be available as early as next year. Mail Online, September 1 2014

    New heart drug will cut deaths by a fifth. The Daily Telegraph, August 30 2014

    Links To Science

    McMurray JJV, Packer M, Desai AS, et al. Angiotensin–Neprilysin Inhibition versus Enalapril in Heart Failure. The New England Journal of Medicine. Published online August 30 2014



  • Students 'showing signs of phone addiction'

    “Students spend up to 10 hours a day on their mobile phones,” the Mail Online reports. The results of a US study suggest that some young people have developed an addiction to their phone.

    Mobile or “cell” phone addiction is the habitual drive or compulsion to continue to use a mobile phone, despite its negative impact on one’s wellbeing.

    The authors of a new study suggest that this can occur when a mobile phone user reaches a “tipping point”, where they can no longer control their phone use. Potential negative consequences include dangerous activities, such as texting while driving.

    This latest study surveyed mobile phone use and addiction in a sample of 164 US students.

    The students reported spending nearly nine hours a day on their mobile phones. There was a significant difference in the amount of time male and female students spent on their phones, with women spending around 150 minutes more a day using the device.

    Common activities included texting, sending emails, surfing the internet, checking Facebook and using other social media apps, such as Instagram and Pinterest.

    It was also found that women spent a lot more time texting than men, and were more likely to report feeling agitated when their phone was out of sight or their battery was nearly dead. Men spent more time than women playing games.

    Using Instagram and Pinterest, and using the phone to listen to music, as well as the number of calls made and the number of texts sent, were positively associated with (increased risk of) phone addiction.

    However, the study did not prove that any of these activities can cause mobile phone addiction.

     

    Where did the story come from?

    The study was carried out by researchers from Baylor University and Xavier University in the US, and the Universitat Internacional de Catalunya in Spain. No financial support was received.

    The study was published in the peer-reviewed Journal of Behavioural Addictions and has been published on an open-access basis, meaning it is free to read online.

    The results of the study were well-reported by the Mail.

     

    What kind of research was this?

    This was a cross-sectional study that aimed to investigate which mobile phone activities are most closely associated with phone addiction in young adults, and whether there are differences between males and females.

    As it is a cross-sectional study, it cannot show causation – that is, that the activities undertaken cause a person to become addicted to their mobile phone.

     

    What did the research involve?

    164 college undergraduates in Texas aged between 19 and 22 years old completed an online survey.

    To measure mobile phone addiction, people were asked to score how much they agreed with the following statements (1=strongly disagree; 7=strongly agree):

    • I get agitated when my phone is not in sight.
    • I get nervous when my phone’s battery is almost exhausted.
    • I spend more time than I should on my phone.
    • I find that I am spending more and more time on my phone.

    People were also asked how much time they spent on 24 different mobile phone activities a day, including:

    • calling, texting and emailing
    • using social media applications
    • playing games
    • taking photos
    • listening to music

    Finally, they were asked how many calls they made, and how many texts and emails they sent a day.

     

    What were the basic results?

    On average, the undergraduates spent 527.6 minutes (almost nine hours) a day on their phones. Female students reported spending significantly more time on their phone than male students.

    The students spent the most time texting (94.6 minutes per day), sending emails (48.5 minutes), checking Facebook (38.6 minutes), surfing the Internet (34.4 minutes) and listening to their iPods (26.9 minutes). There were significant differences between the amount of time male and female students reported performing different mobile phone activities. Women spent more time than men texting, emailing, taking pictures, using a calendar, using a clock, on Facebook, Pinterest and Instagram, while men spent more time than women playing games.

    The study identified activities that were significantly associated with mobile phone addiction. Instagram, Pinterest and using an iPod application, as well as the number of calls made and the number of texts sent, were positively associated with (increased the risk of) mobile phone addiction when males and females were analysed together. Time spent on “other” applications was negatively associated with (reduced the risk of) phone addiction.

    However, there were differences between males and females.

    For males, time spent sending emails, reading books and the Bible, as well as visiting Facebook, Twitter and Instagram, in addition to the number of calls made and the number of texts sent, were positively associated with mobile phone addiction. In contrast, time spent placing calls, using the phone as a clock, visiting Amazon and “other” applications were negatively associated with phone addiction.

    For females, time spent on Pinterest, Instagram, using an iPod application, Amazon and the number of calls made were all positively associated with mobile phone addiction. In contrast, time spent using the Bible application, Twitter, Pandora/Spotify and an iTunes application were negatively associated with phone addiction.

     

    How did the researchers interpret the results?

    The researchers concluded that mobile phone addiction amongst participants was largely driven by a desire to connect socially. However, the activities found to be associated with phone addiction differed between males and females.

     

    Conclusion

    This study found that a sample of college students in the US reported spending nearly nine hours a day on their mobile phones, although there was a significant difference between male and female students. There were also differences in the amount of time male and female students spent performing various activities.

    The study has identified some activities associated with mobile phone addiction, with differences seen between male and female students.

    However, due to the study design, it cannot prove that these activities caused the mobile phone addiction directly.

    This study has several limitations:

    • it was performed on a sample of college students in the US, and the results of this study may not be generalisable to the population at large
    • the mobile phone addiction scale used in this study requires further evaluation
    • participants self-reported the time spent on certain activities

    Mobile phones may help us connect with people all over the world, but possibly at the cost of reducing interaction with “real” people. Failure to connect with others can have an adverse effect on a person’s quality of life. A 2013 study found an association between Facebook use and dissatisfaction – the more time a person spent on Facebook, the less likely they were to report feeling satisfied with their life.

    Read more about how connecting with others can improve your mental health.

    Analysis by Bazian. Edited by NHS ChoicesFollow Behind the Headlines on TwitterJoin the Healthy Evidence forum.

    Links To The Headlines

    Students 'addicted to mobile phones': Some spending up to ten hours a day texting, emailing and on social media. Mail Online, September 1 2014

    Links To Science

    Roberts JA, Yaya LHP, Manolis C. The invisible addiction: Cell-phone activities and addiction among male and female college students. The Journal of Behavioural Addiction. Published online August 26 2014



  • Study finds plain cigarette pack fears 'unfounded'

    "Cigarette plain packaging fear campaign unfounded," reports The Guardian.

    After Australia introduced plain packaging laws in 2012, opponents of the legislation argued it would lead to a number of unintended consequences, including:

    • the market would become flooded by cheap Asian brands
    • smokers would be more likely to buy illegal unbranded tobacco (including raw unbranded loose tobacco known locally in Australia as "chop-chop")
    • smokers would be less likely to buy their cigarettes from smaller mixed businesses such as convenience stores and petrol stations, meaning that small businesses would suffer

    But a new study conducted in Victoria, Australia, suggests these fears are unfounded.

    Researchers compared the responses smokers gave in a telephone survey one year before the introduction of standardised packaging, with responses given one year after its introduction.

    The study found no evidence the introduction of standardised packaging had changed the proportion of people purchasing from small mixed-business retailers, purchasing cheap brands imported from Asia, or using illicit tobacco.

    But this study did not investigate whether there had been an increase in the use of counterfeit branded tobacco products. The researchers noted that smokers may be unaware they are smoking counterfeit products.

    In conclusion, the study suggests there is no evidence for many of the "fears" proposed by opponents of standardised packaging.

     

    Where did the story come from?

    The study was carried out by researchers from the Centre for Behavioural Research in Cancer in Melbourne, Australia.

    It was supported by Quit Victoria, with funding from VicHealth and the Department of Health for the Victorian Smoking and Health annual survey.

    The study was published in the peer-reviewed journal BMJ Open, which is open access, so the study can be read online or downloaded for free.

    The results of the study were well reported by the UK media.

     

    What kind of research was this?

    This was a serial cross-sectional study (a cross-sectional study at different time points) that aimed to determine whether there was any evidence that the introduction of standardised packaging in Australia had changed:

    • the proportion of current smokers who usually purchased their tobacco products from larger discount outlets such as supermarkets, compared with small mixed-business retail outlets
    • the prevalence of the regular use of low-cost brands imported from Asia
    • the use of illicit unbranded tobacco

    In Australia, since 2012 all tobacco products have to be sold in standardised dark brown packaging with large graphic health warnings. Brand names are printed in a standardised position with standardised lettering.

    The researchers state opponents of plain packaging have suggested its introduction could mean smokers would be less likely to purchase from small mixed-business retailers, more likely to purchase cheap brands imported from Asia, and more likely to use illicit tobacco.

     

    What did the research involve?

    Smokers aged 18 and over in Victoria, Australia were identified in an annual population telephone survey (the Victorian Smoking and Health Survey).

    They were asked about:

    • the place they usually purchase tobacco products from (supermarkets, specialist tobacconists, small mixed businesses, petrol stations or other venues, including informal sellers)
    • their use of low-cost Asian brands (whether their main brand was a low-cost Asian brand)
    • their use of unbranded illicit tobacco (whether they had bought or purchased any unbranded tobacco)

    The researchers compared answers from three annual surveys: 

    • 2011 – a year prior to the implementation of standardised packaging
    • 2012 – during roll-out
    • 2013 – a year after implementation

     

    What were the basic results?

    A total of 754 smokers were surveyed in 2011, 590 in 2012 and 601 in 2013.

    The researchers found:

    • the proportion of smokers purchasing from supermarkets did not increase and the percentage purchasing from small mixed-business outlets did not decline between 2011 and 2013
    • the prevalence of low-cost Asian brands was low and did not increase between 2011 and 2013
    • the proportion reporting current use of unbranded illicit tobacco did not change significantly between 2011 and 2013

     

    How did the researchers interpret the results?

    The researchers concluded that, "One year after implementation, this study found no evidence of the major unintended consequences concerning loss of smoker patrons from small retail outlets, flooding of the market by cheap Asian brands and use of illicit tobacco predicted by opponents of plain packaging in Australia."

     

    Conclusion

    The study found no evidence the introduction of standardised packaging had changed the proportion of people purchasing from small mixed-business retailers, purchasing cheap brands imported from Asia, or using illicit tobacco in Victoria, Australia.

    However, this survey was only conducted in Victoria and only among English-speaking residents, so further studies are required to confirm the generalisability of the findings. As with all surveys, there is the possibility of respondent error and misreporting.

    Further studies are required to investigate whether the introduction of standardised packaging has increased the use of counterfeit branded tobacco products, as this was not assessed.

    Overall, the results of this study suggest there is no evidence behind many of the "fears" proposed by opponents of standardised packaging.

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

    Links To The Headlines

    'Plain' packaging not a boost to illegal tobacco use, study suggests. BBC News, August 29 2014

    Australia shows that plain tobacco packaging significantly cuts smoking. The Independent, August 29 2014

    Cigarette plain packaging fear campaign unfounded, Victoria study finds. The Guardian, August 29 2014

    Plain Cigarette Packs Do Not Hurt Retailers. Sky News, August 29 2014

    Links To Science

    Scollo M, Zacher M, Durkin S, Wakefield M. Early evidence about the predicted unintended consequences of standardised packaging of tobacco products in Australia: a cross-sectional study of the place of purchase, regular brands and use of illicit tobacco. BMJ Open. Published online July 18 2014



  • Claims magnetic brain stimulation helps memory

    “Magnetic brain stimulation treatment shown to boost memory,” The Guardian reports. A new study found that magnetic pulses improved recall skills in healthy individuals. It is hoped that the findings of this study could lead to therapies for people with memory deficits such as dementia.

    Researchers investigated the effects of transcranial magnetic stimulation (TMS) every day for five days on connections within the brain and on associative memory (the ability to learn and remember relationships between items – such as “1066” and the “Battle of Hastings”).

    TMS is a non-invasive technique that uses an electromagnet placed against the skull to produce magnetic pulses that stimulate the brain.

    In this study, TMS of a specific area of the brain was compared to “sham” stimulation in 16 healthy adults.

    TMS was found to improve performance on the associative memory test by over 20%, whereas sham stimulation had no significant effect.

    While the results are interesting, there are important limitations to consider. The sample size was small, just 16 people, so the findings need to be replicated in a larger group of people. It is also unclear how long any effect would persist, and if there are any adverse effects of TMS. Long-term studies are also required to determine whether TMS is both safe and effective.

    Of note, the current study involved healthy people, not people with memory deficits, so it is uncertain whether TMS would be of any benefit to people with conditions that cause memory deficits such as dementia.

     

    Where did the story come from?

    The study was carried out by researchers from Northwestern University and the Rehabilitation Institute of Chicago, and was funded by the US National Institute of Mental Health and National Institute of Neurological Disorders and Stroke.

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

    The results of this study were generally well reported by the media, although some headline writers overstated the implications of the results.

     

    What kind of research was this?

    This was a cross-over trial that aimed to determine whether electromagnetic stimulation of a particular region of the brain could improve memory in 16 healthy people.

    The researchers were interested in a region of the brain called the hippocampus, which is necessary for associative memory – this includes the ability to remember the association between a word and a face. It has been hypothesised that this ability also depends on other brain regions, and that the hippocampus could act as a “hub”.

    To see whether this was the case, the researchers used high-frequency TMS to stimulate part of the brain known as the lateral parietal cortex, which is thought to interact with the hippocampus in memory.

    The lateral parietal cortex is part of the cerebral cortex or grey matter, and the hippocampus is located under grey matter.

     

    What did the research involve?

    The researchers compared the effects of high-frequency transcranial magnetic stimulation and “sham” stimulation for five days on the ability of 16 healthy people to remember the association between faces and words.  

    Each person participated for two weeks – one week with TMS and one week with sham stimulation – separated by at least one week. The baseline assessment occurred one day prior to the first stimulation session, and there were five consecutive daily stimulation sessions. The post-treatment assessment occurred one day after the final stimulation session. Half the subjects received TMS first and half received sham stimulation first.

    In the memory test, participants were shown 20 different human face photographs for three seconds each. A researcher read a unique common word aloud for each face. One minute after this had been completed the participants were shown the photos again and asked to recall the words associated with them.

    In addition to looking at the effect of memory, the researchers also looked at the effect of TMS on connectivity within the brain, using a technique called functional magnetic resonance imaging. This technique looks at changes in blood flow, and can be used to assess connectivity by looking for variations in blood flow that are time correlated across the brain.

     

    What were the basic results?

    TMS improved people’s ability to remember the association between a word and a face by more than 20%, whereas sham treatment caused no significant performance change.

    The researchers also gave people other cognitive tests, but found that TMS had no effect on people’s performance on these tests.

    TMS also increased connectivity between specific cortical (grey-matter) regions of the brain and the hippocampus.

     

    How did the researchers interpret the results?

    The researchers concluded that cortical-hippocampal networks can be enhanced noninvasively and play a role in associative memory.

     

    Conclusion

    In this study, TMS was found to improve performance on the associative memory test by more than 20%, whereas sham stimulation had no significant effect.

    TMS also increased connectivity between specific cortical (grey-matter) regions of the brain and the hippocampus.

    This interesting research increases our knowledge of how memory works. However, it was a very small trial with only 16 participants. It is also unclear whether electromagnetic stimulation would be effective for people with memory disorders such as dementia. The media has reported that the researchers are now planning to study the effect of TMS on people with early loss of memory ability.

    Long-term studies are also required to determine how long the improved memory performance lasts and to ensure that electromagnetic stimulation of the brain doesn’t have any adverse effects.

    Dementia remains a poorly understood condition, and claims that brain training exercises have a definitive protective effect against the condition have not held up to scrutiny. That said, keeping the brain active through memory intensive activities such as learning a new language, a musical instrument, or even just picking up a book cannot hurt. Keeping the mind active has been shown to improve quality of life.

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

    Links To The Headlines

    Magnetic brain stimulation treatment shown to boost memory. The Guardian, August 28 2014

    Electrical brain stimulation 'boosts memory'. BBC News, August 29 2014

    Magnetic pulse to head could improve memory of dementia sufferers. The Daily Telegraph, August 28 2014

    Links To Science

    Wang JX, Rogers LM, Gross EZ, et al. Targeted enhancement of cortical-hippocampal brain networks and associative memory. Science. Published online August 29 2014



  • Tomato-rich diet 'reduces prostate cancer risk'

    “Tomatoes ‘cut risk of prostate cancer by 20%’,” the Daily Mail reports, citing a study that found men who ate 10 or more portions a week had a reduced risk of the disease.

    The study in question gathered a year’s dietary information from 1,806 men who were found to have prostate cancer and 12,005 who were clear after random prostate checks. The researchers compared the diets and adjusted the results to take into account factors such as age, family history of prostate cancer and ethnicity.

    They found that men who ate more than 10 portions of tomatoes or tomato products per week have an 18% reduced risk of prostate cancer compared to men who ate less than 10.

    As this was a case controlled study, and not a randomised controlled trial, it cannot prove that eating more tomatoes prevents prostate cancer. It can only show an association.

    The association is biologically plausible, because tomatoes are a rich source of lycopene, a nutrient thought to protect against cell damage. However, the jury is still out on whether it really does protect cells.

    So a healthy, balanced diet, regular exercise and stopping smoking are still the way to go. It’s unlikely that focusing on one particular food will improve your health.

     

    Where did the story come from?

    The study was carried out by researchers from the University of Bristol, the National Institute for Health Research (NIHR) Bristol Nutrition Biomedical Research Unit, Addenbrooke’s Hospital in Cambridge and the University of Oxford. It was funded by the NIHR and Cancer Research UK.

    The study was published in the peer-reviewed medical journal Cancer Epidemiology, Biomarkers and Prevention. The study is open-access so it is free to read online or download.

    In general, the media reported the story accurately but also reported different numbers of study participants, ranging from 1,800 to 20,000. This is because out of the 23,720 men who were initially included in the study, a proportion were excluded from the analyses due to missing questionnaires.

    Several news sources have also reported that eating the recommended five portions of fruit or veg per day reduced the risk of prostate cancer by 24% compared to 2.5 servings or less per day. This seems to have come directly from the lead researcher, but these figures are not clearly presented in the research paper.

     

    What kind of research was this?

    This was a case-control study looking at the diet, lifestyle and weight of men who had had a prostate check and were subsequently diagnosed with (cases) and without (controls) prostate cancer. The researchers wanted to see if there were any factors that reduced the risk of being diagnosed with prostate cancer.

    A previous systematic review suggested that a diet high in calcium is associated with an increased risk of prostate cancer and that diets high in selenium and lycopene are associated with reduced risk. Selenium is a chemical element essential for life that is found in animals and plants, but high levels are toxic. Lycopene is a nutrient found in red foods such as tomatoes and pink grapefruit.

    The researchers defined intake of selenium and lycopene as the “prostate cancer dietary index”. They looked at whether there was an association between men’s index scores and their risk of having prostate cancer.

    In addition, in 2007, the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) made eight recommendations on diet, exercise and weight for cancer prevention. 

    However, recent research has shown conflicting results as to whether these recommendations are applicable to prostate cancer. One large European study found that men who followed the recommendations did not have a lower general prostate cancer risk, and the other found that men did have a reduced risk of aggressive prostate cancer.

    The researchers wanted to see if these recommendations should be changed to include any of the prostate cancer dietary index components for men and/or men at higher risk of prostate cancer.

     

    What did the research involve?

    The researchers used data collected from a large UK study called the ProtecT trial. In this trial, 227,300 randomly selected men aged 50 to 69 were invited to have a prostate check between 2001 and 2009.

    Nearly half of the men then had a prostate specific antigen (PSA) test and 11% of them went on to have further investigations. Before the test they were asked to fill out questionnaires on:

    • lifestyle
    • diet
    • alcohol intake
    • medical history
    • family history

    They were also asked to provide information on their:

    • physical activity level
    • body mass index (BMI)
    • waist circumference
    • body size aged 20, 40 and at the time they entered the study

    Body size was self-estimated by looking at pictures on a scale of 1 to 9. All those selecting 1 to 3 were categorised as normal weight and those selecting 4 to 9 were considered overweight/obese.

    From this study the researchers identified 2,939 men who had been diagnosed with prostate cancer and matched them with 20,781 randomly selected men by age and GP practice who did not have prostate cancer to act as controls. They then excluded anyone who did not return the questionnaires and those who did not provide all of the body metrics.

    This gave a sample of 1,806 men with prostate cancer and 12,005 controls.

    The dietary questionnaires assessed how frequently they had consumed 114 items of food over the previous 12 months. This included an estimate of portion sizes.

    From this information, the men were assigned a score to reflect how well they had achieved the first six of the eight WCRF/AICR recommendations (they did not have enough information for “salt consumption” or “dietary supplements”).

    Adherence to each recommendation was scored (1 – complete adherence, 0.5 – partial adherence or 0 – non-adherence), giving an overall score between 0 and 6.

    The researchers also looked at the intake of components of the “prostate cancer dietary index”: calcium, selenium and tomato products which they used as an indicator of lycopene intake (tomato juice, tomato sauce, pizza and baked beans). To be scored as adherent, men had to:

    • eat less than 1,500mg of calcium per day
    • eat more than 10 servings of tomato and tomato products per week
    • eat between 105 and 200µg of selenium per day

    Statistical analyses were then performed to determine the risk of low or high grade prostate cancer according to adherence to the WCRF/AICR recommendations or intake of any of the three dietary components of the prostate cancer dietary index. The results were adjusted to take into account the following confounders:

    • age
    • family history of prostate cancer
    • self-reported diabetes
    • ethnic group
    • occupational class
    • smoking status
    • total energy intake
    • BMI

     

    What were the basic results?

    After adjusting for possible confounding factors:

    • being adherent to the tomato and tomato product recommendation by eating 10 or more servings of tomatoes per week was associated with an 18% reduced risk of prostate cancer compared to eating less than 10 servings (odds ratio (OR) 0.82, 95% confidence interval (CI) 0.70 to 0.97)
    • each component of the “prostate cancer dietary index” that the men adhered to was associated with a 9% reduction in risk of prostate cancer (OR 0.91, 95% CI 0.84 to 0.99)
    • the overall WCFR/AICR adherence score was not associated with a decreased risk of prostate cancer (OR 0.99, 95% CI 0.94 to 1.05)
    • every 0.25 increase in the score for adherence to the plant food recommendation was associated with a 6% reduced overall risk of prostate cancer (OR 0.94, 95% CI 0.89 to 0.99)

    A 0.25 increase in adherence score could be achieved by increasing fruit and vegetable intake from less than 200g/day to between 200 and 400g/day, or by increasing fruit and vegetable intake from between 200 and 400g/day to 400g/day or more (400g is equivalent to five portions) or by changing intake of unprocessed cereals (grains) and/or pulses (legumes).

     

    How did the researchers interpret the results?

    The researchers concluded that, “in addition to meeting the optimal intake for the three dietary factors associated with prostate cancer, men should maintain a healthy weight and an active lifestyle to reduce risk of developing prostate cancer, cardiovascular diseases and diabetes”. They also say that “high intake of plant foods and tomato products in particular may help protect against prostate cancer, which warrants further investigations”.

     

    Conclusion

    This large study has shown an association between the consumption of more than 10 portions of tomatoes per week and an 18% reduction in risk of prostate cancer. However, as this was a case controlled study, and not a randomised controlled trial, it cannot prove that eating more tomatoes prevents prostate cancer.

    Strengths of the study include its large size and attempts to account for potential confounding factors, although there are some limitations to the study, including:

    • reliance on the accuracy of the dietary questionnaires
    • broad categories for self-estimate of body size

    This study does not provide enough evidence to change the recommendations for reducing the risk of prostate cancer. A healthy, balanced dietregular exercise and stopping smoking are still the way to go, rather than relying on eating one exclusive food type such as tomatoes.

    Following the eight WCRF/AICR recommendations as listed above should also help prevent against other types of cancer as well as chronic diseases such as obesity and type 2 diabetes. 

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

    Links To The Headlines

    Tomatoes 'cut risk of prostate cancer by 20%': It takes 10 portions a week - but even baked beans count. Daily Mail, August 28 2014

    Tomatoes 'important in prostate cancer prevention'. BBC News, August 27 2014

    Tomato-rich diet can lower prostate cancer risk by a fifth, scientists claim. The Independent, August 27 2014

    New research suggests men who eat more than 10 portions of tomatoes a week are less likely to develop prostate cancer. ITV News, August 27 2014

    Links To Science

    Er V, Lane JA, Martin RM, et al. Adherence to dietary and lifestyle recommendations and prostate cancer risk in the Prostate Testing for Cancer and Treatment (ProtecT) trial. Cancer Epidemiology, Biomarkers and Prevention. Published online July 13 2014