A Spotlight On… health

a-spotlight-on-imageMany of us now live with a ‘lifestyle disease’ such as diabetes or cardiovascular disease, or know someone who does.

This section provides information about some of the more commonly known conditions.

Cancer

expand

cancer cellsLifestyle factors including diet and activity levels can play a role in the risk of some cancers.  Research suggests that around 9% of cancers in the UK could be prevented with a healthier diet1.  In particular, diets high in processed and red meat and salt are believed to increase the risks of some cancers including bowel and stomach, whilst a higher intake of fruit and vegetables and fibre may reduce cancer risks2.

Prevention & Management
Eating a healthy, balanced diet is important to reduce your risks of some cancers.  Eating plenty of fruit and vegetables and fibre is recommended, as well as reducing your intake of red and processed meat, saturated fats and salt.

For more dietary advice, visit Cancer Research's diet and cancer pages.

Sugar and cancers
Expert Committees3 have reviewed the scientific evidence on sugar intake and cancer.  Some evidence has suggested a possible increased risk of colo-rectal cancer where intakes of sugar-rich foods are high, however data are limited and insufficient3 and further research is required.

If you have any concerns about your health please consult your doctor.


References
1 Parkin, D. M. (2011).  The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. British Journal of Cancer. 105, Supp. 2
2 Cancer Research UK (2015)
http://www.cancerresearchuk.org/about-cancer/causes-of-cancer/diet-and-cancer/how-healthy-eating-prevents-cancer (accessed 05/06/15)
3 Institute of Medicine (2002) Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, proteins, and amino acids The National Academies Press. Washington, D.C.

Cardiovascular Disease

expand

HeartCardiovascular Disease (CVD) includes all diseases which affect the heart and circulatory system, including coronary heart disease, heart attack, angina and stroke.  This accounts for around a quarter of all UK deaths annually, approximately 160,000 deaths, with a further 7 million people in the UK estimated to be living with CVD1.


Causes
One of the most common causes of heart attack and stroke is atherosclerosis, a condition which occurs when arteries gradually narrow due to the build-up of plaque on artery walls.  Over time this can cause heart attack or stroke depending on the arteries involved.

There are a number of risk factors for developing CVD, which include smoking, type 2 diabetes, being overweight or obese, an inactive lifestyle, high cholesterol, high blood pressure, gender and age.  Family history of heart disease and ethnicity may also increase risk.

Prevention & Management
The most common recommendations for prevention and reduction of heart disease focus on maintaining a healthy lifestyle.  This includes a healthy diet, plenty of physical activity, not smoking, limiting alcohol intake and maintaining a healthy weight.

Dietary recommendations include eating plenty of fruit and vegetables and reducing saturated fat intake, alongside general healthy eating – for more information see the eatwell guide.

Activity recommendations for adults advise at least 150 minutes of moderate intensity activity (of at least 10 minutes duration on each occasion).  This roughly equates to 30 minutes of moderate intensity activity (equivalent to brisk walking or cycling) five days a week.

For further heart-healthy dietary advice, visit the British Nutrition Foundation’s heart health page.

Sugar and heart disease
Expert Committees2,3 have reviewed the evidence linking sugar consumption with heart disease and cardiovascular risk factors and have concluded that there is insufficient data to implicate sugars based on their effects on the risk factors for cardiovascular disease. 

If you have any concerns about your health please consult your doctor.


References
1 British Heart Foundation (2015) - https://www.bhf.org.uk/research/heart-statistics (accessed 04/06/15)
2 European Food Safety Authority (2010) Scientific Opinion on Dietary Reference Values for carbohydrates and dietary fibre. EFSA Journal, 8, 1462.
3 Institute of Medicine (2005) Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, proteins, and amino acids, The National Academies Press, Washington DC.

Dental health

expand

Bacteria in the mouth can use fermentable carbohydrates, both sugary sources such as sugar, fruit and juices, and starchy sources such as bread, rice and pasta, to produce acid that attacks the enamel surface of the teeth. This can lead to increased risk of dental decay, or ‘caries’.

Causes
A number of lifestyle factors including diet, alcohol consumption and smoking, can all contribute to unhealthy teeth and gums. However in particular, eating or drinking fermentable carbohydrates may cause some damage to the teeth if eaten too often.

Prevention / Management
The introduction of fluoride to toothpaste in the 1970s dramatically improved dental health1.  Data from the Children’s Dental Health Survey indicates a general decline in tooth decay each decade the survey has taken place. The number of decayed, missing or filled teeth (DMFT) in 12 year olds has fallen from 4.7 in 1973 to 0.8 in 20132,6.

Thoroughly brushing teeth twice a day with fluoride toothpaste offers the most effective protection against the risks of decay. However it is still important to maintain a healthy lifestyle and where possible reduce the risk of damage to teeth and gums caused by acid.

Chewing stimulates the production of saliva which dilutes and neutralises the acid produced by bacteria and helps to repair teeth; this works best if some time elapses between acid attacks. Therefore sugars should not be eaten more than 4 separate times per day to reduce the risk of tooth decay3.


Did you know: studies have found that eating a small amount of cheese may help to neutralise the damaging effects of acids from food and drinks because cheese is alkaline in nature4.


Sugar and dental caries
The Scientific Advisory Committee on Nutrition’s (2015)5 Carbohydrates and Health Report found an association between the amount of sugars, sugars-containing foods and beverages intake and dental caries.  A higher frequency of consumption of sugar-containing foods and beverages, but not sugars, was also associated with greater risk of dental caries.  Therefore it is not only amount but also frequency of consumption that is the issue for dental caries risk.  Regularly eating fermentable carbohydrates including sugars, i.e., foods that react with bacteria in the mouth to create acids, is a risk factor for tooth decay because eating more regularly allows less time for saliva to balance the damage to teeth from acids.  Therefore considering how often you eat, as well as what you eat, is key.

Carbohydrates, mainly from starchy sources, should still make up the bulk of a healthy balanced diet but it is important to maintain good oral health practices including brushing twice a day with fluoride toothpaste.

If you have any questions about your health please consult a health professional.


References
1 Cottrell, R. C. (2011) Dental disease: Etiology and epidemiology. IN CABALLERO, B., ALLEN, N. & PRENTICE, A. M. (Eds.) Encyclopaedia of Human Nutrition. 2nd Edition ed. Kidlington, UK, Elsevier Academic Press.
2 WHO Oral health database, Malmö University.  Available from http://www.mah.se/CAPP/Country-Oral-Health-Profiles/EURO/European-Union-and-European-Economic-Area–/Dental-Caries-for-12-year-olds/ (accessed 13/07/15)
3 PHE (2014)
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/367563/DBOHv32014OCTMainDocument_3.pdf (accessed 14/07/15)
4 The Dairy Council (2015)
http://www.milk.co.uk/page.aspx?intPageID=79 (accessed 27/05/15)
5 SACN (2015) Carbohydrates and Health Report
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/445503/SACN_Carbohydrates_and_Health.pdf (accessed 20/07/15)
6 Children’s Dental Health Survey (2013)
http://www.hscic.gov.uk/catalogue/PUB17137/CDHS2013-Executive-Summary.pdf(accessed 22/09/15)

Diabetes

expand

diabetesDiabetes is an increasingly common health condition.  3.3 million people have been diagnosed with diabetes in the UK and approximately 590,000 people are thought to have the condition but are undiagnosed1

Diabetes occurs if the body is unable to process glucose (a type of sugar) for fuel and it therefore builds up in the blood. This may be due to the poor production or function of insulin, the hormone produced by the body in the pancreas which allows the body to absorb glucose from the blood.

There are two main types of diabetes:
Type 1 Diabetes
Develops when most or all of the cells in the pancreas that produce insulin are destroyed. It usually occurs in people under the age of 40, commonly during childhood, and accounts for approximately 10% of adults with diabetes2.
Treatment: regular insulin injections.  Recommendations also include lifestyle improvements, including a healthy diet and physical activity.

Type 2 Diabetes
Develops when the pancreas still produces some insulin, but either in an inadequate amount or it is less effective.  Unused glucose therefore builds up in the blood.  It generally occurs in people over the age of 40 and occasionally in younger people - and is caused by a combination of factors, one of the greatest being overweight.  Type 2 accounts for approximately 90% of people with diabetes2.
Treatment: combination of a healthy diet and increased physical activity, and in some cases medication and/or insulin may be required.

Prevention / Management
Diabetes can cause short and long term complications, which may impact widely across the body.  Affected areas may include the eyes, heart, kidneys, nerves and feet and therefore prevention and management of the condition should be a key focus.  Key to this is achieving and maintaining a healthy body weight through diet and physical activity.  Overweight individuals with diabetes should be encouraged to reduce their energy intake and increase their physical activity levels, as even a 5-10% reduction in weight will improve blood glucose control and other metabolic abnormalities associated with the disease3.

More information about managing your diabetes can be found on the NHS website.

Sugar and diabetes
In the UK, the number of people diagnosed with diabetes has more than doubled since 1996, from 1.4 million to 3.3 million4.  At the same time, intakes of sugars have decreased by approximately 7%5.  Scientific evidence has not established that sugars per se are a direct cause of diabetes6.  However, an association has been found between increased intakes of sugars-sweetened beverages and incidence of type 2 diabetes7 although further research is required in order to prove a direct causal link.

If you have any concerns about your health please consult your doctor.


References
1 Diabetes UK (2015) - https://www.diabetes.org.uk/Guide-to-diabetes/What-is-diabetes/ (accessed 17/06/15)
2 WHO (2015) http://www.who.int/mediacentre/factsheets/fs312/en/ (accessed 31/07/15)
3 Van Gaal, L & Scheen, A (2015).  Weight Management in Type 2 Diabetes: Current and Emerging Approaches to Treatment.  Diabetes Care 38:1161-1172
4 Diabetes UK (2015)
https://www.diabetes.org.uk/Documents/Position%20statements/Facts%20and%20stats%20June%202015.pdf (accessed 15/09/15)
5 NDNS (2014)
https://www.gov.uk/government/statistics/national-diet-and-nutrition-survey-results-from-years-1-to-4-combined-of-the-rolling-programme-for-2008-and-2009-to-2011-and-2012 (accessed 22/5/15).  Calculation based on NMES intake data: 63.3g (2000/01) to 58.8g (2008-12)
6 WHO/FAO (2003) Diet, nutrition and the prevention of chronic diseases. Report of a Joint WHO/FAO Expert Consultation. WHO Technical Report Series No. 916., Geneva.
7 SACN (2015) Carbohydrates and Health Report
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/445503/SACN_Carbohydrates_and_Health.pdf (accessed 20/07/15)

Non-alcoholic fatty liver disease

expand

Healthy livers contain little or no fat, however if too much fat builds up, a condition called fatty liver disease occurs.  Fatty liver disease is fairly common in the UK, and is seen most often in those who are overweight or obese.  In fact around 25-30% of people in the UK are in the early stages of non-alcoholic fatty liver disease (NAFLD)1.

There  are four main stages of NAFLD development; fatty liver (steatosis), non alcoholic steatohepatitis (NASH), fibrosis and cirrhosis. Symptoms increase in severity across these stages and include the build-up of excess fat in the liver cells, inflammation, development of scar tissue and finally cirrhosis2.

Causes
The most common risk factors for developing the condition include: being overweight or obese, high blood pressure, high cholesterol, type 2 diabetes and smoking3.

Prevention / Management
Treatment options focus on weight loss and lifestyle improvements, including healthy diet, increased physical activity, not smoking and reduced alcohol intake.  Managing existing conditions, such as diabetes, through the use of medication may also help to reduce symptoms and progression of the disease.

Sugar and NAFLD
Excess energy intake is associated with the risk of developing NAFLD.  Available evidence is insufficient to implicate sucrose consumption alone in NAFLD.  It is important to maintain a healthy, balanced diet and active lifestyle to reduce the risk of developing the condition4.

If you have any concerns about your health please consult your doctor.


References
1 NHS (2015) http://www.nhs.uk/conditions/fatty-liver-disease/Pages/Introduction.aspx (accessed 26/05/15)
2 British Liver Trust (2015) http://www.britishlivertrust.org.uk/liver-information/liver-conditions/cirrhosis/ (accessed 17/06/15)
3 British Liver Trust (2015)
http://www.britishlivertrust.org.uk/liver-information/liver-conditions/non-alcohol-related-fatty-liver-disease/ (accessed 18/06/15)
4 Chung et al (2014) Fructose, high-fructose corn syrup, sucrose, and non-alcoholic fatty liver disease or indexes of liver health: a systematic review and meta-analysis. Am J Clin Nutr doi: 10.3945/ajcn.114.086314

Obesity

expand

Obesity refers to an accumulation of excess body fat and is a major health problem in the UK.  As of 2013, over half of the adult population was overweight or obese, and 26% of men and 23.8% of women were classified as obese1.

The most common classification tool used to define obesity is Body Mass Index (BMI) but measurement of waist circumference (WC) may also be used as a marker of excess abdominal fat.  This is because central obesity, or abdominal fat, is more commonly associated with health risks.

BMI quick reference…
BMI (kg/m2 (calculated as weight (kg) / height (metres)2)
Less than 18.5 = underweight
18.5-24.9 = healthy weight
25.0-29.9 = overweight
30.0 or more = obese

Click here to check your BMI

Causes
Excess calories and lack of physical activity are broadly considered to increase the risk of obesity, although there are many factors which may influence weight gain.

Energy balance = energy intake vs energy expenditure

It is important to ensure the right balance of energy intake (calories consumed) and energy expended (calories used through physical activity and general living).  If energy intake from food and drink exceeds the amount used for physical activity and standard metabolic functions, the excess is stored as body fat which results in weight gain.  The optimal combination to avoid positive energy balance and obesity is a healthy, balanced diet (see our Eating for Health section and the eatwell guide for more information) and regular physical activity.  UK Government activity recommendations for adults advise at least 150 minutes of moderate intensity activity (of at least 10 minutes duration on each occasion).  This is roughly 30 minutes of moderate intensity activity (equivalent to brisk walking or cycling) five days a week2.

Implications / risk factors: being overweight (BMI of over 25kg/m2) is a major risk factor for many other conditions, such as cardiovascular disease, type II diabetes, sleep apnoea (breathing stops for short periods during sleep), certain cancers, psychological conditions and other chronic health problems, which may lead to premature death.

Prevention / Management
Treatment is focused on weight loss and longer-term follow-up to avoid weight gain. This can include dietary changes to reduce calorie intake, increased physical activity, weight loss medication, surgery or a combination of these.

Sugars and obesity
Evidence is inadequate to implicate sugars in the cause of lifestyle disease such as obesity3,4.  In England, adult obesity rates have increased from 13.2% to 24.4% in men and from 16.4% to 25.1% in women between 1993 and 20125.  At the same time, intakes of sugars have decreased by approximately 7%6.

If you have any concerns about your health please consult your doctor.


References
1 HSCIC (2015) http://www.hscic.gov.uk/catalogue/PUB16988/obes-phys-acti-diet-eng-2015.pdf (accessed 21/05/15)
2 www.gov.uk (2015) https://www.gov.uk/government/publications/uk-physical-activity-guidelines
3 Institute of Medicine (2002) Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, proteins, and amino acids The National Academies Press. Washington, D.C.
4 European Food Safety Authority (2010) Scientific Opinion on Dietary Reference Values for carbohydrates and dietary fibre. EFSA Journal, 8, 1462.
5 SACN (2015) Carbohydrates and Health Report – https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/445503/SACN_Carbohydrates_and_Health.pdf (accessed 20/07/15)
6 NDNS (2014) – https://www.gov.uk/government/statistics/national-diet-and-nutrition-survey-results-from-years-1-to-4-combined-of-the-rolling-programme-for-2008-and-2009-to-2011-and-2012 (accessed 22/5/15). Sugars intake calculation based on NMES intake data: 63.3g (2000/01) to 58.8g (2008-12)

Health professionals

Sugar
FAQs

Subscribe