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Wednesday, 11 June 2014

One in three adults in England 'has prediabetes'

reposted from: http://www.nhs.uk/news/2014/06June/Pages/One-in-three-adults-in-England-has-prediabetes.aspx
crabsallover highlights, key points, comments / links.

"One in three adults in England 'on cusp' of diabetes," BBC News and others report. The media reports are based on a study that estimated that 35.3% of adults in the UK now have prediabetes (also known as borderline diabetes).
Prediabetes is where blood sugar levels are abnormally high, but lower than the threshold for diagnosing diabetes. It is estimated that around 5-10% of people with prediabetes will go on to progress to "full-blown" type 2 diabetes in any given years.
Researchers analysed information from the Health Survey for England (HSE). This is a survey that combines questionnaire-based answers with physical measurements and the analysis of blood samples from a representative sample of the English population.
This study found that there has been a significant increase between 2003 and 2011 in the proportion of people aged 16 or older with prediabetes, from 11.6% in 2003 to 35.3% in 2013.
Known risk factors, confirmed in this study, include age (40 and above), body mass index (25 and above), being of south Asian ethnicity, and having high blood pressure.
If you think you may be at high risk of prediabetes, you can ask your GP for a blood test. It is often possible to prevent the condition progressing into diabetes proper through lifestyle changes, such as improving your diet and exercising more.

Where did the story come from?

The study was carried out by researchers from the University of Florida and the University of Leicester, and was somewhat surprisingly funded by the US Department of Defense.
It was published in the peer-reviewed BMJ Open, an open accessmedical journal, so the study is free to read online.
This study was accurately reported in the UK media, with many articles also helpfully outlining the complications of diabetes, its impact on public health, and some relevant contextual information.
For example, this included information about the NHS Health Check programme, which invites people between the ages of 40 and 74 to have a check to assess their risk of heart disease, stroke, kidney disease and diabetes, and to give support and advice to help people reduce or manage their risk.
But as the NHS Health Check programme is in its infancy, it is hard to estimate what the likely take-up will be in the future and what impact it will have on public health.

What kind of research was this?

This was a cross-sectional study that aimed to report trends in the prevalence of prediabetes among people aged 16 or older in England.
Cross-sectional studies are the ideal way of determining how many people have a condition.

What did the research involve?

The research used information collected by the Health Survey for England (HSE) in the years 2003, 2006, 2009 and 2011.
The HSE is an annual population-based survey that combines questionnaire-based answers with physical measurements and the analysis of blood samples from a random sample of participants.
People were classified as having prediabetes if they had glycated haemoglobin (an indicator of blood sugar levels) between 5.7% and 6.4% and had not previously been diagnosed with diabetes.
Glycated haemoglobin is formed when haemoglobin is exposed to glucose in the blood. As the amount of glucose in the blood increases, the fraction of haemoglobin that is glycated increases.
Diabetes is diagnosed when the level is 6.5% or above. However, there is no internationally agreed lower level for prediabetes.
The American Diabetes Association uses 5.7% as the lower cut-off level, but a UK expert group for the National Institute for Health and Care Excellence (NICE) recommend 6.0-6.4%.

What were the basic results?

The prevalence of prediabetes increased over the study period. It was:
  • 11.6% in 2003
  • 20.4% in 2006
  • 32.6% in 2009
  • 35.3% in 2011
Age, being overweight, obesity, blood pressure level and cholesterol level exhibited significant relationships with prediabetes in all years that these were measured.
People with greater socioeconomic deprivation were more likely to have prediabetes in 2003 and 2006, but the relationship was no longer significant in 2009 and 2011.
The researchers found that predictors of prediabetes in 2003 and 2011 included:
  • being 40 years or older
  • being of south Asian ethnicity
  • having a high body mass index (BMI) of 25 or over
  • having been diagnosed with high blood pressure
  • being socioeconomically deprived (being in the second most deprived quintile)

How did the researchers interpret the results?

The researchers concluded that, "There has been a marked increase in the proportion of adults in England with prediabetes. The socioeconomically deprived are at substantial risk.
"In the absence of concerted and effective efforts to reduce risk, the number of people with diabetes is likely to increase steeply in coming years."

Conclusion

This study indicates that there had been an increase between 2003 and 2011 in the proportion of people aged 16 or older with prediabetes, with more than a third of adults in 2011 having prediabetes.
The study is useful because it is based on information from the Health Survey for England (HSE), which sampled a representative sample of the English population.
However, the researchers defined prediabetes using cut-offs used by the American Diabetes Association (5.7-6.4%), but in the UKNICE recommends higher cut-offs to identify people at high risk of diabetes (6.0-6.4%).
There are several ways you can reduce your risk of developing 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

Links to the science

Mainous III AG, Tanner RJ, Baker R, et al. Prevalence of prediabetes in England from 2003 to 2011: population-based, cross-sectional study. BMJ Open. Published online June 9 2014
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Sunday, 8 June 2014

5:2 diet style an 'immune booster,' study finds

reposted from: http://www.nhs.uk/news/2014/06June/Pages/5-2-diet-style-fast-immune-booster-study-finds.aspx
crabsallover highlights, key points, comments / links.

“Fasting for at least two days regenerates immune systems damaged by ageing or cancer treatment, research has shown,” the Daily Express reports. However, the study that is being reported on only involved mice, not humans.
Prolonged or intermittent fasting has become an increasingly popular strategy to achieve weight loss. This has been demonstrated through the incredibly popular 5:2 diet, where participants eat normally for five days a week and then fast for the remaining two.
There have been reports that the 5:2 diet can lead to weight loss for some people, with others claiming that fasting can boost immune function and prevent chronic diseases.
In this study, which used only mice, the researchers aimed to see whether prolonged fasting could reverse the toxic effects of chemotherapy – specifically, damage to white blood cells and bone marrow activity, which leaves the body weakened and vulnerable to infection.
Researchers found that mice fasting for two to five days before being given chemotherapy showed a faster recovery in terms of their white blood cell count. A later-stage clinical trial in humans is reported to be underway.
It is extremely important to stress that if you are undergoing chemotherapy treatment, you should not make any kind of radical changes to your diet unless advised to by your doctor. Doing so could make you vulnerable to complications.

Where did the story come from?

The study was carried out by researchers from the University of Southern California, Ohio University and the University of Palermo, in Italy. The study was supported by the National Institutes of Health and Aging and was published in the peer-reviewed science journal Cell. It has been published on an open-access basis, so it is free to read online.
The Daily Telegraph’s reporting of the study was accurate and included discussion from experts, who said that while the findings may have relevance for people receiving cancer treatment, further study is needed, and prolonged fasting should only be considered under the guidance of a doctor. As the Professor of Regenerative Medicine at UCL, Chris Mason, suggests: “The most sensible way forward would be to synthesise this effect with drugs. I am not sure fasting is the best idea. People are better eating on a regular basis.”
The Daily Express’s coverage, while not inaccurate, was not as clear as it should be. It is not until the last part of the article that you realise the study involved mice, not humans.

What kind of research was this?

This was a scientific study using mice, which aimed to look at the effect prolonged fasting might have on reversing the toxic effects of chemotherapy.
This included how it affected bone marrow regeneration and circulating white blood cells – key components of the body’s immune system.
The researchers explain how immune system defects are central to the ageing process and are associated with a range of diseases. One of the effects of chemotherapy is DNA damage and cell death, to both circulating blood cells and to stem cells of the bone marrow, which are responsible for producing new blood cells.
This leads to reduced numbers of red blood cells (which carry oxygen), platelets (which help blood to clot) and white blood cells (which make up the body’s immune system), leaving the body weakened and vulnerable to infection.
All of this can result in a wide range of side effects for people undergoing chemotherapy.
The authors state that prolonged fasting for two to five days activates cellular pathways in mice and humans, which enhance the resistance of cells to toxins, such as chemotherapy. Previous studies in mice have found that prolonged fasting leads to this protective effect, by reducing levels of insulin-like growth factor-1 (IGF-1) – a protein involved in growth and development, with a similar function to insulin.
The theory is that the reduction of IGF-1 resulting from prolonged fasting may allow regeneration of stem cells in the bone marrow, and so help to reverse the toxic effects of chemotherapy.

What did the research involve?

Mice were divided into two groups who were either fed or fasted prior to being injected with chemotherapy drugs for two weeks. The researchers looked at white blood cell counts during and after chemotherapy treatment, and also assessed DNA damage in circulating blood cells and bone marrow cells.
As their previous study had shown that prolonged fasting leads to a reduction in IGF-1 levels, and they believed that this was responsible for the protection against chemotherapy, they also looked at what would happen when mice genetically engineered to have IGF-1 deficiency were given chemotherapy without having fasted.

What were the basic results?

The researchers found that multiple cycles of prolonged fasting protected mice from some of the toxic effects of chemotherapy, reducing DNA damage to both circulating white blood cells and bone marrow stem cells. It also led to the regeneration of bone marrow stem cells. Mice who were given chemotherapy but fed as normal showed prolonged white blood cell depletion, while mice who had fasted beforehand saw their white blood cell count return to normal levels at a faster rate.
As expected, they found that using mice genetically engineered to have IGF-1 deficiency – replicating the effects of prolonged fasting – also showed faster recovery of their bone marrow stem cells. This confirmed that the effect on bone marrow stem cells was probably being mediated by a reduction in IGF-1 levels. Reduction of IGF-1 signalling seemed to promote the renewal of bone marrow stem cells.

How did the researchers interpret the results?

The study authors concluded that their results “indicate that cycles of an extreme dietary intervention represent a powerful mean[s] to modulate key regulators of cellular protection and tissue regeneration, but also provide a potential therapy to reverse or alleviate the immunosuppression caused by chemotherapy treatment and ageing”.

Conclusion

This scientific study suggests that multiple cycles of prolonged fasting may be able to reverse some of the toxic effects of chemotherapy in mice, by causing the regeneration of stem cells in bone marrow.
This allowed white blood cell counts to return to normal much faster after chemotherapy, compared to mice that were allowed to eat normally.
The study researchers indicated very early-stage study in humans (not appraised here), which found that fasting for 72 hours, rather than 24 hours, in combination with chemotherapy reduced some of the toxic effects of chemotherapy, in line with the findings in mice.
However, the study’s authors acknowledge that these results are very tentative and will need to be confirmed in larger, more robust, human studies.
A phase 2 randomised control trial is said to be underway. 
Based on this study alone, it can be stated that people receiving cancer treatment, including chemotherapy, should not fast for extended periods of time without fully consulting a health professional, as this could be damaging to their health in other ways. Appropriate nutrition is very important for people with cancer, during treatment and when recovering from treatment. You should not make any significant changes to your diet without first seeking the advice and guidance of the health professionals treating you.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links to the headlines

Fasting 'revives immune system'. MSN News, June 6 2014

Links to the science

Cheng C, Adams GB, Perin L, et al. Prolonged Fasting Reduces IGF-1/PKA to Promote Hematopoietic-Stem-Cell-Based Regeneration and Reverse Immunosuppression. Cell Stem Cell. Published online June 5 2014
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Friday, 30 May 2014

FTO 'fat gene' may make people more impulsive

reposted from: http://www.nhs.uk/news/2014/05May/Pages/FTO-fat-gene-may-make-people-more-impulsive.aspx
crabsallover highlights, key points, comments / links.
"Carriers of the FTO gene are more likely to succumb to impulsive hunger pangs and prefer high-calorie foods," the Mail Online reports.
A study of carriers of a variant of the FTO gene found reduced activity in areas of the brain associated with impulse control. This was associated with changes in weight, brain function, impulse eating and dietary intake as people got older.
All humans carry the FTO gene, a gene involved in appetite. There is a wide body of research that suggests that certain "high-risk" variants of FTO make people more vulnerable to becoming obese as they get older. It is still unclear why this is the case.
Brain scans suggest that carriers of a specific high-risk variant – rs1421085 – appeared to have decreased brain activity in areas of the brain associated with impulse control. The carriers may also have a "hardwired" preference to find eating high-fat food more enjoyable. Ongoing research did find that these carriers were more likely to become obese as they got older.
This study gives us more information about whether or not some people may have a genetic predisposition towards becoming overweight or obese, and why. It does not mean that this is inevitable, nor does it show that some people are genetically unable to resist impulse eating. 
Whatever your genes, you can maintain a healthy weight. Why not try the NHS Choices 12-week diet and exercise plan?

Where did the story come from?

The study was carried out by researchers from the National Institute on Aging, Florida State University, and Johns Hopkins Medical Institutions in the US.
It was funded by the US National Institute on Aging and published in the peer-reviewed journal, Molecular Psychiatry.
The Mail Online's coverage was fatalistic in tone, implying that people with the "obesity gene" are unable to do much about their impulse eating or their weight.
But this study does not show that impulse eating is determined by our genes. It did not look at actual impulse eating, only self-reported "impulsivity" as a personality trait.
While brain scans were used to study areas of the brain associated with impulse control, at present this is a very inexact diagnostic tool. Brain scans certainly cannot prove that a person is genetically predisposed to impulse eating.
The true picture of obesity is far more complex. It is likely that there are many genes associated with obesity, some of them still unidentified. The study looked at only one particular variant in one of these genes. 
There are also environmental factors to consider. The United States is notorious for being an obesogenic environment. This is an environment that makes inhabitants more prone to obesity because of a number of factors, such as the ready availability of cheap, energy-rich food and lack of opportunities to exercise.

What kind of research was this?

This was a cohort study of ageing which looked at what happened to people who carried a particular variation (rs1421085) in a gene known as the FTO gene as they aged.
This variation has been found to be associated with obesity in children and young people. Less research has been done on its effect in older people or on weight changes over time. The variant has also been found to be associated with mental health disorders and brain shrinkage in older people.
The researchers say that the biological basis of obesity-related behaviour is poorly understood. Overweight people are sometimes portrayed as being weak-willed and unable to control their eating.
However, the researchers argue that it is unclear whether a common biological mechanism underlies a predisposition to obesity, as well as impulse behaviour and a preference for calorie-dense foods.
They wanted to see if the FTO gene variant was associated with changes in body mass index (BMI), as well as changes in brain function and personality traits such as "impulsivity", as people grew older.

What did the research involve?

The researchers used a large long-running US study of ageing, which began in 1958. They identified which participants carried the FTO gene variant and which did not, and compared their BMIs, brain function and personality traits over time.
People carry two copies of any given gene, so participants were tested for whether they carried one or two copies of the FTO gene variant. They also underwent detailed examinations, including neuropsychological assessments and neurological, laboratory and radiological tests every two years.
The participants' height and weight was measured at each visit to determine changes in their BMI as they got older. They were also asked details about their physical activity.
A subset of participants also underwent regular brain scans, which began in 1994, to measure changes in blood flow to different parts of the brain and changes in brain function. The researchers were particularly interested in parts of the brain known to be involved in controlling impulses and response to taste.
Personality traits were also assessed as people aged using a validated 240-item questionnaire. For their current analysis, the researchers primarily focused on the personality traits of impulsivity, excitement-seeking, self-discipline and deliberation. These traits were assessed because they could potentially affect eating behaviour.
Dietary intake was assessed by seven-day dietary records reported by the participants and collected during four time periods – 1961-65, 1968-75, 1984-91 and 1993-2005. The participants were trained in the procedure for completing these records – such as how to assess portion size – by dietitians.
The final sample analysed in this study consisted of 697 participants who were cognitively normal (those with dementia or mild cognitive impairment were excluded). Their average age was 45 at the start of the study, and they had been followed up for between 11 and 35 years (average 23 years).
The analyses took into account factors (confounders) such as age, race, education and cardiovascular risk that might influence the results.

What were the basic results?

The researchers found that about 20% of the study's participants had two copies of the obesity-related FTO gene variant, and 48% carried one copy.
They found that over time, changes to BMI as people got older were significantly different between carriers and non-carriers of the gene variant.
Peak BMI (the highest BMI a person reached during the study) was highest in those with two copies of the variant, intermediate in those with one copy, and lowest in non-carriers. The difference appeared relatively small.
The researchers also found that carriers of the variant were more likely than non-carriers to have reduced activity in certain parts of the brain as they grew older. This included an area involved in impulse control.
They found that measures of impulsivity decreased over time in both carriers and non-carriers, while the trait of deliberation increased. However, the presence of the FTO gene variant was associated with less of a decline in excitement-seeking, with the largest effect found in those with two copies of the variant.
On dietary patterns, they found that all participants reported eating less fat and more carbohydrates over time. However, the presence of the obesity-related variant was associated with less of a decline in fat intake. It was also associated with less of an increase in carbohydrate intake.
Again, the effects were strongest in those with two copies of the variant, who showed some increase in fat intake at older ages.

How did the researchers interpret the results?

The researchers conclude that it is possible that the FTO gene may have an influence on brain function, personality and diet in older people.
They suggest that changes in brain function shown in the study may be associated with increasing impulsivity and greater preference for dietary fat among carriers.

Conclusion

This study has tried to further our understanding of how variations in the FTO gene associated with obesity result in people being overweight or obese. It found that a variation in the FTO gene was associated with BMI changes over time, as well as with changes in the brain and in impulsivity and diet as people age.
This genetic variant was already known to be associated with obesity, but this study is one of the few to look at changes over time. However, this study did not examine whether people were inclined to eat on impulse objectively, instead relying on participants reporting impulsivity as a personality trait themselves.
The researchers suggest that genetic variant-related changes in brain function may be linked to an increase in impulse eating, but at present this is just speculation.
The true picture of obesity is likely to be very complex. It is likely that there are many genes associated with obesity, some of them still unidentified, and that they work in different ways.
The study looked at only one particular variant in one of these genes. Carrying this single genetic variant is not a guarantee that a person will become overweight or obese, or that they cannot eat a healthy diet.
Research on the causes of obesity and on why some people may be predisposed to it is important. This study may be of interest to specialists, but as yet it does not really help anyone trying to keep to a healthy weight as they grow older.
There's no question that for many people this is a struggle, but a healthy diet and regular exercise is within everyone's reach. If you are having problems coping with cravings, there are low-calorie snacks that can help you feel full without derailing your diet. 

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

Links to the headlines

Links to the science

Chuang YF, Tanaka T, Beason-Held LL, et al. FTO genotype and aging: pleiotropic longitudinal effects on adiposity, brain function, impulsivity and diet. Molecular Psychiatry. Published online May 27 2014
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NICE: 'Obese should be prescribed slimming clubs'

reposted from: http://www.nhs.uk/news/2014/05May/Pages/NICE-Obese-should-be-prescribed-slimming-clubs.aspx
crabsallover highlights, key points, comments / links.

“GPs told to prescribe £100 slimming courses for millions of obese patients,” the Daily Mail reports.
The news is based on new guidelines from the National Institute for Health and Care Excellence (NICE) that aim to encourage sustainable weight loss in the obese; “lose a little, and keep it off”.
The guidance is mainly aimed at commissioners (who plan and agree which services will be provided in the NHS and monitor them), health professionals and groups who provide lifestyle weight management programmes. The recommendations may also be of interest to members of the public, including people who are overweight or obese.
The guidance has been issued because being overweight or obese is a common and important health problem in the UK. In 2012 about a quarter of men and women aged 16 and over in England had a body mass index (BMI) over 30, classified asobese.
In addition, 42% of men and 32% of women were categorised as overweight (BMI of 25 to 30). Life expectancy is estimated to be reduced by an average of two to four years for people with a BMI of 30 to 35, and eight to 10 years for a BMI of 40 to 50.
The cost of obesity to society was estimated to be almost £16 billion in 2007, which is predicted to rise to £50 billion by 2050 if obesity levels continue to rise.
NICE has estimated that across the population, a 12-week weight management programme costing £100 or less for people who are overweight or obese would be cost-effective if they were to lose at least 1kg and keep the weight off for life.

What are the main recommendations?

NICE recommends that local authorities and clinical commissioning groups should provide access for people to be referred to a range of lifestyle weight management schemes.
GPs, practice nurses, health visitors, pharmacists and the local adult population should be informed of what services are available locally. And they are advised to use informed advice from the NHS Choices website on weight management.
GPs, health and social care professionals are advised to raise the issue of weight loss for overweight and obese adults in a non-judgemental way. They should consider referring adults of any age to local programmes. They should take the person’s preferences into account. but choose group programmes where possible as they provide better value for money. The programmes should be able to show that at least 60% of people are likely to complete them and that they are likely to lead to an average loss of at least 3% of body weight, with a minimum of 30% of people losing 5% of their initial weight.
People should be referred who have:
  • BMI over 30 (or lower for people from black and minority ethnic groups as they have a higher risk of type 2 diabetes), or people with other risk factors such as already having diabetes
  • BMI between 25 to 30 if there is enough local resource
GPs, health and social care professionals and providers of lifestyle weight management services should be trained to deliver multicomponent programmes, tailored to the individual needs of the person. The programmes should have been developed by a multidisciplinary team including a registered dietician, registered psychologist and qualified physical activity instructor. The programme should be collaborative, and cover:
  • dietary habits
  • safe physical activity
  • strategies to achieve behaviour change
  • prevention of weight regain
Commissioners and local authorities should regularly monitor the provision of services and how effective they have been in helping people to lose weight to ensure that the measures are working and are providing good value for money (are cost effective). This includes collecting outcomes such as:
  • the percentage of people losing more than 3% or 5% of their baseline weight
  • how the weight changes in the 12 months after the programme is completed
  • changes in other outcomes such as blood pressure

What are the main benefits of weight loss?

The more weight that is lost, the greater the benefits – especially if a person is able to lose 5% to 10% of their body weight, and maintain it. However, even losing just 3% body weight if obese or overweight can be beneficial.
Weight loss reduces the risk of:
Read more about the complications of obesity.

What are the dangers of rapid weight loss?

Setting realistic goals for weight loss is an important part of the NICE recommendations. This is to ensure a steady rate of weight loss within safe limits, and to increase chances that the weight loss can be maintained, rather than having weight regain. 

The dangers of rapid weight loss include feeling tired and unwell, as well as the potential for more serious complications such as malnutrition and gallstones. The recommended safe level of weight loss to aim for is between 0.5kg and 1kg per week.

How accurate and balanced is the media’s reporting of the guidelines?

The media have accurately described the extent of people being overweight and obese in the UK, and the cost of treating obesity-related illnesses. They have also highlighted the risks of obesity and the benefits of long term weight loss.
Arguably some of the papers have missed the point of NICE’s main arguments. That is while funding weight-loss programmes may cost the NHS money in the short-term (the Daily Mail quotes a figure of a £100 million a year, but it is unclear how it came up with the figure), it could potentially save the NHS billions of pounds in the long-term. This remains to be proven. 

The NHS weight loss plan

NHS Choices provides a downloadable 12 week weight loss plan that:
  • promotes safe and sustainable weight loss
  • helps you learn how to make healthier food choices
  • provides support from our online community
  • offers a weekly progress chart 
  • presents an exercise plan to help you lose weight
  • hopefully allows you to learn skills to prevent regaining weight
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links to the headlines

Most Brits need slimming classes, NHS guidance says. The Daily Telegraph, May 28 2014

Links to the science

National Institute for Health and Clinical Excellence. Managing overweight and obesity in adults – lifestyle weight management services (PDF, 355kb). May 2014
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Monday, 12 May 2014

ONS suggests that one in four deaths are 'avoidable'

reposted from: http://www.nhs.uk/news/2014/05May/Pages/ONS-suggests-that-one-in-four-deaths-are-avoidable.aspx
crabsallover highlights, key points, comments / links.

“1 in 4 deaths could have been prevented,” The Times reports. Figures released by the Office for National Statistics (ONS) found that 23% of deaths could have been prevented through better care, more effective treatment and healthier living.
The news is based on an ONS bulletin titled Avoidable Mortality in England and Wales, 2012 (PDF 186kb).
The bulletin provides mortality figures for causes of death that are considered avoidable if timely and effective healthcare is received or healthier lifestyle choices adopted.
Figures were provided for the period 2001 to 2012 so that trends can be seen.
The bulletin found that deaths from potentially avoidable causes accounted for about 23% of all registered deaths in England and Wales in 2012. While one avoidable death is one too many, there was a downward trend as this rate has fallen from 25% in 2003.
The report also found that:
  • avoidable death rates were higher in Wales than England
  • the leading causes of avoidable deaths were ischaemic heart disease (the most common type of heart disease) in males, and lung cancer in females
  • the neoplasms (cancers and non-cancerous abnormal tissue growths) that are considered to be avoidable have overtaken cardiovascular diseases as the leading cause of avoidable deaths since 2007
According to the report, a degree of caution should be used when interpreting the findings. This is due to factors such as advances in healthcare and policy not being reflected in mortality rates in the short term.

The NHS Health Check

If you are aged 40 or above then you are eligible for a NHS Health Check.

The NHS Health Check is a sophisticated check of your heart health. Aimed at adults in England aged 40 to 74, it checks your vascular or circulatory health and works out your risk of developing some of the most disabling – but preventable – illnesses, such as heart disease, diabetes anddementia.

Read more about the NHS Health Check.

Where did the story come from?

The report was carried out by the UK Office for National Statistics (ONS). Statistics on avoidable deaths are used by governments, public health experts, academics and charitable organisations to reduce the amount of specific conditions considered avoidable causes of death.
According to the report, it is anticipated that the statistics provided will help in assessing the quality and performance of healthcare as well as wider public health policies. However, several limitations listed in the report are described further below and the report states a degree of caution is required when interpreting the findings.
The ONS is a government body that provides data on the economy and population at a national and local level. Summaries and detailed data are released free of charge.

What did the report base its findings on?

The report provides mortality (death) figures for causes of death that are considered avoidable if timely and effective healthcare or public health interventions are received.
Figures are provided for both England (including the regions of England) and Wales for the period 2001 to 2012 and trends are reported.
The report has presented the statistics using age-standardised rates, which is a standard method for carrying out calculations on mortality rates. This makes allowances for differences in the age structure of the population over time and between genders.
Statistics on mortality are taken from the information provided when deaths are certified or registered (in England and Wales deaths should be registered within five days of the death occurring).

What are the main findings of the report?

The key findings of the report are:
  • deaths from potentially avoidable causes accounted for about 23% (112,493 out of 499,331) of all registered deaths in England and Wales in 2012 (in 2003 this figure was 25%, so deaths from avoidable causes since 2003 have actually decreased)
  • avoidable death rates were significantly higher in Wales than England for the period 2001 to 2012
  • avoidable death rates varied across the regions of England with the highest in the North of England and the lowest in the South and East of England for the period 2001 to 2012
  • for the period 2001 to 2006, cardiovascular diseases were the leading contributors to avoidable deaths. However since 2007, neoplasms (cancers and non-cancerous abnormal tissue growths) that are considered to be avoidable have taken over as the leading cause of avoidable deaths and there has been no significant decrease in the death rate from neoplasms since 2009
  • in males, the leading cause of avoidable death was ischaemic heart disease (representing 22% of all avoidable male deaths)
  • in females, lung cancer was the leading cause of avoidable death (representing 15% of all avoidable deaths in females)

What are the limitations of the report?

According to the report, one of the main difficulties in producing an indicator of avoidable deaths is the selection of the causes of death to be included. While a particular condition can be considered avoidable, the report says this does not mean that every death from that condition could be prevented. This is due to factors such as the age of the patient, the extent of disease progression at diagnosis or the existence of other medical conditions that are not taken into account when compiling a list of causes.
Another limitation the report lists is that improvements in the healthcare system (such as a change in resources or the introduction of a new healthcare innovation or policy) may not equate to immediate changes in death figures in the short term and that this is sometimes mistakenly interpreted as a decrease in healthcare quality.

How can you reduce your risk?

The good news about reducing your risk for one avoidable condition is that it often leads to a reduction in risk for other conditions. For example, if you make an effort to reduce your heart disease risk through exercise and healthy eating, this will also reduce your risk of stroke, diabetes and kidney disease.
Proven methods of reducing your risk of avoidable conditions include:
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

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Further reading

Office for National Statistics. Avoidable Mortality in England and Wales, 2012. May 2014
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