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An outbreak of E. coli food poisoning has killed at least two people in Germany and caused serious complications in over 200 people, the Health Protection Agency (HPA) has announced. Two batches of Spanish cucumbers are believed to be behind the outbreak, while a batch of Dutch cucumbers is also being tested for harmful strains of E. coli bacteria.

Although there have been reports of a small number of E. coli infections in the UK, these were in people who had travelled from Germany and fell ill on their arrival here. Initial surveillance suggests that no affected produce has been imported into the UK, although the situation highlights the general need to wash fruit and vegetables properly before eating them.

The German outbreak has caused cases of haemolytic uraemic syndrome (HUS), a serious complication arising from a strain of E. coli bacteria that produces a toxic substance called verocytotoxin. HUS occurs when the verocytotoxin-producing E. coli (VTEC) infection affects the blood, kidneys and, in some cases, the nervous system. It requires hospital treatment and can be fatal. Milder forms of infection with this bacterium usually clear within seven days without treatment. The strain of E. coli involved is called O104, which is an uncommon strain of the infection and is rarely seen in the UK.

Several news sources have covered the outbreak, although the numbers of deaths and infections they have reported are generally much higher than official figures.

 

Have these cucumbers reached the UK?

The UK Food Standards Agency and the HPA have confirmed that German authorities have traced the outbreak back to organic cucumbers from two areas of Spain (Almeria and Malaga). They also say that cucumbers from the Netherlands are also a suspected source. They say that there is currently no evidence that any affected cucumbers from these sources have been distributed to the UK, although they are continuing their investigations.

 

How did the cucumbers become contaminated?

People carry harmless strains of E. coli in their intestines, but can acquire harmful strains if they eat food that has been in contact with animal or human faeces. These harmful strains of E. coli may then be transferred to other people if an infected person prepares food after going to the toilet and not washing their hands adequately.

In this particular case, it is unclear how the cucumbers became contaminated, but it may have been the result of animal manure products being used as fertilisers or the presence of animals on the farms in which the cucumbers were grown.

 

Who has been affected?

According to the European Centre for Disease Prevention and Control (ECDC), the outbreak in Germany has mainly affected adults and almost 70% of affected adults have been female. The number of severe cases of HUS is unusual and the affected age groups are not typical – HUS as a complication of E. coli infection is generally more common in children. The rare strain of E. coli in this outbreak is called O104 and is not often seen in the UK.

 

What are the symptoms of food poisoning?

The most common symptoms of food poisoning are nausea, vomiting and diarrhoea. People may also experience stomach cramps and abdominal pain, loss of appetite, fever, muscle pains and chills.

In the German outbreak, bloody diarrhoea was a symptom and the HPA has recommended that any UK tourists returning from Germany with illness, including bloody diarrhoea, should seek urgent medical treatment and mention where they have travelled.

For general food poisoning (from any type of bacteria), you should see a doctor if:

• vomiting lasts for more than two days
• it is not possible to keep liquids down for more than a day
• diarrhoea lasts for more than three days
• there is blood in your vomit or stools
• you experience seizures, fits, slurred speech or double vision
• you are dehydrated (symptoms include dry mouth, sunken eyes and being unable to pass urine)

 

How can I avoid food poisoning?

It is important to wash your hands before preparing food and after handling raw meat. The German outbreak highlights the importance of washing all vegetables. Peeling and cooking fruit and vegetables can also remove these germs.

Chopping boards and work surfaces can harbour germs, and it is especially important to use separate chopping boards and utensils for raw and ready-to-eat foods and to wash them well between uses.

It is important to cook food thoroughly, particularly meat. If you are reheating food, make sure it is piping hot all the way through and do not reheat food more than once.

Cooked leftovers should be cooled quickly, ideally within one or two hours, and then put in the fridge or freezer once cooled.

 

Where can I get more info?

Further updates on the German E. coli Outbreak are available from the Health Protection Agency and the Food Standards Agency.

Links To The Headlines

World’s largest E coli outbreak kills 14 in Germany. The Guardian, May 31 2011

BBC video on e coli. BBC News, May 31 2011

Food handling tips in wake of E.coli scare. The Independent, May 31 2011

E coli deaths in cucumber scare reach 11. Daily Express, May 31 2011

Killer cucumbers death toll rises to 10 and 1000 have deadly E.coli strain. Daily Mirror, May 29 2011

Scientists probe deadly cucumbers as E.coli fears grow. Metro, May 31 2011

Links To Science

Update on E. coli outbreak in Germany. Food Standards Agency, May 31 2011

Update on large outbreak of haemolytic uraemic syndrome caused by E. coli in Germany – important advice for travellers. Health Protection Agency 2011

Information on food poisoning and tips to avoid it are available from NHS Choices. NHS Choices

Children should avoid energy drinks due to ‘toxic’ levels of caffeine,” reported the Daily Mail. This news piece is based on a clinical report of the ingredients of sports and energy drinks and a review of previous research into their effects on children. The researchers combined these findings with expert opinion to make recommendations about the suitability of these drinks for children and teenagers.

This is a well-argued and convincing argument that sports drinks are unnecessary for children and adolescents doing regular amounts of physical activity and that energy drinks are also unsuitable for them because of their high caffeine content.

This is a US study, but many of the results are probably applicable to the UK. The researchers conclude that sports drinks are no more beneficial than water after regular exercise for children. They also say that both energy and sports drinks have high levels of sugar increasing the risk of obesity and that their acidity can damage teeth enamel. They conclude that the very high caffeine content of energy drinks (sometimes equivalent to 14 cans of common caffeinated soft drinks) makes them unsuitable for children.

The Food Standards Agency recommends that children should only ‘consume in moderation drinks with high levels of caffeine’.

 

Where did the story come from?

The study was carried out by researchers from the American Academy of Pediatrics Committee on Nutrition (CON) and Council on Sports Medicine and Fitness (COSMF). Sources of funding were not given. The study was published in the peer-reviewed journal Pediatrics.

The research was generally covered well by the Daily Mail and The Independent.

What kind of research was this?

This review examined the ingredients of sports and energy drinks, and the similarities and differences between the products. The researchers then carried out a systematic review of the evidence of the effects of these drinks on children and adolescents.

The researchers said that sports and energy drinks are a large and growing beverage industry and are marketed to children and adolescents for “optimisation of performance and replacement of fluid and electrolytes lost during exercise”. Energy drinks, meanwhile, are marketed as being able to boost energy, decrease fatigue and enhance concentration. The researchers say that sports drinks and energy drinks are two different products, but the two may be confused with each other. For example, “energy” can be thought to imply calories only (which sports drinks also contain), but energy drinks also contain stimulants such as caffeine or guarana, a South American plant extract also containing caffeine.

 

What did the research involve?

The researchers defined and categorised popular sports and energy drinks and reviewed their ingredients.

The sports drinks that were assessed were All Sport Body Quencher, All Sport Naturally Zero, Gatorade, Gatorade Propel, Gatorade Endurance, Gatorade G2, Powerade Zero, Powerade, Powerade Ion4 and Accelerade.

The energy drinks assessed were Java Monster, Java Monster Lo-Ball, Monster Energy, Monster Low Carb, Red Bull, Red Bull Sugar Free, Power Trip Original Blue, Power Trip “0”, Power Trip the Extreme, Rockstar Original, Rockstar Sugar Free and Full Throttle.

The researchers conducted a systematic review of the evidence relating to the effect of the ingredients of these drinks on children’s health. They then discussed the evidence for and against the use of sports and energy drinks in children and adolescents. The researchers aimed to produce guidelines for parents, government policy makers, schools and youth sports clubs on the appropriate use of sports drinks for children doing average amounts of activities. Where there was a lack of evidence, the authors instead considered the expert opinions of the American Academy of Pediatrics Committee on Nutrition (CON) and Council on Sports Medicine and Fitness (COSMF).

The researchers highlighted that their report was not intended to be a guide for the effectiveness of sports drinks in children and adolescents involved in competitive endurance, repeated-bout sports such as tournaments, or other prolonged vigorous physical activities.

 

What were the basic results?

Water ‘best for hydration’

The researchers first looked at the effect of the drinks on hydration. They said that dehydration can be associated with premature fatigue, impaired sports performance, cognitive changes, possible abnormalities in the body’s salt balance (electrolytes), and an increased risk of heat illness. However, they say that water is generally the appropriate first choice for hydration before, during and after most exercise regimens, rather than sports or energy drinks.

High carb content ‘raises obesity risk’

The researchers then looked at the carbohydrate content of sports drinks, such as sugar. With the exception of the sugar-free sports drinks, the drinks contained 2–19g of carbohydrate (glucose and fructose) per 240ml serving. This corresponds to 10–70 calories per drink. The researchers said that although carbohydrates are the most important source of energy for an active child or adolescent, in general there is little need for children to drink carbohydrate-rich drinks other than the recommended daily intake of fruit juice and low-fat milk.

Energy drinks (those with added caffeine) generally had more carbohydrates than sports drinks: 0–67g per serving with a calorie content of 10–270 calories. The researchers said that routinely drinking these sports and energy drinks (and soft drinks) will result in excessive calorie intake and substantially increase the risk of becoming overweight or obese.

‘Risks of high caffeine’

The researchers said that caffeine has been found to enhance physical performance in adults by increasing aerobic endurance and strength, improving reaction time and delaying fatigue. The size of the effects can vary, however, and there have been no studies in children. Caffeine can have a wide range of effects on the body, including increasing the heart rate and blood pressure. It also reportedly increases speech rate, attentiveness and motor activity as well as body temperature and the secretion of gastric juices. Caffeine is also a diuretic. Psychological effects include effects on mood, increasing anxiety in people who are prone to this and sleep disturbances in some people.

The researchers say that energy drinks can contain large amounts of caffeine, often more per serving than cola. It can be hard to determine the amount of caffeine in the drink from the packaging as the serving size may be different from the packaging size. They say that the total amount of caffeine in some cans or bottles of energy drinks can exceed 500mg, which they say is equivalent to 14 cans of common caffeinated soft drinks. To put this in context, they say that a lethal dose of caffeine is considered to be between 200–400mg per kg of weight (about 6g for a 30kg child).

They say that caffeine has other dangers for children, and can affect the developing brain and heart and the risk of developing addiction. They recommend that children should be discouraged from consuming caffeine. They also highlight that the most common way children would be exposed to caffeine is in soft drinks, which have around 24mg of caffeine per serving.

Guarana ‘adds even more caffeine’

Energy drinks often include the plant extract guarana. This extract contains caffeine, and 1g of guarana is equivalent to 40mg of caffeine. Therefore, guarana will increase the total caffeine content in the beverage. In the energy drinks that the researchers sampled, they found that the drinks contained up to 30mg of guarana per 240ml.

Electrolyte needs ‘met by the diet’

Sports and energy drinks may contain electrolytes (sodium and potassium salts). The sodium content of the drinks was 25–200mg and the potassium content was 30–90mg per serving (240ml). However, the researchers say that most children and adolescents get enough electrolytes from a healthy, balanced diet and that sports drinks offer “little to no advantage over plain water”.

Added protein and vitamins ‘not needed’

Proteins are often added to sports drinks based on the idea that protein can enhance muscle recovery when consumed soon after exercise. However, the researchers say that most children can easily get their recommended intake (1.2–2.0g of protein per kg of body weight a day) from a well-balanced diet, which is sufficient even for those who are regularly sporty. Likewise, vitamins that are sometimes added to sports drink can be obtained in the required amounts from a balanced diet without the need for supplements.

High acidity ‘erodes teeth’

The researchers say that there is some concern that these sports and energy drinks will cause tooth decay in children and adolescents. They say that most of these drinks are acidic and can contain citric acid, which is highly erosive to the teeth. They report a study that found that 57% of 11- to 14-year-olds had erosion to the enamel of their teeth.

 

How did the researchers interpret the results?

The researchers said, “for the average child engaged in routine physical activity, the use of sports drinks in place of water in the sports field or school lunchroom is generally unnecessary. Stimulant- containing energy drinks have no place in the diets of children or adolescents.”

 

Conclusion

This review delivers a well-argued and convincing case that energy and sports drinks are unnecessary and possibly unsuitable for children and adolescents doing average amounts of physical activity. The researchers say that, in the US, there is a drive to stop schools selling high-calorie fizzy drinks, but that sports drinks have been marketed as a “healthier alternative”.

The researchers make a series of recommendations for parents, schools and policy makers. Though these recommendations are intended for the US, some translate to the UK. These include educating parents, children and paediatricians about the risks of these drinks, including the risks of caffeine, obesity and tooth erosion. They suggest that water should be promoted as the best source of hydration for children and adolescents.

A similar review published by a group American researchers in February this year highlighted background research on energy drinks and their consumption by children and adolescents. The research, covered by Behind the Headlines, describes in further detail the potential dangers of energy drinks for younger people.

The Food Standards Agency recommends that “children, or other people sensitive to caffeine, should only consume in moderation drinks with high levels of caffeine”.

Links To The Headlines

Doctors warn against giving  energy drinks to children claiming they contain ‘toxic’ levels of caffeine. Daily Mail, May 31 2011

Energy drinks make children fat, not fit, says study. The Independent, May 31 2011

Links To Science

Schneider MB, Benjamin HJ. Clinical Report–Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate? Pediatrics 2011, Published online May 29

Many newspapers have today reported that alcohol-related hospital admissions have risen to record levels, with over one million drink-related admissions in 2009/10. The level of admissions is nearly double of those seen in 2002/3. These stories have been prompted by the release of 2011’s alcohol statistics report from the NHS Information Centre.

 

What did the report assess?

The report covered a range of issues relating to alcohol use, ranging from drinking habits to alcohol prices and hospitalisation rates. It covered drinking in adults (aged 16 and over) and schoolchildren (aged 11-15), drinking-related ill health and mortality, affordability of alcohol and alcohol-related costs. Some of the information in the report has been published previously but the information on hospital admissions is new.

 

What did the report find out about drink-related admissions?

The report found that in England in 2009/10:

• There were 1,057,000 alcohol-related admissions to hospital. This was an increase of 12% on the 2008/09 figure (945,500 admissions), and more than twice as many as in 2002/03 (510,800 admissions).
• Most (63%) of alcohol-related admissions were men. There were more admissions in the older age groups than in the younger age groups, in both men and women.
• When the researchers looked at the rate of admissions and standardised the figures for gender and age, they found that the rates of alcohol-related admissions varied across different Strategic Health Authorities (SHAs). The rate ranged from 1,223 admissions per 100,000 of the population in the South Central SHA, to 2,406 and 2,295 admissions per 100,000 in the North East SHA and the North West SHA, respectively.

 

What kinds of problems were drinking-related?

In addition to admissions to hospital, the NHS Information Centre (IC) also reported on deaths related to alcohol. It said that in 2009, there were 6,584 deaths directly related to alcohol. This was a 3% decrease from the 2008 figure (6,769 deaths) but an increase of 20% on the 2001 figure (5,477 deaths). Of these alcohol-related deaths, the majority of people (4,154 people) died from alcoholic liver disease.

 

What did it say about drinking behaviour in adults?

The report found that in England in 2009:

• Among adults aged over 16, just over two-thirds of men (69%) and half of women (55%) reported drinking an alcoholic drink on at least one day in the week before they were interviewed. A tenth of men and 6% of women reported drinking every day in the previous week.
• Over a third of men (37%) drank over four units on at least one day in the week prior to interview and 29% of women drank more than three units at least one day in the week prior to interview (that is, more than the daily maximum levels recommended by the government). A fifth of men (20%) reported drinking over eight units and 13% of women reported drinking over six units on at least one day in the week prior to interview.
• Average weekly alcohol consumption was 16.4 units for men and 8.0 units for women.
• Just over a quarter (26%) of men reported drinking more than 21 units in an average week. For women, 18% reported drinking more than 14 units in an average week.
• The overall volume of alcoholic drinks purchased for consumption outside the home decreased from 733millilitres (ml) of alcohol for each person a week in 2001/02 to 446ml for each person a week in 2009. This reduction is mainly due to a 45% decrease in the volume of beer purchases from 623ml to 342ml for each person a week over the same period.

Hazardous and harmful drinking

The report also discussed hazardous and harmful drinking behaviours. Hazardous drinking is defined as a pattern of drinking that brings about the risk of physical or psychological harm. Harmful drinking is a more serious subset of hazardous drinking behaviours. It is defined as a pattern of drinking that is likely to lead to physical or psychological harm.

Figures were not available for hazardous or harmful drinking in 2009, but figures were given for 2007.

• In 2007, 33% of men and 16% of women (24% of adults) were classified as hazardous drinkers. This included 6% of men and 2% of women estimated to be harmful drinkers.
• Among adults aged 16 to 74, 9% of men and 4% of women showed some signs of alcohol dependence.
• The prevalence of alcohol dependence was slightly lower for men than it was in 2000, when 11.5% of men showed some signs of dependence. There was no significant change for women between 2000 and 2007.

 

What did it say about drinking behaviour in schoolchildren?

In children aged 11 to 15 in England in 2009, the results showed some improvement:

• eighteen percent of secondary school pupils aged 11 to 15 reported drinking alcohol in the week prior to interview, compared with 26% in 2001
• around half of pupils had ever had an alcoholic drink (51%), which was less than the proportion seen in 2003 (61%)
• those pupils who had drunk in the last week consumed an average of 11.6 units

 

What about attitudes to alcohol?

Surveys of the British population in 2009 indicated that there was high awareness of the use of units to measure alcohol, with 90% of respondents saying they had heard of measuring alcohol in units. There had also been an increase in the proportion of people in Great Britain who had heard of daily drinking limits, from 54% in 1997 to 75% in 2009.

 

How much does drinking cost the NHS?

The report features figures from a 2008 government report that estimated that the cost of alcohol harm to the NHS in England was £2.7 billion in 2006/07 prices. This accounted for the costs of hospital inpatient stays, day visits, outpatient visits, A&E visits, ambulance services, GP consultants, practise nurse consultants, lab tests, drugs to treat alcohol dependency, specialist treatment services, and other healthcare costs.

The NHS IC report also looked at the treatment of alcohol dependency in the NHS in England. It found that:

• In 2010, there were 160,181 prescription items for drugs for the treatment of alcohol dependency prescribed in primary care settings or NHS hospitals, and dispensed in the community. This was an increase of 6% on the amount prescribed in 2009 (150,445 items) and an increase of 56% on the amount prescribed in 2003 (102,741 items).
• The net cost of these prescription items (called the net ingredient cost) was £2.41 million in 2010. This was an increase of 1.4% on the cost in 2009 (£2.38 million) and an increase of 40% on the cost in 2003 (£1.72 million).
• When looking at the number of prescription items issued they found that in 2010 there were 290 prescription items dispensed for alcohol dependency per 100,000 of the population 2010. Among SHAs this ranged from 130 items per 100,000 of the population in London SHA, to 515 and 410 items per 100,000 of the population in North West SHA and North East SHA, respectively.

 

How can I tell if I am drinking too much alcohol?

Current government recommendations are that:

• adult men should not regularly drink more than three to four units a day
• adult women should not regularly drink more than two to three units a day

 

Where can I get more information on alcohol?

You can find more information on alcohol, units and drinking habits in our Live Well alcohol section.

Links To The Headlines

Hospitals treat a million for booze. The Sun, May 27 2011

Alcohol-related hospital admissions top one million. The Daily Telegraph, May 27 2011

Alcohol-related hospital admissions at record high. The Guardian, May 27 2011

Our binge-drinking nation: Alcohol-related hospital admissions double in a decade to top ONE MILLION a year. Daily Mail, May 27 2011

Alcohol to blame for 1m hospital cases each year. Daily Express, May 27 2011

Alcohol-related hospital admissions reach record level. BBC News, May 27 2011

Many newspapers have today reported that alcohol-related hospital admissions have risen to record levels, with over a million drink-related admissions in 2009/10. The level of admissions is also nearly double of those seen in 2002/3. These stories have been prompted by the release of this year’s alcohol statistics report from the NHS Information Centre.

 

What did the report assess?

The report covered a range of issues relating to alcohol use, ranging from drinking habits to alcohol prices and hospitalisation rates. It covered drinking in adults (aged 16 and over) and schoolchildren (aged 11-15), drinking-related ill health and mortality, affordability of alcohol and alcohol-related costs. Some of the information in the report has been published previously but the information on hospital admissions is new.

 

What did the report find out about drink-related admissions?

The report found that in England in 2009/10:

• There were 1,057,000 alcohol-related admissions to hospital. This was an increase of 12% on the 2008/09 figure (945,500 admissions), and more than twice as many as in 2002/03 (510,800 admissions).
• Most (63%) of alcohol-related admissions were men. There were more admissions in the older age groups than in the younger age groups, in both men and women.
• When they looked at the rate of admissions and standardised the figures for gender and age, the researchers found that the rates of alcohol-related admissions varied across different Strategic Health Authorities (SHAs). The rate ranged from 1,223 admissions per 100,000 of the population in the South Central SHA, to 2,406 and 2,295 admissions per 100,000 in the North East SHA and the North West SHA, respectively.

 

What kinds of problems were drinking-related?

In addition to admissions to hospital, the NHS Information Centre (IC) also reported on deaths related to alcohol. It said that in 2009, there were 6,584 deaths directly related to alcohol. This was a 3% decrease from the 2008 figure (6,769 deaths) but an increase of 20% on the 2001 figure (5,477 deaths). Of these alcohol-related deaths, the majority of people (4,154 people) died from alcoholic liver disease.

 

What did it say about drinking behaviour in adults?

The report found that in England in 2009:

• Among adults aged over 16, just over two-thirds of men (69%) and half of women (55%) reported drinking an alcoholic drink on at least one day in the week before they were interviewed. A tenth of men and 6% of women reported drinking every day in the previous week.
• Over a third of men (37%) drank over four units on at least one day in the week prior to interview and 29% of women drank more than three units at least one day in the week prior to interview (that is, more than the daily maximum levels recommended by the government). A fifth of men (20%) reported drinking over eight units and 13% of women reported drinking over six units on at least one day in the week prior to interview.
• Average weekly alcohol consumption was 16.4 units for men and 8.0 units for women.
• Just over a quarter (26%) of men reported drinking more than 21 units in an average week. For women, 18% reported drinking more than 14 units in an average week.
• The overall volume of alcoholic drinks purchased for consumption outside the home decreased from 733millilitres (ml) of alcohol for each person a week in 2001/02 to 446ml for each person a week in 2009. This reduction is mainly due to a 45% decrease in the volume of beer purchases from 623ml to 342ml for each person a week over the same period.

Hazardous and harmful drinking

The report also discussed hazardous and harmful drinking behaviours. Hazardous drinking is defined as a pattern of drinking that brings about the risk of physical or psychological harm. Harmful drinking is a more serious subset of hazardous drinking behaviours. It is defined as a pattern of drinking that is likely to lead to physical or psychological harm.

Figures were not available for hazardous or harmful drinking in 2009, but figures were given for 2007.

• In 2007, 33% of men and 16% of women (24% of adults) were classified as hazardous drinkers. This included 6% of men and 2% of women estimated to be harmful drinkers.
• Among adults aged 16 to74, 9% of men and 4% of women showed some signs of alcohol dependence.
• The prevalence of alcohol dependence was slightly lower for men than it was in 2000, when 11.5% of men showed some signs of dependence. There was no significant change for women between 2000 and 2007.

 

What did it say about drinking behaviour in schoolchildren?

In children aged 11 to 15 in England in 2009, the results showed some improvement:

• eighteen percent of secondary school pupils aged 11 to 15 reported drinking alcohol in the week prior to interview, compared with 26% in 2001
• around half of pupils had ever had an alcoholic drink (51%), which was less than the proportion seen in 2003 (61%)
• those pupils who had drunk in the last week consumed an average of 11.6 units

 

What about attitudes to alcohol?

Surveys of the British population in 2009 indicated that there was high awareness of the use of units to measure alcohol, with 90% of respondents saying they had heard of measuring alcohol in units. There had also been an increase in the proportion of people in Great Britain who had heard of daily drinking limits, from 54% in 1997 to 75% in 2009.

 

How much does drinking cost the NHS?

The report features figures from a 2008 government report that estimated that the cost of alcohol harm to the NHS in England was £2.7 billion in 2006/07 prices. This accounted for the costs of hospital inpatient stays, day visits, outpatient visits, A&E visits, ambulance services, GP consultants, practise nurse consultants, lab tests, drugs to treat alcohol dependency, specialist treatment services, and other healthcare costs.

The NHS IC report also looked at the treatment of alcohol dependency in the NHS in England. It found that:

• In 2010, there were 160,181 prescription items for drugs for the treatment of alcohol dependency prescribed in primary care settings or NHS hospitals, and dispensed in the community. This was an increase of 6% on the amount prescribed in 2009 (150,445 items) and an increase of 56% on the amount prescribed in 2003 (102,741 items).
• The net cost of these prescription items (called the net ingredient cost) was £2.41 million in 2010. This was an increase of 1.4% on the cost in 2009 (£2.38 million) and an increase of 40% on the cost in 2003 (£1.72 million).
• When looking at the number of prescription items issued they found that in 2010 there were 290 prescription items dispensed for alcohol dependency per 100,000 of the population 2010. Among SHAs this ranged from 130 items per 100,000 of the population in London SHA, to 515 and 410 items per 100,000 of the population in North West SHA and North East SHA, respectively.

 

How can I tell if I am drinking too much alcohol?

Current government recommendations are that:

• adult men should not regularly drink more than three to four units a day
• adult women should not regularly drink more than two to three units a day

 

Where can I get more information on alcohol?

You can find more information on alcohol, units and drinking habits in our Live Well alcohol section.

Links To The Headlines

Hospitals treat a million for booze. The Sun, May 27 2011

Alcohol-related hospital admissions top one million. The Daily Telegraph, May 27 2011

Alcohol-related hospital admissions at record high. The Guardian, May 27 2011

Our binge-drinking nation: Alcohol-related hospital admissions double in a decade to top ONE MILLION a year. Daily Mail, May 27 2011

Alcohol to blame for 1m hospital cases each year. Daily Express, May 27 2011

Alcohol-related hospital admissions reach record level. BBC News, May 27 2011

“Children who get insufficient sleep at night are more likely to become overweight,” reported BBC News.

The news report was based on a study of 244 children, whose sleep patterns were assessed between the ages of three and five years old to see if they affected their body mass index (BMI) at the age of seven. The study found that, on average, children who slept for an hour less in their earlier years had a later BMI that was about 0.4 points higher. The study has some strengths, such as its use of objective measurements of sleep, but is limited by its small size. It is also difficult to be sure that sleep directly caused the differences seen in BMI.

It is clearly important that children get enough sleep, but it is not possible to say from the results of this study alone that interventions to increase children’s sleep will reduce their risk of being overweight. At present, the best advice to prevent a child becoming overweight is to make sure that they do enough physical activity and eat a healthy, balanced diet with the right amount of calories and nutrients for their age group.

 

Where did the story come from?

The study was carried out by researchers from the University of Otago in New Zealand, who also funded the study along with the Child Health Research Foundation, the New Zealand Heart Foundation, and the Dean’s Bequest-AAW Jones Trust. The study was published in the peer-reviewed British Medical Journal.

BBC News, the Daily Mail and The Daily Telegraph covered this story. While they accurately described the study, they did not highlight its limitations.

 

What kind of research was this?

This prospective cohort study investigated whether the duration of children’s sleep between the ages of three and five was related to their body composition and risk of being overweight at the age of seven.

The researchers say that previous studies have shown a “relatively consistent” link between shorter sleep duration and an increased risk of children being overweight, but that most of these studies had limitations. For example, they were mainly cross-sectional studies, which cannot establish whether the shorter sleep duration preceded the child being overweight. The studies that did follow children up over time relied on parents to report how long their children slept for, rather than measuring this objectively.

The current study aimed to do better than these studies by following children up over time to ensure that their sleep duration was measured before they were overweight, and by using an objective measure of sleep duration. A prospective cohort study is the best type of study for investigating this subject. However, children who sleep less may have other habits that could contribute to them being overweight, which need to be taken into account in the study’s analysis. The researchers addressed many of these habits.

 

What did the research involve?

The researchers enrolled 244 children who were part of a birth cohort, a study that follows all of the children born in a specific period and location. They followed these children up and looked at whether their sleep patterns between the ages of three and five years were related to their body composition and body mass index (BMI) at the age of seven.

The children were recruited in Dunedin, New Zealand, at the age of three, and all children born at the Queen Mary Maternity Unit in Dunedin between July 19 2001 and January 19 2002 were eligible. The researchers excluded any children who were born prematurely, were one of a multiple birth (i.e. twins or triplets), were born with major abnormalities or whose mother had a severe illness after their birth. Of the 413 children who were eligible, 244 participated (a response rate of 59%).

The children attended the research clinic every six months between the ages of three and seven. Their body composition, height and weight were measured every year. Their dietary patterns, physical activity and sleep patterns were assessed at the ages of three, four and five. Parents filled in questionnaires about their children’s diets and how much TV they watched. The children’s levels of physical activity and sleep duration were measured using a motion-sensing monitor (called an accelerometer), which was worn around the waist. The monitors were worn constantly for five consecutive days. The parents also recorded when the children went to bed, went to sleep and got up each day over the same period.

The researchers then analysed whether the children’s average sleep patterns between the ages of three and five were linked to their body composition or risk of being overweight at age seven. The researchers took into account some factors that could influence the results, including age, gender, dietary habits, TV watching, physical activity, children’s BMI at age three and their mothers’ BMI, education, income, birth weight, ethnicity and whether they smoked in pregnancy.

 

What were the basic results?

Most of the children who enrolled (83%) were successfully followed up to age seven. Between the ages of three and five, average sleep duration was about 11 hours a day. At age seven, the children’s average weight was 25kg and their average BMI was 16.7. At this age, 28% of girls and 22% of boys were classed as overweight (defined as having a BMI in the highest 15% expected for their age group).

The researchers found that children who slept longer between the ages of three and five had lower BMIs and were less likely to be overweight at age seven. Once the researchers took into account all the factors they thought might influence the results, including BMI at age three:

• Each additional hour of sleep at ages three to five was associated with a reduction in BMI at age seven of 0.39kg/m2 (95% confidence interval [CI] 0.06 to 0.72).
• Each additional hour of sleep was associated with a reduction in the risk of being overweight of 56% (relative risk 0.44, 95% CI 0.29 to 0.67).

The researchers found that this difference was mainly due to difference in fat mass rather than non-fat mass.

 

How did the researchers interpret the results?

The researchers concluded that “young children who do not get enough sleep are at increased risk
of becoming overweight,” even after they adjusted their results to account for the children’s initial weight and other factors that could have had an effect.

 

Conclusion

This study suggests that getting less sleep between the ages of three and five is associated with a greater risk of being overweight at age seven. The strengths of the study are its cohort design, use of an objective measure of sleep, and high follow-up rate. The study also had some limitations:

• The use of objective measures of sleep helps ensure that these measurements are more accurate. However, there may still be some inaccuracy with the measure used as sleep duration was based on motion and children may lie still without being asleep.
• The researchers measured sleep, physical activity and diet intermittently throughout the study. Although this is better than many studies that only assess such measures once, these periodic measurements may still not have fully captured the child’s habits over the whole period. In addition, the researchers had to rely on the parents’ reports of their child’s diet, which may have led to inaccuracy if, for example, parents were too embarrassed to report their child’s intake accurately because they felt they ate too much unhealthy food.
• The researchers took several confounding factors into account in their analyses, but it is possible that these adjustments did not completely remove the effect of these factors. Other factors may also have had an effect, such as the fathers’ socioeconomic status, which was not taken into account.
• The study was relatively small, and only about 60% of those who were asked to participate did. This may mean that the results are not representative of all children and are more susceptible to being influenced by chance.
• The size of the effect on BMI was relatively small. The researchers say that while this might seem minor in individual children, the benefits for public health, if looked in the population as a whole, could be considerable. To help interpret the importance of the results, it would have been useful to see figures showing the BMIs and proportion of children who were overweight among the groups with different sleep durations at ages three to five, but these were not shown in the paper.

Based on this study alone, it is not possible to say whether lack of sleep directly caused the children to become overweight. Proving that one factor causes another requires the accumulation of a range of evidence, which will require more research in this area. Clearly, it is important that children get enough sleep, but it is not possible to say for certain whether this will reduce their risk of being overweight.

At present, the best advice that can be given to prevent a child becoming overweight is to make sure that they do enough physical activity and eat a healthy, balanced diet with an appropriate amount of calories and nutrients for their age group.

Links To The Headlines

Can more sleep prevent obesity in children? Children who don’t sleep enough more likely to grow up fat, say scientists. Daily Mail, May 27 2011

Less childhood sleep has fat risk. BBC News, May 27 2011

Children who sleep less ‘are fatter’. The Daily Telegraph, May 27 2011

Links To Science

Carter PJ, Taylor BJ, Williams SM, Taylor RW. Longitudinal analysis of sleep in relation to BMI and body fat in children: the FLAME study. BMJ 2011; 342:d2712