When the NHS turned 70 this year, I was reminded of another anniversary which has had an enormous impact on healthcare over many years. Penicillin is 90 this year.
Discovered in September 1928 by Alexander Fleming, it was first used as a cure when George Paine treated eye infections with it in 1930. A method for mass production was devised by Howard Florey and Ernst Chain in 1940, and it was first mass produced in 1942, with half of that total supply used for one patient being treated for streptococcal septicaemia. Continue reading →
Your body mass index (BMI) indicates whether you are within a healthy weight range based on your height. Having a higher BMI – meaning more weight relative to height – can increase your risk of developing heart disease, cancer and type 2 diabetes. While BMI is partly determined by your environment and lifestyle – including your diet and how much you exercise – our genes also play a role.
Genes are inherited from our parents. When this genetic information from the egg and sperm combine, the DNA is replicated continuously – doubling the number of cells until an entire baby is formed. DNA replication is not perfect and every single base in the human genome – the single blocks of code which make up entire DNA strand – has the potential to be mutated for good or for bad. Importantly, this creates a huge amount of random genetic variation at a population level, which is like a huge natural genetic experiment. If we know that these random genetic changes are linked to small changes in BMI, we can test whether BMI influences lots of different things, including cardiovascular health – like a randomized controlled trial.
Broadly, there are two ways of identifying parts of our DNA which are linked with particular traits. Studies of patients affected by rare obesity-related disorders (candidate gene studies) or large-scale population-based genome-wide association studies (GWAS). Findings from the latter of these methods – studies that look to see whether a change at any position in our DNA is linked with a particular trait – have implicated hundreds of common genetic variants associated with BMI.
A 2015 study conducted by the Genetic Investigation of Anthropometric Traits (GIANT) consortium and published in Nature found 97 places in our DNA which influence BMI levels and which were responsible for small differences between people, regardless of how different their environment and lifestyles were. This means that, while we cannot predict an individual’s BMI with genetics, we can refer to genetics to understand if patterns materialise in populations.
Small, genetically driven changes in BMI provide an opportunity to determine whether differences in BMI between people have a role in health and disease. Genetic mutations which are randomly allocated at conception aren’t easily changed by our environment and experiences later in life. As a result, our BMI, weight and chances of developing obesity-related diseases could partly be determined before we’re even born.
Low BMI, low heart disease risk
Using this property of genetic variation, we undertook a study that was recently published in the scientific journal Circulation. Our research showed that higher BMI is likely to have an influence on measures of cardiovascular health, such as blood pressure, in more than 3,000 healthy 17-year olds from the Avon Longitudinal Study of Parents and Children (also known as the Children of the 90s).
The Children of the 90s study, based in Bristol, has followed families in the UK through data collected from questionnaires, clinics and biological samples since the early 1990s. Using MRI scans from 400 21-year old Children of the 90s participants, who were recruited based on genetically driven differences in BMI, we also demonstrated that having a higher BMI is likely to lead to structural damage to heart tissue, including an enlarged left ventricle – the heart’s main pumping chamber.
Until now, studies have typically looked at the link between BMI and cardiovascular health in adults by observing patterns within populations. However, it’s difficult to conclude a relationship between the two without confusing the role that lifestyle factors play or finding how cardiovascular disease changes BMI rather than the reverse. Surveying people is also open to many sources of bias, such as recalling or reporting information incorrectly.
We wanted to isolate the property of genetic variation to improve our confidence in drawing conclusions about the relationship between BMI and cardiovascular health in a population of healthy young people.
Our results support the idea that having a healthy, normal BMI from a young age is likely to maintain a healthy cardiovascular system and help prevent heart disease later in life. Modern genetics allow us to investigate the causes of disease more quickly and cheaply than ever before, and the availability of genetic data in studies such as the Children of the 90s means we can more readily overcome limitations of traditional studies. We hope these findings lead to increased efforts to tackle the obesity epidemic at all stages of life, starting in early age.
As the NHS celebrates its 70th birthday, I hope that in another 58 years there will be similar celebrations and appreciation when its research arm, the National Institute for Health Research (NIHR), turns 70. Continue reading →
Back when it first started, 17% of young pregnant women in the Children of the 90s study reported symptoms severe enough to indicate clinical levels of depression. This figure was already worryingly high in the 1990s, but in their daughters’ generation it is even more common: 25% of the second generation of the study – women under the age of 24 who are becoming pregnant now – are reporting signs of depression and anxiety. Continue reading →
‘Old? What is old? I don’t feel old! Old is nearly dead. Look at me, do I look nearly dead to you?!’
“Skype is a wonderful invention! I was one of those people who said I don’t understand computers, I don’t want to stare at a screen; but it’s marvellous – you feel so connected!”
These are two extracts from ‘ALONELY’, a powerful and emotive set of monologues, developed by community researchers and based on real-life experiences, and one of the research projects tackling the subject of loneliness. Continue reading →
Ian Kirkpatrick, Andrew Sturdy, and Gianluca Veronesi
A recent study on the impact of management consultants on public service efficiency, published in Policy & Politics, prompted this letter from the authors calling for a moratorium on their use until effective governance is established.
Open letter to the Rt Hon Jeremy Hunt MP, Secretary of State for Health and Social Care
2nd July, 2018
Dear Mr Hunt,
Re Calling for a moratorium on the use of external management consultants in the NHS until effective governance is established
We recently conducted independent research on the use of external management consultants in the NHS in England. This was subjected to peer review to establish the rigour of its analysis and published in an academic journal (Policy & Politics). Since then, it was mentioned in a parliamentary debate (23rd April, 2018, Hansard Volume 639) and widely reported in the media (21st February, 2018), including in The Times, which has also seen this letter. Continue reading →
Eating fish while you’re pregnant does not increase the chance that your child will be autistic or have autistic traits, our latest study shows. In fact, our study suggests that fish may be beneficial for the development of a healthy nervous system.
A possible link between mercury exposure and autism has been the subject of much debate over the years. In pregnancy, mercury travels in the mother’s blood through the placenta and into the foetus, where it acts as a toxin, affecting the development of the foetal nervous system. Continue reading →
Around one in five children in the UK have been exposed to domestic violence or abuse between their parents or caregivers. When adults are involved in an abusive relationship, their children bear the consequences. Continue reading →
Dr Fiona Lithander, Senior Research Associate, NIHR Bristol Biomedical Research Centre.
Fiona explains how a new questionnaire could be used to increase healthy food and drink options in hospital retail outlets
At the National Institute for Health Research (NIHR), Bristol Biomedical Research Centre we are interested in the role the NHS plays in promoting good nutrition and health in children. Recent reports have shown a quarter of children in the UK are overweight or obese; a worrying statistic in itself, and the problem doesn’t appear to be getting any better.
NICE guidelines say that retail outlets in hospitals such as shops, cafes, restaurants and vending machines should offer healthy food and drink options, and that these options should be prominently displayed. They also say that nutritional information about the foods on their menus should be available. These guidelines do not refer to foods served to patients, although patients may have access to foods and drinks for sale onsite.
At NIHR Bristol Biomedical Research Centre we developed a new questionnaire to help NHS Trusts assess how healthy their food and drink options are. This differs from other questionnaires in that it allows Trusts to compare their findings with the NICE guidelines. Trusts can use this questionnaire to measure how healthy prepared foods for sale are, and can make changes accordingly. These changes may involve, replacing sugary drinks with sugar-free options such as water, and replacing chocolate bars with more healthy options such as unsalted nuts.
Using this questionnaire, we measured how healthy the foods and drinks were in two Trusts, and how closely they followed NICE guidelines. Our findings showed a lack of healthy food and drink options for sale in vending machines. Nutritional information on menus was minimal, and there was limited promotion and advertising of healthy foods and drinks. Since the findings were published, both of the Trusts have made improvements.
Our plan is to further develop the questionnaire in conjunction with the NICE guidelines, so that it can be used more widely in NHS Trusts and in local authority settings, such as leisure centres. Making it easier for parents to direct their children to healthier choices should be a central element of our healthcare system.
Disclaimer: This study was supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol. The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.