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J Epidemiol Community Health. 2007 August; 61(8): 752.
PMCID: PMC2653011

Hygieia

Screening for childhood obesity in the UK

While population monitoring has been introduced in UK primary schools in an effort to track the growing obesity epidemic, a review commissioned by the Health Technology Assessment Programme found a lack of data on the potential impact of the screening and recommends more research as a priority. It has been argued that parents should be informed of their child's results. The review looked at the evidence that moving from monitoring to screening would be more effective. The review took as its data source published and unpublished studies (any language) from electronic databases, clinical experts, primary care trusts and strategic health authorities, and reference lists of retrieved studies. Studies whose primary outcome was population prevalence were excluded. The review found that there were no trials assessing the effectiveness of monitoring or screening for obesity. Instead, studies had focused on diagnostic accuracy of measurements. Information on attitudes of children, parents and health professionals was sparse. The review found that more large‐scale studies are needed to identify effective weight reduction strategies for children and clarification of the role of preventive measures. If effective treatments can be found, effort should be focused upon methods of identifying overweight and obese children without stigmatisation and upon defining the appropriate target population. The review found that it was difficult to see how screening to identify individual children can be justified without effective interventions. (Arch Dis Child 2007;92:416–22)

Impact of breast feeding on asthma, coeliac disease and obesity in the UK

The nutritional, growth and immunological benefits of breast feeding are well documented but rates of breast feeding remain low in many countries. Recent epidemiological studies suggest that breast feeding may also reduce the risks of certain chronic childhood disorders. A recently described measure, the population impact number of eliminating a risk factor over a time period, PIN‐ER‐t, was used to quantify the burden of low rates of breast feeding in a UK population of babies born in 2002 with regard to asthma, coeliac disease and obesity. Literature was searched for systematic reviews with meta‐analyses that had investigated the association between breast feeding and asthma, coeliac disease and obesity. Based on these data, and the published data on the prevalence of breast feeding and the prevalence of these disorders, PIN‐ER‐t values were calculated and the number of cases of each disorder that could be prevented by eliminating “no breast feeding” as a risk factor were calculated. In a population of 596 122 babies born in England and Wales in 2002 the number of cases of asthma, coeliac disease and obesity that could be prevented over 7–9 years by eliminating “no breast feeding” as a risk factor were 33 100, 2655 and 13 639, respectively. Thus the population burden of low breast feeding rates is high with regard to these common disorders. The measure PIN‐ER‐t allows this to be quantified and communicated in a way that will make it easier for the general public and decision makers to understand. (Arch Dis Child 2007;92:483–5)

Glenys Hughes ghughes@bmjgroup.com

Occupational exposure to asbestos and man‐made vitreous fibres and risk of lung cancer in Europe

Occupational exposure to asbestos and man‐made vitreous fibres (MMVF) does not appear to contribute to the risk of lung cancer in men in Central and Eastern Europe, but in the UK there was an increased risk of lung cancer after exposure to asbestos, a multicentre study has shown. The large community based study was conducted between 1998 and 2002 in seven European countries—Czech Republic, Hungary, Poland, Romania, Russia, Slovakia and the UK. The study population comprised 2205 newly diagnosed male lung cancer cases and 2305 controls, with mean ages of 60.8 and 60.6 years, respectively. Odds ratios of lung cancer were calculated after adjusting for other relevant occupational exposures and tobacco smoking. As expected there was a marked difference between cases and controls with respect to smoking habits; 2.2% of cases and 23.2% of controls had never smoked while 35.4% of cases and 12.5% of controls were longstanding current smokers. Among cases 14.4% were classified as ever exposed to asbestos compared with 13.1% of controls. For MMVF (glass and mineral wool) these proportions were 5.2% and 3.9%, respectively. The proportion of exposure to asbestos among controls was 8.1% in Poland, 8.3% in Romania, 9.4% in Russia, 9.8% in Hungary, 15.6% in Slovakia, 19.8% in the Czech Republic and 37.1% in the UK. The proportion of those ever exposed and highly exposed to asbestos and MMVF was considerably higher in the UK, while high frequency of exposure was more often reported among subjects in Central and Eastern Europe. Differences in fibre type and circumstances of exposure may explain these results. (Occup Environ Med published online 19 Oct 2006; doi: 10.1136/oem.2006.027748)

Tooth loss and mortality patterns in Glasgow

Over the past decade evidence has emerged that there may be an association between oral infection and systemic chronic diseases, and many studies have found that poor oral health, mainly caused by periodontal disease, is associated with an increased risk of both cardiovascular disease (CVD) and, possibly, cancer. Data were taken from the Glasgow Alumni Cohort to investigate whether oral health in young adulthood (individuals aged 30 years or less) is independently associated with cause‐specific mortality after allowing for childhood socioeconomic background and other risk factors. Of the original cohort of 15 322 students registered at the University of Glasgow between 1948 and 1968 invited to have annual medical examinations at the Student Health Service, 12 631 were traced though the NHS Central Register. Of these, 9569 men and 2654 women were 30 years or younger at baseline. During up to 57 years of follow‐up there were 1432 deaths, including 509 deaths from CVD and 549 from cancer. After adjusting for potential confounders no substantial association was found between missing teeth and all‐cause mortality, CVD mortality or cancer mortality. When the number of missing teeth was treated as a categorical variable, there was evidence that students with nine or more missing teeth at baseline had an increased risk of CVD compared to those with fewer than five missing teeth. However, causal mechanisms underlying the association between tooth loss and CVD mortality remain uncertain. (Heart published online 12 Dec 2006; doi: 10.1136/hrt.2006.097410)


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