Is there really a middle-class drinking 'epidemic' in over-50s?

Friday July 24 2015

A glass or more of wine each day can soon add up

"Middle-class over-50s have become a generation of problem drinkers," the Mail Online reports – a headline that actually has little basis in fact.

This follows the analysis of more than 9,000 adults aged over 50 from the English Longitudinal Study of Ageing. It found that over-50s falling into a "higher-risk drinking" category were more likely to have middle-class traits such as high educational achievement, better self-rated health, and being socially active.

Higher-risk drinking was defined as drinking more than 50 alcohol units per week (equivalent to five or more bottles of wine) for men, and over 35 units per week (three-and-half bottles of wine) for women.

The Mail's headline got the wrong idea though, because only 3-7% of over-50s drank at these "higher-risk" levels. While an obvious issue of concern, it a stretch to say this is a generation of problem drinkers.

There were also significantly different patterns between men and women. For example, higher-risk drinking was linked to higher income, but only in women.

These uncertainties aside, the study does reinforce the fact that alcohol misuse and the risks of drinking too much do not respect class boundaries. You can do just as much damage by drinking champagne to excess as you can by drinking cheap cider.

Where did the story come from?

The study was carried out by Professor José Iparraguirre from the Research Department of Age UK and was also funded by Age UK.

The study was published in the peer-reviewed medical journal BMJ Open. This is an open-access journal, meaning anyone is free to read the study online.

The Mail, The Daily Telegraph, The Times and The Guardian reported the research facts accurately, although none discussed any limitations associated with the research. All papers carried useful quotes from independent experts. For example, the Mail included a quote from Professor Sir Ian Gilmore, chairman of the Alcohol Health Alliance, who said: "Whilst it may be true that middle-class drinkers are able to offset some health problems because of healthier diets and lifestyles more generally, the risks of serious health harms are still significant. For example, even low levels of drinking increase the risk of developing cancer."

What kind of research was this?

This was an analysis of a longitudinal survey of ageing, estimating what risk factors might be linked to harmful alcoholic drinking in over-50s.

A longitudinal study involves repeated measures over time, so is great for measuring changes in drinking behaviour. One of the disadvantages is that they tend to rely on self-reported survey estimates of alcohol intake, which can be an unreliable reporting method. Some people may deliberately under-report their drinking habits out of embarrassment or social pressure. Others might under or overestimate them by accident through not knowing how many units are in their drinks. Heavy drinkers may forget how much they drank over the course of their sessions.

By using lots of people, over and underestimates should even out to give a relatively accurate picture of what’s going on, but this is never perfect. 

What did the research involve?

Researchers analysed the drinking habits of 9,251 adults aged over 50, looking for links between their drinking habits and their income, lifestyle and social situation.

The drinking and other lifestyle information came from responses to the English Longitudinal Study of Ageing. This gathered data from a representative sample of UK men and women aged 50 and over from 2008 to 2011.

Their definition of harmful drinking used the highest risk category from NICE guidelines. This is called "higher-risk drinking" and describes men drinking more than 50 alcohol units per week, or women drinking more than 35 units per week. For men, this is equivalent to five or more bottles of wine a week, or 16 pints or more of strong lager, and equivalent to three-and-half bottles of wine, or 11 pints or more of strong lager for women.

They used two sources of alcohol unit measures, to see if that made any difference to the findings. The first calculated that:

• one pint of normal-strength beer was equivalent to two units
• a 175ml glass of wine is equivalent to two units
• a 250ml glass of wine is equivalent to three units

The second, using the drinkaware website, calculated that:

• one glass of wine was equivalent to three units
• one pint of beer was equal to three units

The analysis estimated how the risk of harmful drinking was influenced by:

• age
• income
• education
• lifestyle (diet, smoking and physical activity levels)
• depression
• loneliness
• self-reported health (poor to excellent)
• marital status
• caring responsibilities
• children in the home
• employment
• social isolation

The researchers looked for a link between heavier drinking and people quitting the longitudinal survey. They found no link, suggesting that people dropping out were not an important issue.

What were the basic results?

The results showed different patterns for men and women:

• The risk of women being in the higher-risk drinking category reduced steadily from the ages of 50 to 90.
• By contrast, men’s risk peaked in their mid-60s, before declining.
  For both sexes, reporting better health,
• Achieving higher educational attainment and smoking were linked to being in the higher-risk drinking category.
• Income was linked to higher-risk drinking in women, but not men.
• Having a job had no link overall. But retirement increased the chances of drinking at higher risk levels for women.
• Being single, separated or divorced was linked to being in the higher-risk drinking category, although only for men.
• Loneliness and depression are not associated with higher-risk drinking.
• Having caring responsibilities reduces the probability of being at higher risk for women.

Some of the analysis looked at how likely people were to enter the higher-risk category from lower drinking levels over a two-year period. This found:

• For women, being younger and having a higher income increased the probability of becoming a higher-risk alcohol drinker over time.
• For men, not eating healthily, being younger and having a higher income increase the probability of becoming a higher-risk alcohol drinker

How did the researchers interpret the results?

The researchers attempted to draw some themes from their many individual results: "… we can sketch – at the risk of much simplification – the problem of harmful alcohol drinking among people aged 50 or over in England as a middle-class phenomenon: people in better health, higher income, with higher educational attainment and socially more active are more likely to drink at harmful levels."

They say the concept of: "successful ageing […] embraces components such as non-smoking, greater physical activity, more social contacts, better self-rated health and absence of depression, among others." And that their results show: "generally speaking, people aged 50 or over ageing 'successfully' in England are more at risk of drinking at harmful levels".

Conclusion

This study showed that higher-risk drinking was linked to a number of factors the researchers described as "middle-class", like higher educational attainment, being socially active and good ratings of health.

Professor Jose Iparraguirre, author of the research, said in the Guardian: "Because this group is typically healthier than other parts of the older population, they might not realise that what they are doing is putting their health in danger".

There are a few reasons to be cautious with these findings.

The study produced a lot of results, so there is a risk some were chance findings. This is particularly relevant, as the analysis focused on higher-risk drinking. Of the large number of people taking part in this survey, only a small chunk (3-7%) fell into this category. Analyses based on these smaller numbers are more likely to give chance findings.

Also, the study only tracked people for a maximum of three years, which isn’t particularly long. Studies tracking drinking behaviour over longer periods of time might show different patterns.

The study used a representative group of UK older adults, which is a strength. However, we can’t be sure this paints a totally realistic picture across the UK, as there may be geographical variation.

The researchers tell us that heavy drinking in older age is linked to death in the short term. This means there was a risk of higher-than-normal numbers of older moderate drinkers, as heavy drinkers might have died earlier. Usefully, the researchers re-ran the stats using an age cut-off of 70. This showed no difference to the age 90 cut-off used for the main analysis, meaning this wasn’t an important influencing factor.

Rosanna O’Connor, director of Alcohol Drugs and Tobacco at Public Health England, said in the Guardian: "Around one in five adults regularly drinks at levels that can damage their health, leading to serious, but preventable, conditions such as stroke, some cancers, depression and liver disease. Many are unaware of the harm caused, especially from drinking frequently throughout the week."

The NHS Health Check, which is available to everyone in England aged 40-74, includes an alcohol risk assessment and advice for those whose drinking may be putting their health at risk.  

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Study says 'size really doesn’t matter' when it comes to a penis

Thursday July 23 2015

Its seems quality is more important than quantity

"Scientists claim they've worked out what makes the perfect penis," The Independent reports.

According to Swiss researchers, women value overall cosmetic appearance of a penis over length.

The actual point of the study was to assess women’s perception of the penises of men who have had surgery for hypospadias, a condition where the hole through which urine passes (meatus) is not at the tip of the penis. The condition is typically corrected in childhood by surgery.

Researchers asked women to compare pictures of men who have been treated for hypospadias with men who had been circumcised.

Overall general penile appearance was found to be the most important aspect of a penis for women and the position and shape of the meatus to be the least important.

Out of a list of eight aspects, the length of a penis was actually rated as coming sixth out of eight. Research suggests a massive disconnect between what men think is important about their penis and what women actually think. One study found that 85% of women were satisfied with their partner’s penis size while only 55% of their corresponding partners felt the same. 

Where did the story come from?

The study was carried out by researchers from University Children’s Hospital Zurich and the University of Zurich. The source of funding was not reported.
 
The study was published in the peer-reviewed Journal of Sexual Medicine on an open-access basis so the study is available to read online or download as a PDF (as an advanced warning, the study does contain some graphic images of different types of penises).

This story has been reported accurately in the media with quotes from authors and a detailed report of study findings.

Much of the reporting on the study takes a light-hearted tone, but it is important not to discount the anxieties that many men, usually without justification, experience about penis size. Read more advice about penis size

What kind of research was this?

This was a cross-sectional study which aimed to investigate the importance of single aspects of penile appearance for women, which is an appropriate design for this research question.

What did the research involve?

This cross-sectional study was part of a larger project on hypospadias.

The three aims of this study were:

• to investigate which aspects of penile appearance are considered to be relevant by women
• to know whether penises that have undergone surgery for hypospadia are perceived to be less normal looking than circumcised genitals
• to identify the most relevant observer-related predictors for normal penile perception

Women of three age groups, 16 to 20, 25 to 30 and 40 to 45 years, were asked to rate photosets of men with hypospadias-affected surgically repaired genitals (HASRGs) and men with circumcised genitals. They then answered a questionnaire on the importance of different aspects of a penis in general. Age categories were meant to reflect different degrees of sexual experience.

The 20 photosets included 10 circumcised genitals and 10 HASRGs (various techniques represented) which were paired according to penile size, age and bodyweight. Each photoset was rated on a four point scale, one being total disagreement and four being full agreement, to the statement "This is a normal (looking) penis." The women were unaware that half the photoset showed ‘normal’ circumcised genitals.

Women were also questioned on the importance of eight different aspects of a penis. This used a five point scale, one being very unimportant and five being very important.

Penile aspects investigated, chosen based on the Penile Perception Score, were: 

• length
• girth
• position and shape of meatus
• shape of glans
• appearance of scrotum
• shape of penile skin
• appearance of pubic hair
• general cosmetic appearance

Women were also questioned on their own sexuality and sexual desire.

What were the basic results?

General cosmetic appearance was considered the most import aspect of penile appearance, with length being much further down the rankings at sixth place. The least important item was the position and shape of the meatus.

Rankings differed depending on whether the photographs of HASRGs were seen before or after the questionnaire. The differing items were importance of shape of glans, importance of appearance of scrotum, importance of penile skin, and importance of penile length.

The general cosmetic appearance and position and shape of the meatus were not considered more important by women before or after exposure to the photosets.

Statistical analyses found that the genital appearance of circumcised penises was significantly more normal looking than HASRGs, however distal hypospadias was perceived to appear as normal looking as circumcised penises. It was also found that the most relevant observer related predictors for penile perception were:

• higher age of women
• higher sexual interest of women
• evaluating penile length as less important

How did the researchers interpret the results?

The researchers conclude "Overall, women were found to consider the ‘position and shape of the meatus’ as the least important penile aspect. These findings may stimulate reflections regarding the relevance of surgical correction of the meatus in minor forms of hypospadias. In addition, this study indicates that women perceived genitals of men with distal operated hypospadias (which represents the majority of hypospadias) to be as normal as non-affected, circumcised genitals."

Conclusion

This was a cross sectional study assessing women’s perception of single aspects of penile appearance and whether hypospadias-affected surgically repaired genitals (HASRGs) are seen to be as normal-looking as circumcised.

The findings are that overall general penile appearance is the most important aspect of appearance, and the position and shape of the meatus to be the least important. And despite assumptions to the contrary, women in the survey rated penile size as being relatively unimportant.

There was some variation between the other aspects depending on whether women had seen the photosets before or after answering questions. HASRGs with distal hypospadias were seen to be as normal looking as circumcised genitals; however proximal hypospadias appeared significantly less normal. This may not be a clinically relevant finding as the effect size was small.

There are some limitations to the study:

• The sample size was small, with only 105 out of a possible 911 women agreeing to participate. The reasons for non-participation were not included in the study, but it would have been interesting to further understanding of women’s perceptions. Thus the sample is of a select group of women willing to participate and from a small local area in Switzerland, so these findings may not be generalizable to other populations or to perception of men.
• The study did not include any photos of hypospadias that had not been surgically corrected or of penises with intact foreskin.
• There was a very low response rate from men invited to participate. It may be that men with less satisfactory surgical results did not wish to take part.

Overall, these findings will be of relief to men with surgically-corrected hypospadias.

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Night shifts 'linked to increased breast cancer risk'

Tuesday July 21 2015

Disturbed sleep patterns from night shifts could contribute to cancer risk

"Irregular sleeping patterns have been 'unequivocally' shown to lead to [breast] cancer in tests on mice, a study suggests," BBC News reports. Scientists are concerned a similar effect may occur in women working night shifts.

This study looked at mice genetically modified to develop breast cancer. They were exposed to either a normal cycle of 12 hours of light and 12 hours of darkness or an inverted cycle. It found mice in the inverted group gained more weight and developed breast cancer sooner.

These findings appear to support previous research suggesting a link between night-shift work and breast cancer, which we discussed in 2012 and 2013.

Further human research will be required to determine if shift working does increase the risk and what measures can be taken to minimise this.

The researchers go as far as recommending that women with a known predisposition to breast cancer (such as having genetic mutations linked to breast cancer) should avoid shift work. But, obviously, not everyone has the luxury of picking and choosing what hours they work.

If you work night shifts, you can offset your risk of breast cancer and other cancers by quitting smoking if you smoke, maintaining a healthy weight, eating a healthy, balanced diet, moderating your consumption of alcohol and taking regular exercise. 

Where did the story come from?

The study was carried out by researchers from the National Institute for Public Health and the Environment (RIVM), Erasmus University Medical Center and Leiden University Medical Center, all in the Netherlands, and Ludwig-Maximilian University in Germany.

Funding was provided by the RIVM Strategic Programme and the Dutch Ministry of Social Affairs and Employment.

It was published in the peer-reviewed medical journal Current Biology on an open access basis, so it is free to read online or download as a PDF.

The BBC's reporting of the study was accurate and made it very clear at the start of the story that the research involved mice, so the results may not necessarily apply to humans.  

What kind of research was this?

This laboratory research assessed the effects of alternating light cycles in mice. This involved conducting two related studies – a randomised longitudinal study and a cross-sectional study – to assess breast cancer risk with alternating light cycles.

Findings from animal studies are useful for making discoveries to be investigated further in humans.  

What did the research involve?

This study aimed to investigate the causal links between chronic circadian rhythm disturbance (CCRD) and increased cancer risk. CCRD is a term used to describe persistent disruption of the body clock – the normal sleep-wake cycle. 

Breast cancer-prone mice were placed in a cycle of 12 hours of light and 12 hours of dark. At the end of every week, the light or dark phase was extended to 24 hours to invert the light-dark cycle.

Two studies were performed on the mice, controlling for other possible factors contributing to cancer risk:

• all mice were melatonin deficient
• neither group was exposed to sunlight
• there was no vitamin D difference between groups

The only other possible difference between the groups was the timing of food intake, which may be disruptive to metabolism.

Longitudinal study

When the mice reached eight weeks old they were randomly assigned to remain under a normal 12:12-hour light-dark cycle or undergo a weekly alternating 12:12-hour light-dark cycle. Measurements of body weight and tumour-free survival were taken.

Cross-sectional study

Mice who did not take part in the longitudinal study were analysed further in a cross-sectional study. These mice stayed under the light-dark cycle or weekly light-dark inversion, representing circadian rhythm disturbance. After 18 cycles, blood and tissue samples were collected for analysis. 

What were the basic results?

In the longitudinal study, mice exposed to weekly light-dark inversions saw a larger increase in body weight compared with those kept in the normal light-dark conditions.

This was not the result of food intake as a significantly smaller amount of food was consumed by mice in the inversion group. This effect could be seen at six weeks, but it only became significant at week 24.

There was no significant difference in body weight gain in the cross-sectional part of the study, perhaps because there were fewer light-dark inversions.

Mice exposed to the weekly inversions showed a decrease in tumour suppression. This is carried out by certain genes that try to prevent normal cells turning cancerous.

The time taken to breast tumour development was reduced by 17% in the inversion mice compared with the control mice, at 42.6 weeks compared with 50.3 weeks.

The cross-sectional study indicated the circadian rhythm was still disrupted seven days after the light-dark pattern was switched. 

How did the researchers interpret the results?

The researchers concluded that, "Animals exposed to the weekly light-dark inversions showed a decrease in tumour suppression. In addition, these animals showed an increase in body weight.

"Importantly, this study provides the first experimental proof that CRD increases breast cancer development." 

Conclusion

This study in mice appears to support previous research suggesting a link between night-shift work and breast cancer. It looked at an inverted pattern of light and dark to assess whether this is linked to greater risk.

The researchers found mice exposed to weekly light-dark inversions saw a larger increase in body weight and quicker tumour development.

One limitation with this study is it is an animal study, which reduces the generalisability of findings. However, as there are a number of studies that have drawn similar conclusions – some in humans – these findings do add to the research in this area.

Shift working can disturb what is known as the circadian rhythm – the internal body clock. This can disrupt the normal workings of a hormone called melatonin and lead to poor sleep and chronic fatigue.

Rotating shift work and a persistent lack of quality sleep can also disrupt the production of insulin, which may increase the risk of someone developing type 2 diabetes. It has also been linked to a range of chronic conditions, such as obesity, depression, diabetes and heart disease.

The Health and Safety Executive has some useful and practical advice for people who work night shifts:

• take extra care if you drive to and from work as your concentration may be impaired – if possible, it may be a better idea to use public transport
• identify a suitable sleep schedule of at least seven hours a day – you may find it useful to keep a diary to assess what sleep times suit you best
• try to create an environment that promotes good sleep – for example, heavy curtains or an eye mask may help you sleep during the day
• make changes to your diet to improve alertness and digestion – smaller healthy snacks during your shift may be a better idea than one big meal
• limit your use of stimulants such as caffeine or energy drinks, as well as sedatives such as alcohol – while they may bring short-term benefits, they are unlikely to help in the long term
• try to get regular exercise of at least 30 minutes a day

If these findings are correct and shift working does increase breast cancer risk, it is even more important to modify other lifestyle factors known to increase the risk of several types of cancer.

These include quitting smoking if you smoke, maintaining a healthy weight, eating a healthy, balanced diet, moderating your consumption of alcohol and taking regular exercise.

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Weak link between depression and frequent smartphone use

Thursday July 16 2015

Smartphones may provide a distraction from depression

"Smartphone behaviour 'could diagnose depression' says new scientific study," the Daily Mirror reports. But based on the data presented in the study the paper is reporting on, we would disagree.

The story was prompted by a small US study of adults who agreed to have a freeware app – Purple Robot – installed on their phone. The app tracks phone usage and physical movement via GPS.

Researchers found people who reported depressive symptoms used their phone more often, visited fewer locations, and spent more time at home than the group of people who did not have symptoms of depression.

The results should not be taken too seriously as these two groups of people were not matched, so other factors could have influenced the results (confounders).

A major factor that was not accounted for was whether any of the people involved in the study were employed, the nature of the employment, or whether they were looking after children or caring for someone. This would have had a major impact on their phone use and the amount of time they spent going out to different places.

Other factors commonly taken into account but not included in this study are a history of mental health problems, age, sex and any medical or psychiatric conditions.

In short, this study does not show smartphone use can diagnose depression.  

Where did the story come from?

The study was carried out by researchers from Northwestern University and Michigan State University, and was funded by the US National Institute of Mental Health.

It was published in the peer-reviewed Journal of Medical Internet Research.

The authors do not declare any conflict of interest. They developed an open-source app called Purple Robot, which is designed to collect mobile phone sensor data.

Purple Robot has also been used in studies designed to optimise adherence to treatment regimes for people with HIV, ulcerative colitis and Crohn's disease.

The Mail Online coverage of the story included some inaccuracies, such as saying, "The phone data turned out to be a more reliable way of detecting depression than asking participants questions about how sad they were feeling on a scale of one to 10".

But the scales used were from one to three, and it is not clear how the phone data could be "more reliable" when none of the participants were assessed for symptoms of depression other than their answers to this symptom-scale questionnaire.

The Mail also says that, "Using a phone stops people dealing with difficult feelings" without pointing out this was just the authors' hypothesis and not actually assessed in the study.

Similarly, the Daily Mirror carried a number of quotes from the lead author, such as, "We now have an objective measure of behaviour related to depression", without subjecting these comments to any scrutiny.  

What kind of research was this?

This observational study aimed to see if people who self-reported symptoms of depression were likely to use their mobile phones more than people who did not have symptoms of depression.

It also aimed to see if they were less likely to go out to different places.

This type of study can only show an association and cannot prove cause and effect.

What did the research involve?

Forty adults aged between 19 and 58 were recruited to take part in the study. They were asked to download an app called Purple Robot on to their phone.

This app measured their phone usage and mapped their location using GPS. The participants were asked to keep the phone with them at all times for two weeks.

At the beginning of the study they completed the Patient Health Questionnaire-9 (PHQ-9) to record any self-reported symptoms of depression. This questionnaire asks people to rate nine different symptoms of depression from 0 (not at all) to three (nearly every day). Scores can range from 0 to 27.

This screening questionnaire gives an indication of whether a person is likely to be depressed, but a diagnosis would require further clinical assessment. The scores suggest the following:

• 5 to 9 – mild depression
• 10 to 14 – moderate depression
• 15 to 19 – moderately severe depression
• 20 or more – severe depression

The researchers split the people into two groups – one group scored less than five on the PHQ-9 and the other group scored five or more. The researchers then analysed the results looking for any associations between depressive symptoms, phone usage and how much a person was out and about.  

What were the basic results?

Data was available for only 28 of the participants, with 14 in each group. The average PHQ-9 score for the depressive group was 9.6, which would be rated as mild.

People with depressive symptoms went out less often and spent more time at home. They also used their phone more often, but the study doesn't report if these participants used their phone for texting, surfing the internet or talking to someone.  

How did the researchers interpret the results?

The researchers concluded mobile phone use could be used to help identify people with depressive symptoms.

They say that, "While these findings must be replicated in a larger study among participants with confirmed clinical symptoms, they suggest that phone sensors offer numerous clinical opportunities, including continuous monitoring of at-risk populations with little patient burden and interventions that can provide just-in-time outreach." 

Conclusion

This small study suggests people who report higher levels of depressive symptoms may use their phone more and go out less.

However, these findings should not be taken too seriously as this study has many limitations, including:

• a small sample size – data from only nine people in each group was used for the location data
• there was no attempt to ensure the two groups were matched in terms of any medical illness, age, sex, whether they were employed, or any other potential confounding factors
• it's not known whether any of the participants in either group had a diagnosis of depression or any other mental illness
• the analysis relied on the participants keeping their mobile phone with them continuously, which may or may not have actually happened

In short, this study does not show that mobile phone use can diagnose depression. As the researchers point out, a much larger – and, in our opinion, better designed – study would be required to see if a depression app or similar would be a viable idea.

If you are feeling low, it is a good idea to talk to someone or seek professional help. The Samaritans are available 24 hours a day, 365 days a year if you are in distress and can be reached on 08457 90 90 90.

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Heart attack, stroke and diabetes 'can shorten life by 23 years'

Wednesday July 8 2015

A poor diet can increase the risk of a range of chronic diseases

"Suffering from heart disease, stroke and type two diabetes could knock 23 years off life," The Daily Telegraph reports, covering the stark conclusion of a major new UK study. The good news is many chronic diseases, such as stroke, are preventable.

As The Guardian reports, having a history of both heart attack and type 2 diabetes – increasingly common chronic conditions – can shorten life by around a decade.

Researchers looked at more than 130,000 deaths over 50 years. They then estimated the life-shortening effects of different diseases alone and in combination, and found these big three conditions significantly shortened lifespan.

The researchers used a large group and long timespan to make their estimates, giving us confidence in their main conclusions. But they are based on averages.

Each person's risks and lifespan is individual, and it is never too late to improve your health, even if you do have one or more chronic conditions: you can work towards maintaining a healthy weight, exercising more, eating healthily, not smoking, and not drinking too much alcohol. 

Where did the story come from?

The study was carried out by researchers from the Emerging Risk Factors Collaboration co-ordinated by the University of Cambridge.

It was funded by the UK Medical Research Council, the British Heart Foundation, the British Heart Foundation Cambridge Cardiovascular Centre of Excellence, the UK National Institute for Health Research Cambridge Biomedical Research Centre, the European Research Council, and the European Commission Framework Programme 7.

A number of study authors declared potential financial conflicts of interest relating to funding from pharmaceutical companies, health trust funds and not-for-profit research organisations.

The study was published in the peer-reviewed Journal of the American Medical Association (JAMA).

Both The Guardian and The Daily Telegraph reported the main findings accurately, although neither discussed any limitations. Limitations are important to remind the reader no study is perfect or completely accurate.

The first line of The Telegraph's story told readers the diseases behind the 23-year life loss are largely preventable for "8 out of 10 people". This figure doesn't appear to have been taken from the main study publication, so we can't confirm whether or not this is accurate.

The Telegraph also used the term "heart disease", but the researchers specifically looked at people who had a heart attack (myocardial infarction). While a heart attack can be a common complication of heart disease, not everyone with heart disease will have one.

Nonetheless, it is well known you can reduce your risk of these conditions by living healthily, so there is something you can do about it.   

What kind of research was this?

This analysis of two large cohort studies looked at the impact of diabetes, stroke and heart attack on life expectancy.

The researchers say more and more people are living with one or more conditions that increase their chances of dying early. The conditions of interest were heart attack, stroke and type two diabetes.

The researchers wanted to know the impact on lifespan of having more than one of these three conditions, looking at a large group of people over a significant amount of time.

To do this, they analysed some large and long-term cohort data sets. This is one of the most effective ways of estimating the impact of lifestyle on death across large groups.

The estimates rely on accurate estimates of lifestyle, usually reported in surveys, as well as having a lot of people in the group to boost reliability and generalisablity. 

Such analysis produces averages – what happens to most people most of the time. While very useful, individual risk profiles vary from person to person, and can vary a lot around the average. 

What did the research involve?

The research team analysed two large cohort studies, both of which had rich sources of lifestyle and medical information, allowing them to estimate the impact of different lifestyles and diseases on life expectancy.

The first and largest cohort was from the Emerging Risk Factors Collaboration. This had 689,300 participants from 91 cohorts, covering around 50 years of survey data from 1960-2007. This collected information on 128,843 deaths up to April 2013. The average age was 53, and most participants were from Europe (69%) or North America (24%).

The second cohort was from the UK Biobank. It was a little smaller, but more relevant to the UK. It had data on 499,808 participants with survey-derived lifestyle information spanning from 2006-10. Data on 7,995 deaths was gathered, the latest from November 2013. The average age was 57, and all from the UK.

Death rates were calculated for those with a history of two or more of the following:

• diabetes mellitus
• stroke
• heart attack

The impact on lifespan of having each of the three conditions at different ages, alone or in combination, was estimated independently in both cohorts and then compared.  

What were the basic results?

In men aged 60, a history of any two of the three conditions was associated with a 12-year lower life expectancy. A history of all three of these conditions was associated with 15 years of reduced life expectancy. The estimates were similar for women: 13 years lost for two conditions and 16 years for three.

Life lost was greatest if the history of the conditions was present earlier in life. Estimates in this study started at 40 and ran through until 95.

The highest estimate of life loss was 23 years, the figure picked up by The Telegraph. This related to men aged 40 with a history of diabetes, stroke and heart attack. The loss was only slightly lower in women with the same age and conditions, at 20 years.

Broadly speaking, the impact on risk of death from the three conditions was similar in both cohorts. The researchers found risk of death doubled with one condition, was four times as high with two conditions, and eight times higher with all three. This showed the risk effects were piling on top of each other in an exponential manner, rather than overlapping.

How did the researchers interpret the results?

The authors made three main interpretations. First, because of the addition nature of the results, they concluded that, "Our results emphasise the importance of measures to prevent cardiovascular disease in people who already have diabetes, and, conversely, to avert diabetes in people who already have cardiovascular disease."

Second, they said the shortening of life as a result of the three conditions studied was "of similar magnitude to those previously noted for exposures of major concern to public health, such as lifelong smoking (10 years of reduced life expectancy) and infection with the human immunodeficiency virus [HIV] (11 years of reduced life expectancy)."

Finally, they said there were important differences between men and women. "For men, the association between baseline cardiovascular disease (i.e. a history of stroke or MI) and reduced survival was stronger than for women, whereas the association between baseline diabetes and reduced survival was stronger for women." 

Conclusion

This study used two large cohort-derived data sets to estimate the number of years of life lost as the result of a history of heart attack, stroke or diabetes across different ages.

The study's large size, relevance to the UK and long-term follow-up increases our confidence in its conclusions and their relevance to England and Wales. As with all studies, it has limitations, but these were relatively small and unlikely to affect the main conclusions.

This study shows a history of stroke, type 2 diabetes and heart attack can significantly shorten life expectancy, especially if these conditions are developed earlier in life, at around the age of 40.

But the good news is this is preventable – you can act now to minimise your risk of developing each of these conditions by maintaining a healthy weight, taking more exercise, eating healthily, stopping smoking, and not drinking too much alcohol.

Find out how you can reduce your risk of developing type 2 diabetes or having a heart attack or stroke. 

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People may age at different rates

Wednesday July 8 2015

Your ‘biological age’ may not be the same as your actual age

“Ageing rates vary widely, says study,” BBC News reports. For 12 years, researchers tracked a range of biomarkers associated with the ageing process.

Biomarkers are indicators of how well certain biological processes or systems are functioning.

In this study, the researchers described age-related biomarkers as signs of “gradual and progressive deterioration of integrity across multiple organ systems”.

The biomarkers used included cholesterol levels, gum health and body mass index, among others.

The idea being that, for example, your chronological age could be 30, but you could have the cholesterol levels of a typical 50-year-old.

Researchers looked at just over 1,000 mainly white adults in New Zealand followed from birth to age 38, and information on the biomarkers was collected from the ages of 26 to 38.

The study found that people who had a higher “biological age” also had a higher “pace of biological ageing”. Both were associated with poorer physical and cognitive function, feeling less healthy, and looking older at age 38.

These early stage results will need to be confirmed in larger and broader samples. The idea is that the methods used in the study could eventually be useful in assessing the effectiveness of any future anti-ageing treatments.

The obvious question is: What can people do to slow down their pace of ageing? There is currently no definitive answer to that question. What we do know is regular exercise, a balanced diet and maintaining a healthy weight will give you the best chance of keeping healthy.

Where did the story come from?

The study was carried out by researchers from Duke University and other research centres in the US, UK, Israel and New Zealand. It was funded by the US National Institute on Aging, UK Medical Research Council and the Jacobs Foundation. The New Zealand centre received funding from the New Zealand Health Research Council, and another author received support from the Yad Hanadiv Rothschild Foundation.

The study was published in the peer-reviewed journal Proceedings of the National Academy of Sciences (PNAS) of the USA. The study has been published on an open-access basis, so it is free to read online or download as a PDF.

While the majority of the UK media’s reporting of the study was accurate and informative, the Mail Online decided to go on a flight of fancy with the question: “Has science finally cracked the secret of eternal youth?” The obvious answer being: “No”.

What kind of research was this?

This was an analysis of data from a cohort study, which aimed to develop ways to assess “biological ageing” in young adults.

The global population is ageing, and increasing age is linked to more disease and disability. Because of humans’ long life span, much of the research into ageing is done in animals with short lifespans, or in older adults, many of whom already have age-related illnesses. The researchers say that one of the reasons why younger people are not studied is that assessing biological ageing in this age group is controversial, as there are various possible indicators, and findings have been mixed. They wanted to see if they could develop reliable ways to do this.

If there were such measurement tools, researchers would like to use these to give an early indication of whether any new “anti-ageing” treatments might be working. This would be quicker than having to wait until people develop age-related diseases or to see how long they live.

This is an appropriate approach to developing these measures, but ideally the research would continue to follow up people, to see if their measures correctly predict health in later life, or their lifespan.

What did the research involve?

The researchers studied 1,037 adults from Dunedin in New Zealand, who had been followed up from birth to age 38. They assessed a range of biological characteristics tested at age 26, 32 and 38, to see if some people seemed “biologically older” than others of the same age, and whether people aged at different rates.

The researchers first looked at biological age, using what was known as the “Klemera-Doubal method”, which had been shown to be a better predictor of risk of death than a person’s age alone in a previous US study. This method assesses 10 biological characteristics, including tests of lung function, blood pressure and cholesterol, among others.

They used the Klemera-Doubal method to assess biological age in their study participants at age 38. They then looked at 18 different biological characteristics measured in participants at ages 26, 32 and 38, to see how much they had changed. The characteristics assessed are ones which change with age. They included assessments of the heart and blood (cardiovascular), metabolic and immune systems, as well as the kidneys, liver, gums, lungs and DNA. Some of these characteristics were also included in the biological age calculation.

They used this information to calculate each person’s “pace of ageing” compared to the average change over one year within the group. They then compared whether those with an older Klemera-Doubal biological age showed a more rapid “pace of ageing” than those with a younger biological age.

Finally, they compared physical and cognitive function, and self-rated health among those with different biological ages or pace of ageing. They also got blinded raters to guess how old individuals were from a photo, to see if this differed among those with different biological ages or pace of ageing.

What were the basic results?

The researchers found that, according to the Klemera-Doubal method, their sample of 38-year-olds had biological ages ranging from 28 to 61 years old.

The 18 biological characteristics they followed showed different rates of change in different people from the ages of 26 to 38. They calculated people’s “pace of ageing” based on these characteristics, and found that some people showed zero years of biological change per chronological year, while others showed almost three years of biological change per chronological year.

People with an older biological age had a more rapid pace of ageing from the ages of 26 to 38 than those with a younger biological age. Each year increase in biological age compared to actual age added a 0.05 year increase in pace of ageing. So, a person who was 38 but had a biological age of 40 was estimated to have aged 1.2 years faster over the past 12 years, compared to a person who had a biological age of 38.

They also found that at age 38, those with a higher biological age or faster pace of ageing performed less well on physical and cognitive function tests than those with a younger biological age or slower pace of ageing. Those with a higher biological age or faster pace of ageing had also rated themselves as less healthy and were estimated to be older based on facial appearance by volunteers who did not know the participants’ ages.

How did the researchers interpret the results?

The researchers concluded that, “young individuals of the same chronological age varied in their 'biological ageing'” and that “already, before midlife, individuals who were ageing more rapidly were less physically able, showed cognitive decline and brain ageing, self-reported worse health, and looked older”. They suggest that these measures of biological ageing in young adults could be used to identify causes of ageing and evaluate anti-ageing treatments.

Conclusion

This study has developed a new method of assessing the “pace of biological ageing” over time in adults under 40. It showed an association between this measure and another measure of biological age, as well as physical and cognitive function, and how healthy people felt and how young they looked.

In some ways, these results are unsurprising, as the biological measures assessed are measures relating to health, such as blood pressure and cholesterol, as well as measures of fitness and weight.

These results will also need to be confirmed in larger and broader samples – for example, of different ethnicities – as the study was in mainly white participants. Longer-term studies would also be needed to assess whether these measures predict health outcomes at later ages, or lifespan.

As for practical implications, this sort of measure is most likely to be used in research. It’s unlikely that individuals will be able to use this method to calculate their biological age, as the measures used need blood and other clinical tests, and getting the “pace of ageing” needs measurements collected over 12 years. We also don’t yet know whether interventions, either lifestyle or drug treatments, will impact this “biological ageing”.

Based on what we already know, to maximise your chances of living a long and healthy life, taking steps such as maintaining a healthy weight, eating a varied and balanced diet, keeping physically active, moderating your consumption of alcohol and avoiding smoking are likely to be your best bet. 

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Does a lack of sleep lead to a lack of self-control?

Monday July 6 2015

Lack of sleep could lead to bad decisions

"Not enough shut-eye makes you more impulsive and can fuel addiction," the Mail Online reports. The claim was prompted by a review of evidence into the link between sleep and self-control carried out by American psychologists.

The authors looked at previous research, including studies into how poor sleep affects our blood sugar regulation and apparently exhausts our internal resources and willpower. They suggest poor sleep could extend into poor health and how we function at work, and could even fuel addictive behaviours.

The crux of their argument is that self-control is like physical strength; we don't have an infinite amount and being tired depletes our resources, so other areas of our life may be affected.

The authors linked their findings about sleep deprivation having an effect on self-control to addiction. But addictions have many influences and sleep problems are very unlikely to be the single cause. Even if there is a link, it's just as likely to be the reverse: addictions adversely impact sleep quality.

This article must largely be considered to be the opinions of the authors. No method was provided, so we don't know how they selected the evidence on which to base their discussion. Crucially, other relevant studies could have been missed.

Most people experience problems sleeping at some point in their life, but you should ask your GP for advice if you are experiencing persistent insomnia. You should also seek help from your GP if you think you may have developed an addiction. 

Where did the story come from?

The study was carried out by researchers from the Department of Psychology at Clemson University in the US. No sources of funding are reported.

It was published in the peer-reviewed journal Frontiers in Human Neuroscience on an open access basis, so it is free to read online or download as a PDF.

The Mail discussed the findings of this article as fact, but did not consider the limitations of this opinion piece. The paper does not make it clear that the study is an evidence-informed opinion piece, which ranks low on the level of evidence scale. A systematic review would rank much higher as credible evidence.  

What kind of research was this?

This narrative review aimed to explore the interactions between sleep habits and self-control.

As we all know, good sleep is essential for good functioning. But, as the researchers say, chronic sleep loss is common for many, and may lead to problems such as inattention and lack of self-control, which includes acting on impulse.

The authors say there have been limited attempts to develop theories to better understand and predict the effects of poor sleep and sleep deprivation. The researchers drew attention to previous discussions of models that were developed to try to understand how sleep deprivation affects performance.

The publication describes itself as a "mini review", and no methods are provided. This implies it is not a systematic review, so the authors may not have considered all the relevant evidence on the topic. This means there is a risk key evidence has been missed. 

What are the models of self-control?

One model suggests self-control stems from a few internal resources that become exhausted when we have to repeatedly exert self-control. This is said to be called "ego depletion".

Previous research has shown having low blood glucose causes this, leading to poor self-control when we're hungry. Anyone walking through a supermarket while hungry might be familiar with this sensation. But other things besides blood glucose could contribute to this.

A second model suggested loss of self-control could be related to psychological processes. Some research suggests maintaining self-control could be the result of choosing between competing goals or making priorities, or believing in willpower.

This suggests self-control is largely an issue of correct allocation of effort: you can make a decision not to eat the donut or go to the gym after work, but not both.

Combining the different models gives the idea that self-control is the result of internal psychological resources, and can be influenced by personal choices and beliefs. It is said these models can explain self-control when someone is exposed to a minor stressor that results in mild ego depletion.

In these situations, the person can choose to make a different goal, work on a different task, or choose to believe in their ability to complete the necessary work and overcome the negative effects of ego depletion. But if the person's internal resources have become significantly depleted, they may not be able to exert self-control until these have been restored.  

How does poor sleep affect self-control?

Sleep is an example of a physiological necessity that can overwhelm any type of mental effort to resist it. For example, if a person is driving a car when overly tired, they may fall asleep even when psychologically they know the consequence could be death.

Part of the effect of sleep on self-control could be through glucose levels, which go through a cycle with the daily body clock. Research has shown our ability to metabolise glucose is affected by our sleep habits.

Sufficient sleep at night may restore internal resources for self-control, and has also been shown to promote plasticity in the brain – that is, the ability to make new nerve connections, change and adapt. 

Previous research has also suggested those who report good sleep have lower psychological strain and better self-control. But there is said to be limited research looking into how poor sleep affects things such as effort, exertion and choice.

One study is said to have shown that when making choices, sleep-deprived people will pick the less challenging options, even if it's as simple as a test of walking – sleep-deprived people walk more slowly. Sleep loss has a negative impact on the person's performance, as well as their access to energy resources.

Other research supports this, suggesting sleep deprivation causes lack of activity in the parts of the brain involved with thinking and planning, so this could impair the person's ability to exert self-control. 

How do the researchers interpret their results?

The authors concluded that, "Sleep and self-control form an integrated system that provides the basis for complex decision making and capabilities." They say good sleeping habits could refuel a person's ability to make more difficult choices instead of opting for the easier option.

They go on to say the effects of better sleep and self-control could extend into better work performance and better health, and even help with social issues as addiction, excessive gambling and overspending. 

Conclusions

This narrative review, which explored theories on how sleep may influence self-control, will be of interest to psychologists and sociologists.

But no methods are provided on how the narrative was produced, so we don't know how the researchers selected the studies that informed their discussion.

Calling their study a "mini review", it seems unlikely this is a systematic review. This means not all relevant evidence may have been considered, and this article must therefore largely be considered to be the opinions of the authors.

Without clearly defined methods, any review of this type is always vulnerable to the accusation of "cherry-picking" – that is, research that supports the authors' opinion has been included, but research that challenges their opinion has been ignored.

Although the research has linked the effects of lack of sleep on self-control to the problems of addiction, addictive behaviours such as gambling are complex conditions. They can be influenced by many things, including a person's characteristics, personal and social circumstances, and mental health.

Lack of sleep might make a person more likely to give into addictions, but it is unlikely sleep is the single cause. On the flip side, a person with addictions could have poorer sleep as a result of their addiction, or because of various other life and health circumstances associated with this. There is not always a clear-cut cause and effect relationship.  

Good sleep is essential. Most of us have first-hand experience of the effects of poor sleep – we don't feel our best and our functioning and performance in many areas can be affected. But getting a good night's sleep every night is not always easy, and many things can affect people's ability to get to sleep or stay asleep.

Get 10 tips for better sleep.

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