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Sugar intake guideline 'needs lowering'

NHS Choices - Behind the Headlines - Tue, 16/09/2014 - 13:00

“Sugar intake must be slashed further,” reports BBC News today.

The news reports follow an ecological study estimating the burden of disease caused by sugar-related tooth decay in adults and children across a life course, in a number of different countries.

It calculated that the burden would be significantly reduced by setting a target limit of less than 3% of total energy intake from sugar. This is much lower than the current figure outlined by the World Health Organization (WHO), which says that sugars should be less than 10% of a person’s daily calorie intake.

This reassessment of the target figure is not official from either the WHO or Public Health England, but has led to widespread media reports stating, “action needed to curb sugar” (Mail Online), while others have outlined possible sugar bans in schools and hospitals (The Daily Express and The Daily Telegraph) or sugar-related taxes. These angles were not put forward in the academic publication, which only suggested new, lower targets for sugar intake should be developed. It did not specify how to achieve them.

Potential limitations of the study include the accuracy of the sugar intake estimates and the percentage of total intake derived from sugar. This may or may not affect their overall conclusion that the existing target, of less than 10%, should be lowered.

On its own, this study does not appear robust enough to lead to policy changes.

 

Where did the story come from?

The study was carried out by researchers from University College London, who reported that no external funds were required for these analyses, interpretation or the writing of the paper.

The study was published in the peer-reviewed medical journal BMC Public Health. It is an open access journal, so it can be read for free online.

The reporting of the study was generally accurate across media outlets, with most coverage bringing in other issues around sugar bans, sugar taxes and other potential control measures in schools. These were not proposed in the original publication, so their source is unclear.

 

What kind of research was this?

This was an ecological study of national data on sugar intake and dental decay in many countries around the world, to assess the burden of disease in adults and children. 

Tooth decay is a common problem that occurs when acids in your mouth dissolve the outer layers of your teeth. It is also known as dental decay, tooth decay or dental caries. Although levels of tooth decay have decreased over the last few decades, it is still one of the most widespread health problems in the UK.

Sugar is a known cause of tooth decay, but the research team say no analysis has been made of the lifetime burden of dental decay by sugar. They wanted to estimate this and also see whether the WHO goal of less than 10% of total energy intake from sugar is optimal and compatible with low levels of dental decay.

 

What did the research involve?

The study gathered information on the prevalence and incidence of dental caries from nationally representative datasets. They then looked for links with national estimates of sugar intake from dietary surveys, or from the national intake assessed from the UN Food and Agriculture Organization Food Balance Sheet.

Analysis looked at countries where sugar intake had changed due to wartime restrictions or as part of a broader nutritional transition linked to becoming a more industrialised nation. The main analysis established a dose response relationship between sugar consumption and risk of dental decay across a life course. This was different to many previous studies that focused on the impact in children only. The impact of fluoride, in the water supply or applied through toothpaste, on the dose response relationship was also considered.

Sugar intake was defined differently in different national dietary surveys, but generally referred to sucrose consumption, often termed “non-milk extrinsic sugars”. In the US, fructose syrups are included, and in the UK, the term “non-milk extrinsic sugars” is used to define these non-lactose disaccharides, with maltose making a negligible contribution. The statistics do not take account of sugars contained in dried fruit.

Estimates of national sugar consumption were used to calculate the proportion of total energy a person might be getting from sugar each day, and were based on an estimate of average global energy intake (men, women and children) of 2,000 calories per day.

 

What were the basic results?

Detailed information from Japan indicated sugar was directly related to dental decay when sugar increased from 0% to 10% of total daily energy intake. This led to a 10-fold increase in dental caries over several years.

Adults aged over 65 had nearly half of all tooth surfaces affected by caries, even when they lived in water-fluoridated areas, where high proportions of people used fluoridated toothpastes. This did not occur in countries where the intake of sugar was less than 3% of total daily energy intake.

Therefore, the cut-off they calculated to reduce the burden of disease caused by sugar was a daily intake of less than 3% of total energy intake. They suggested that less than 5% might be a more pragmatic target for policy makers. The current WHO recommendation is less than 10%.

 

How did the researchers interpret the results?

The researchers concluded that, “there is a robust log-linear relationship of [dental] caries to sugar intakes from 0% to 10% sugar [of total energy]. A 10% sugar intake induces a costly burden of caries. These findings imply that public health goals need to set sugar intakes ideally <3%, with <5% as a pragmatic goal, even when fluoride is widely used. Adult as well as children’s caries burdens should define the new criteria for developing goals for sugar intake.”

 

Conclusion

This ecological study looked at national data sets to estimate the burden of disease caused by sugar-related tooth decay in adults and children across a life course. It calculated that the burden would be significantly reduced by setting a target limit of less than 3% of total energy intake coming from sugar. This is much lower than the current figure outlined by the WHO, which states that sugar should be less than 10% of a person's daily calorie intake.

This reassessment of the target figure is not official, but has led to widespread media reports stating, “action needed to curb sugar” (Mail Online), with others outlining possible sugar bans in schools and hospitals (Express and Telegraph) or sugar-related taxes. These angles were not put forward in the academic publication, which only went as far as suggesting that new, lower targets for sugar intake should be developed. They did not specify how the reduction could or should occur.

The study has many potential limitations, thereby reducing its reliability and calling into question the precision of its estimates and the 3% cut off. Namely, it is likely to include inaccuracy in its estimates of sugar intake and particularly the percentage of total intake derived from sugar. For this, it used a generic figure of 2,000 calories per day for men, women and children. This may not be an accurate representation of intake present across a very diverse demographic of people from a range of different countries.

The severity of the health effects of sugar has long been debated and was somewhat popularised in the 1972 book “Pure White and Deadly” by Professor John Yudkin. Discussions since then have considered whether more restrictions should be placed on sugar, given the many estimates of its widespread negative effect on health in terms of weight gain, tooth decay, diabetes and contribution to other diseases. 

This has also included debate around whether the food and drinks industries should do more (through voluntary or mandatory mechanisms) to reduce the sugar content of their products, particularly those marketed at children, in a similar vein to efforts to reduce the salt and saturated fat content of food in the 1980s and 90s.

On its own, this study does not appear robust enough to lead to policy changes; however, the debate is clearly underway, as some media reports indicated both the WHO and advisors in England may be considering a cut in their recommendations for sugar consumption.

These considerations are likely to be based on much stronger or broader evidence than this single study.

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

Links To The Headlines

Sugar intake must be slashed further, say scientists. BBC News, September 16 2014

Action needed to curb sugar intake. Mail Online, September 16 2014

Ban sugary foods in schools and hospitals, doctors say. The Daily Telegraph, September 16 2014

Sugar ban: Junk food should be axed from school to stop tooth decay. The Daily Express, September 16 2014

Links To Science

Sheiham A, James WPT. A reappraisal of the quantitative relationship between sugar intake and dental caries: the need for new criteria for developing goals for sugar intake. BMC Public Health. Published online September 16 2014

Categories: NHS Choices

Brain scans offer fresh insights into ADHD

NHS Choices - Behind the Headlines - Tue, 16/09/2014 - 12:50

"Doctors could soon diagnose ADHD in children with a brain scan," is the over-exuberant headline from the Mail Online.

The underlying research, based on comparing the brain scans of 133 people with attention deficit hyperactivity disorder (ADHD) with people without the condition, highlighted areas of brain connectivity that were different in the two groups. These differences may be a result of the slower maturation of these connections in people with ADHD. 

These regions of the brain have previously been associated with some of the symptoms characteristic of the condition, such as impulsivity. This suggests these areas may be involved in the development of ADHD.

The study authors' conclusions were considered and did not suggest that improvements in ADHD diagnosis were imminent based on these results alone. They called for further research to confirm and validate their findings and to develop further understanding of the neurological basis of ADHD.

If you think you or your child may have ADHD, you might want to consider speaking to your GP about the condition.

 

Where did the story come from?

The study was carried out by researchers from the Department of Psychiatry at the University of Michigan, and was funded by the US National Institutes of Health, a University of Michigan Center for Computational Medicine pilot grant, and the John Templeton Foundation.

It was published in the peer-reviewed journal, Proceedings of the National Academy of Sciences (PNAS).

The Mail Online coverage was generally accurate, but their headline suggesting that "Doctors could soon diagnose ADHD in children with a brain scan" read too much into these early-stage results.

Researchers neither tested nor validated the use of brain scans alone as a method of diagnosing ADHD, or when coupled with current diagnosis methods.

 

What kind of research was this?

This was a case-control study comparing the brain scans of children and young adults with ADHD with those of typically developing control participants without ADHD.

The researchers state individuals with ADHD have delays in brain maturation. This study aimed to investigate this in detail by establishing which parts of the brain, and which connections between different parts of the brain circuitry, were delayed in people with ADHD.

 

What did the research involve?

The research involved comparing the brain scans of 133 people diagnosed with ADHD, the cases (age range 7.2 to 21.8 years), with 443 typically developing controls (age range selected to match cases). The analysis compared the connectivity between a number of distinct areas of the brain to look for differences between the cases and controls.

The scans assessed functional connectivity to gauge which areas of the brain were functionally connected to other areas. They referred to this approach as a "connectomic" method.

This is slightly different from many previous studies, which mainly looked at whether certain areas are active or not, or at the relative sizes of different areas of the brain. The analysis took account of age differences in the two samples.

 

What were the basic results?

The scans showed differences between the brain connectivity maturation of people with ADHD and those without.

Those with ADHD had a lag in the maturation of connections in a specific brain network region called the default mode network, a poorly understood structure whose functions are uncertain.

They also had delays in connections between the default mode network and two other areas called task-positive networks, which deal with tasks requiring attention: the frontoparietal network and ventral attention network.

The research team indicated these areas of brain connectivity and interaction have previously been associated with the behavioural characteristics of ADHD, such as impulsivity, providing some degree of external validity for the importance of this region.

 

How did the researchers interpret the results?

The researchers stated their results suggest "maturational lag of regulatory control networks contributes to inattention and/or impulsivity across different clinical populations, and they invite new research aimed at direct comparative investigation".

 

Conclusion

This research, based on comparing the brain scans of people with ADHD with those without, highlighted areas of brain connectivity that were different in the two groups. These regions have previously been associated with some of the symptoms characteristic of ADHD. 

The study's authors were considered in their conclusions and did not suggest that improvements in ADHD diagnosis could be made based on their results. They called for further research to confirm and validate their findings and to develop further understanding of the neurological basis of ADHD.

It is feasible this sort of technology might be used to aid ADHD or other mental health-related conditions in the future, but this is very speculative based on what is a relatively small early-stage study.

Larger studies comparing more diverse groups of people with and without ADHD could shed more light on whether this sort of scan could be used as a diagnostic tool.

This is just one avenue of research – a related aim of this type of scanning is to generally increase understanding of the neurological basis of ADHD, which could then lead to new treatments.

ADHD is currently diagnosed through a formal assessment performed by a health professional such as a psychiatrist, a doctor specialising in children's health, a learning disability specialist, a social worker, or an occupational therapist with expertise in ADHD.

If you think you or your child may have ADHD, you might want to consider speaking to your GP about the condition first.

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

Links To The Headlines

Doctors could soon diagnose ADHD in children with a brain scan. Mail Online, September 15 2014

Links To Science

Sripada CS, Kessler D, Angstadt M. Lag in maturation of the brain's intrinsic functional architecture in attention-deficit/hyperactivity disorder. PNAS. Published online September 15 2014

Categories: NHS Choices

Raphael and Elizabeth Wallfisch play Brahms Double - 18th October 2014

Events - Tue, 16/09/2014 - 12:18
Date:  Saturday, 18 October 2014 - 7:30pm - 10:00pm Raphael and Elizabeth Wallfisch play Brahms Double - 18th October 2014 International artists, cellist Raphael Wallfisch and his wife, violinist Elizabeth Wallfisch, will make a rare appearance together to play Brahms' Double Concerto in Ely Cathedral on Saturday 18th October 2014 Cost: 

Tickets start at just £7 (unreserved) and rise to £20 (premium)

Contact:  Patricia Mathieson Telephone:  01353 660349 Email:  box.office@cathedral.ely.anglican.org Website:  Ely Cathedral Box Office Location Ely Cathedral Palace Green Ely CB7 4DL United Kingdom See map: Google Maps

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Bruckner E Minor Mass & Motets: Ely Choral Society - 25th October 2014

Events - Tue, 16/09/2014 - 12:09
Date:  Saturday, 25 October 2014 - 7:30pm Bruckner E Minor Mass & Motets: Ely Choral Society - 25th October 2014 Ely Choral Society and Wymondham Symphony Orchestra collaborate to present a rare opportunity to hear Anton Bruckner's E minor Mass, his first recognised masterpiece. The performance is conducted by Andrew Parnell. Cost:    £20, £15 and under 18s £5 Contact:  Ely Cathedral Box Office Telephone:  01353 660349 Email:  tickets@elychoralsociety.org Website:  Ely Cathedral Box Office Location Ely Cathedral (Lady Chapel) Palace Green Ely CB7 4DL United Kingdom See map: Google Maps

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GM's Opel to cut Russia production as slowdown bites

Reuters UK Business News - Tue, 16/09/2014 - 12:07
BERLIN (Reuters) - U.S. carmaker General Motors is cutting production and shedding around 500 jobs at its Opel division in Russia, hit by a plunge in local demand due to a slowing economy and Western sanctions.






ASOS to cut prices after third profit warning

Reuters UK Business News - Tue, 16/09/2014 - 12:03
LONDON (Reuters) - British online fashion retailer ASOS warned on profit for the third time in seven months, saying its needs to cut prices in international markets to reverse a sharp slowdown in sales growth.






Willow Weaving Workshop - 8th November 2014

Events - Tue, 16/09/2014 - 11:55
Date:  Saturday, 8 November 2014 - 10:00am - 4:00pm Willow Weaving Workshop - 8th November 2014 Learn how to weave willow and other natural fibres with local expert Jane Frost Cost:    Half day workshop £12 per adult, £18 for one adult and child One day workshops £55 per person Two-day workshops £95 per person   Booking essential with deposit of £25 or full payment in advance, through Jane Frost. Contact:  Jane Frost Telephone:  01353 861944 or 07967 088348 Email:  Jane@FrostArt.co.uk Website:  WWT Welney Wetland Centre Location WWT Welney Wetland Centre Hundred Foot Bank Welney, Norfolk PE14 9TN United Kingdom See map: Google Maps

Financial stocks push FTSE lower as Scottish vote approaches

Reuters UK Business News - Tue, 16/09/2014 - 11:51
LONDON (Reuters) - Britain's top share index fell on Tuesday, with financial stocks underperforming as investors showed reluctance to buy up new positions due to uncertainty before Scotland's independence vote on Thursday.






Orange strikes 3.4 billion euros deal to buy Spain's Jazztel

Reuters UK Business News - Tue, 16/09/2014 - 11:48
PARIS/MADRID (Reuters) - France's Orange has reached a deal to buy Spanish fixed line telecoms operator Jazztel in an effort to bolster its mobile operation in the country and better compete with rivals Telefonica and Vodafone.






Blackstone Group seeks to raise $16 billion for its latest fund - WSJ

Reuters UK Business News - Tue, 16/09/2014 - 11:30
(Reuters) - Blackstone Group LP is aiming to raise about $16 billion (9.8 billion pounds) for its latest buyout fund, the Wall Street Journal reported, citing sources familiar with the matter.






Europe’s startups get bootcamp booster

Reuters UK Business News - Tue, 16/09/2014 - 11:27
AMSTERDAM (Reuters) - In the two years that Rockstart Accelerator - a private bootcamp for tech firms - has been going, it says the 20 startups it has backed have raised 15 million euros (12.01 million pounds) and created nearly 150 permanent jobs.






Ukraine, Scotland push German investor morale lower

Reuters UK Business News - Tue, 16/09/2014 - 11:14
MANNHEIM Germany (Reuters) - German analyst and investor morale fell in September to its lowest level since December 2012 in a sign that the Ukraine crisis is taking its toll on Europe's largest economy while uncertainty about the Scottish referendum is also weighing.






Europe’s startups get bootcamp booster

Reuters UK Business News - Tue, 16/09/2014 - 11:09
AMSTERDAM (Reuters) - In the two years that Rockstart Accelerator - a private bootcamp for tech firms - has been going, it says the 20 startups it has backed have raised 15 million euros (12.01 million pounds) and created nearly 150 permanent jobs.






German judge set to rule on Uber injunction appeal on Tuesday

Reuters UK Business News - Tue, 16/09/2014 - 11:06
FRANKFURT (Reuters) - The Frankfurt judge who issued an injunction against online taxi service Uber from operating a novel car-sharing service in Germany appeared ready to rebuff an appeal on Tuesday by the firm, which has argued it should not be subject to taxi rules.






AXA IM upgrades euro zone stocks to 'overweight' post - ECB

Reuters UK Business News - Tue, 16/09/2014 - 11:04
PARIS (Reuters) - AXA Investment Managers has upgraded its short-term recommendation on global and euro zone equities to "overweight" following the latest measures unveiled by the European Central Bank to support the region's economy.






Foodbank issues rallying call as demand outstrips supply by ‘one tonne per month’

Ely Standard - Tue, 16/09/2014 - 11:02

The need for food to help people struggling with homelessness and debt is now out-stripping supply by as much as a tonne every month, according to the Ely Foodbank partnership.

Categories: Local Press

China August FDI at two-and-a-half-year low as factory investments slow

Reuters UK Business News - Tue, 16/09/2014 - 10:59
BEIJING (Reuters) - China's foreign direct investment fell to a low not seen in at least 2-1/2 years in August, underscoring the challenges to growth facing the world's second-biggest economy.






UK financial adviser fined, banned over dishonest investment advice

Reuters UK Business News - Tue, 16/09/2014 - 10:53
LONDON (Reuters) - A former senior partner at St James's Place, a UK wealth manager, has been fined and banned for persuading clients to invest millions of pounds in companies in which he had an interest, which then went into liquidation.






Chatteris man traps hand in ride on lawn mower accident

Ely Standard - Tue, 16/09/2014 - 10:43

A man has suffered a serious hand injury after trapping it in a ride-on lawn mower in Chatteris.

Categories: Local Press

Euro zone second quarter labour costs jump despite stalling economy

Reuters UK Business News - Tue, 16/09/2014 - 10:29
BRUSSELS (Reuters) - The rise in euro zone labour costs accelerated in the second quarter compared to the first three months despite a stalling economy, the European Union's Statistics Office said on Tuesday.






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