Popularity of sushi has brought rise in parasitic infections, warn doctors

From nigiri to temaki, sushi has boomed in popularity in the west, but now doctors are warning of a less appetising trend: a rise in parasitic infections.

A team of doctors from Portugal raised concerns after a 32-year old man was admitted to hospital complaining of pain in his abdomen just below his ribs, vomiting and had a slight fever, all of which had lasted for a week.

An endoscopy soon revealed the culprit: the larvae of a type of parasitic worm from the genus Anisakis. The doctors note that the condition, known as anisakiasis, is caused by eating undercooked or raw fish or seafood that has been contaminated: indeed, questioning of the patient revealed that he had recently eaten sushi.

After the larva was removed the man rapidly recovered, say the medics.

Two views of the parasite, seen here firmly attached to an area of the patient’s upper gastrointestinal tract. Photograph: Carmo et al/BMJ case reports

Writing in the journal BMJ Case reports, the team warn that with sushi in vogue in the west, awareness of anisakiasis is growing.

“Most of the cases were described in Japan due to food habits; however, it has been increasingly recognised in western countries,” the authors write, pointing to a Spanish study that reported 25 cases of the condition over a three year period from 1999 to 2002, with all patients having eating raw anchovies, as well as Italian research which flagged both anchovies and sushi as routes by which individuals could become infected.

The Italian study added that medical professionals should suspect the condition should patients complain of severe abdominal pain after eating raw fish, pointing out that “no effective pharmacological treatment is able to kill the larvae once eaten”.

Indeed, as the US Center for Disease Control and Prevention notes, “The treatment for anisakiasis may require removal of the worm from the body by endoscopy or surgery.”

The authors of the latest report add that besides the symptoms shown in the Portuguese case, the condition can also trigger a host of other symptoms including severe allergic reaction, as well as complications such as digestive bleeding, bowel obstruction and peritonitis.

The Food Standards Agency noted that raw fish occasionally contain parasitic larvae, but said that under European food hygiene legislation fish that is to be eaten raw should be frozen before it is sold to consumers to ensure any parasites have been killed.

The FSA added that fish and meat should always be cooked properly according to the producer’s instructions, but offered a few tips to those planning to make their own sushi.

“If you do choose to make your own sushi from fish at home, ensure you follow a reputable recipe,” the FSA advised. “If wild fish are to be eaten raw or lightly cooked, ensure that all parts, especially the thickest part, have been frozen for at least four days in a domestic freezer at -15C or colder. This will ensure that any undetected Anisakis larvae are killed.”

Popularity of sushi has brought rise in parasitic infections, warn doctors

Poverty blighting health of many UK children, paediatricians warn

Poverty is seriously affecting the health of many British children, who are paying a heavy price as a result of housing, food and financial insecurity, paediatricians have warned.

A report from the Royal College of Paediatrics and Child Health (RCPCH) and Child Poverty Action Group (CPAG) paints a bleak picture of the wellbeing of children in low-income households.

Among the problems cited by paediatricians are poor growth in children, whose parents cannot afford healthy food or to take them to medical appointments, respiratory illnesses being caused or exacerbated by cold, damp housing, and mental health problems resulting from financial stress.

Two in five of surveyed doctors said they had experienced difficulty discharging a child in the past six months because of concerns about housing or food insecurity.

Prof Russell Viner, RCPCH officer for health promotion, said its members were seeing problems that seemed to belong to a bygone era.

“Paediatricians around the country are telling us that poverty is affecting the health of children in a way we haven’t seen before,” he said.

“It’s an absolute wake-up call for our political parties that they really need to deliver on promises to make Britain a more equal society.

“The prime minister talked on her first day about the burning injustices in society and how she wants to change that and this chimes with that kind of focus.”

Latest figures show that 4 million children in the UK live in poverty and projections suggest that could rise to 5 million by 2020. In 2015, the Conservative government scrapped the target requiring the eradication of child poverty by the end of the decade. The decision was much-criticised at the time and the restoration of the target is one of the recommendations of the RCPCH and CPAG in their report, published on Thursday.

Only one respondent out of 266 paediatricians from 90 NHS trusts who completed the survey said poverty and low income did not contribute to the ill health of the children they work with, while more than two-thirds said it contributed “very much”. Almost half of doctors who responded said things were getting worse and only three believed they were improving.

Housing problems or homelessness were a concern for just under nine out of 10 respondents, with one London doctor commenting that “overcrowded, damp or unsuitable housing amongst our patients is the rule rather than the exception”.

Another paediatrician said that they had seen a number of babies unable to be discharged from the special care babies unit due to the parents being homeless. Four out of five doctors said an inability to keep warm at home contributed to ill health among children they treat.

More than three in five said food insecurity contributed very much to the ill health of children, with more than nine in 10 saying it had some impact. The inability to afford enough healthy food is associated both with poor growth of deprived babies and children on the one hand, and rising child obesity on the other.

One doctor who responded to the survey said the biggest impact of poverty on their patients was “insecurity, inferiority and stress. Through the biological and psychological factors these undoubtedly lead to poor health”.

More than nine in 10 paediatricians said financial stress and worry contributed to the ill health of children they work with.

The CPAG chief executive, Alison Garnham, said the results “should sound alarms for the next government. Low family incomes, inadequate housing and cuts to support services are jeopardising the health of our most vulnerable children.”

As well as restoring child poverty targets the report recommends that the next government reverses cuts to public health and universal credit, and examines the impact on child health of all prospective policies.

Viner stressed that the report did not aim to lay the blame for the problem at the door of one political party. “We need our children to be healthy, for the economy to be competitive, post-Brexit,” he said.

The shadow health secretary, Jonathan Ashworth, said child health inequality was a “national scandal”. He added: “Labour will bring down childhood obesity rates, improve early years’ services, enhance mental health provision and improve the state of all our children’s teeth.

“Our children deserve the best possible start in life and no child will be left behind under the next Labour government.”

Poverty blighting health of many UK children, paediatricians warn

Gluten-free diet carries increased obesity risk, warn experts

Substituting everyday staples with gluten-free foods could increase the risk of obesity, experts have warned, after finding that such products often contain higher levels of fats than the food they aim to replace.

A gluten-free diet is essential to those with coeliac disease – an auto-immune condition that is thought to affect 1% of Europeans – while the regime is also proving increasingly popular among those without the disease. But while a host of gluten-free products are on the market, researchers have said they have a very different nutritional make-up to conventional staples.

“There is very little [consumers] can do about it,” said Joaquim Calvo Lerma of the Instituto de Investigación Sanitaria La Fe in Spain and co-author of the research. “Unfortunately consumers can [only] eat what is available on the market.”

Calvo Lerma’s warning comes after he and his and colleagues compared 655 conventional food products to 654 gluten-free alternatives across 14 food groups including breads, pasta, breakfast cereals, biscuits and even ready meals, covering a range of brands.

The results – presented at the annual meeting of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition – reveal that, overall, gluten-free products were more energy-dense than their conventional counterparts.

The team found that, on average, gluten-free bread loaves had more than twice the fat of conventional loaves, while gluten-free breads in general had two to three times less protein than conventional products. Gluten-free biscuits were also found to be lower in protein but higher in fat, while gluten-free pasta had lower levels of sugar and just half of the protein of standard pasta.

Calvo Lerma warned that gluten-free foods could be contributing to an increased risk of obesity, particularly among children who are more likely to eat products like biscuits and breakfast cereals. He urged consumers to compare gluten-free products across brands to find those with the lowest fat content.

Calvo Lerma also called on manufacturers to innovate. “It is the responsibility of the food industry to produce these type of gluten-free products from other materials that are much healthier or have a [more] enhanced nutritional profile than the current raw materials being used, like cornflour or potato starch,” he said, pointing out that healthier products could be made, for example, using grains such as buckwheat or amaranth.

He added that manufacturers should also add more complete and clearer labels to products to highlight their nutritional content, including levels of vitamins and minerals.

Benjamin Lebwohl, from the coeliac disease centre at Columbia University, who was not involved in the research, said that the study backs up previous evidence that gluten-free foods are nutritionally suboptimal. But while a gluten-free diet is essential for coeliacs, it is not intrinsically healthy or unhealthy, he added. “It depends on the choices you make as part of the gluten-free diet,” he said.

Sarah Sleet, chief executive of Coeliac UK, said the latest findings tie in with the charity’s own research, adding that further development of lower-fat, gluten-free products would be welcomed.

David Sanders, professor of gastroenterology at the University of Sheffield, noted that other studies have found gluten-free and conventional foods to have similar nutritional value. “The jury is out,” he said.

But Sanders cautioned that there is no evidence a gluten-free diet has benefits for those without gluten sensitivity or coeliac disease. “Once you go into the territory of dietary restrictions without medical symptoms then you are running the gauntlet of missing out on various vitamins or minerals without realising it,” he said.

Gluten-free diet carries increased obesity risk, warn experts

"Unnecessary" painkillers could leave thousands addicted, doctors warn

Powerful and potentially addictive opiate painkillers are being handed out too readily, leading doctors have warned after it emerged that the number of times the drugs are being prescribed in the UK has doubled in the past decade.

The Faculty of Pain Medicine and the Royal Pharmaceutical Society said they were worried about the high and growing use of opioid drugs such as codeine and tramadol – while other experts warn that hundreds of thousands of patients could be addicted to them.

Dr Barry Miller, dean of the Faculty of Pain Medicine, said that the increase in the prescription rates of painkillers in the UK should be “met with concern”, adding: “While some of the increase can be attributed to an improved understanding of the effectiveness of these medications by medical professionals, we are concerned by reports of unnecessary prescription.”

NHS Digital figures released last week showed that prescriptions of opioids have doubled in the past decade, with the number of prescriptions issued rising from 12m in 2006 to 24m in 2016. One of the highest increases in prescriptions was for oxycodone, which shot up from 387,591 to 1.5m – a 287% rise – over that period. There was a 236% increase in prescriptions for morphine sulphate and a 143% rise for fentanyl.

“Our greater understanding of these medications can improve the quality of life for tens of thousands of patients in the UK living with complex pain. However, all NHS staff prescribing these medications need to ensure they are not doing more harm than good,” said Miller, whose organisation represents anaesthetists who specialise in the relief of acute, chronic and cancer pain.

rising rates of pain killer prescriptions

Doctors have warned about the numbers of people in Britain who may be addicted to these drugs as a result, with recent estimates suggesting over 192,000 could be dependent, partly because some medics prescribe them too readily.

In the US, since 1999 the number of overdose deaths involving opioids such as oxycodone, hydrocodone and methadone has more than quadrupled. The number of prescriptions of these drugs rose dramatically – from 76m to 219m a year between 1991 and 2011. This comes despite the fact there has been no change in the amount of pain Americans report.

Harry Shapiro of the DrugWise information service warned of the growing risks of addiction in the UK and said the growing prescription of painkillers was leading to a “public health disaster hidden in plain sight”. He is calling for more dedicated specialist centres to help people with painkiller addiction and also to help track the scale of the problem.

“People are not staggering around the streets and buying dodgy drugs off dealers, they are getting painkillers. It’s a problem hidden in plain sight – a problem in every GP surgery and pain specialist clinic,” he said.

Martin Johnson, clinical lead for chronic pain at the Royal College of General Practitioners, raised concern about the number of people who may be on repeat prescriptions. He said those with other conditions such as diabetes were monitored while on medication, but it doesn’t always happen for people with chronic pain. He called for an annual review, potentially conducted by pharmacists, to check in on those given these drugs. “So many say painkillers don’t do anything, but they keep getting prescribed them,” he said.

Many patients also reportedly use these drugs recreationally, obtaining them non-prescriptively after being introduced to them by their doctors. In Britain, there is less recreational use and most people are given opioids by their doctor for chronic pain.

Opioids act on different parts the brain and nervous system, including the spinal cord. The latter receives sensations from the body before sending them to the brain. Opioids work on this area to decrease feelings of pain, even after injury. One of the risks with the drugs is that they are addictive, with users complaining of withdrawal symptoms when they stop taking them.

But doctors say that while medications such as codeine can be effective for cancer patients and for tissue damage, they do not always help the growing number of patients now taking them for long-term pain. These drugs also have side effects such as severe constipation and dangerous sedation.

Dr Jane Quinlan, consultant in anaesthesia and pain management at Oxford University Hospitals NHS foundation trust, said: “For the majority of patients with chronic pain opioids don’t reduce their pain, but the side effects can significantly worsen their quality of life. Over time opioids can actually make people more sensitive to pain, she added.

One former user, who asked to remain anonymous, said: “I was prescribed tramadol for about three years for my ongoing back condition. I was addicted to them after a few months, it got to the stage where it became part of my routine. I suffered awful withdrawal when I stopped taking them. Without them my pain was overwhelming.”

Yasir Abbasi, a psychiatrist with Mersey Care NHS trust, said: “Being dependent or addicted to prescribed painkillers can lead towards a slippery slope of illicit behaviour, which can pave the way for hardcore drugs. There are not enough non-pharmacological interventions available to reduce our reliance on opioid medication.”

Cathryn Kemp, 45, from Hastings: ‘I ended up in rehab after taking 60 fentanyl lozenges a day’

Cathryn Kemp: ‘In the morning I would wake up, crawl to the bathroom and take six lozenges.’ Photograph: Andrew Hasson for the Guardian

I was working as a journalist when, after a period of illness, I was finally diagnosed with a disorder of the sphincter. I had lots of scary procedures to make me better. I was very ill and eventually discharged with a repeat prescription for fentanyl lozenges. I’ve since been told that fentanyl is 100 times stronger than heroin.

At the time, I was told to take a maximum of eight lozenges a day. I was also on fentanyl transdermal patches – 100mg ones, the strongest. That shows the level of pain I was in. Then one day I took an extra lozenge and after that my use of the drug spiralled.

Two years later I ended up in rehab after taking 60 lozenges a day – all of them on prescription from my GP. I kept thinking I was in loads of pain and needed more.

I felt like I was taking control of things, which is completely insane. I hid the problem brilliantly from my family and friends. I used to hide lozenges around the cottage where I lived, putting them in tampon boxes so no one would know how many I was taking. Taking fentanyl would make me woozy and then about an hour or two between doses I would go to withdrawal – vomiting, shaking and hallucinating.

In the morning I would wake up, crawl to the bathroom and take six lozenges. This would stop me shaking. I would then be well enough to get a cup of tea and then have to take six more. This would go on all day. The tiny bit of me that was still myself at this point knew I was abusing drugs, but I was afraid to stop as I feared living in pain again.

At this stage I was dangerously dependent. My GP said he would write me my last fentanyl prescription and I was forced to borrow lots of money from my parents and sell my cottage in order to pay for private rehab. My GP applied for NHS detox for me, but I was told that I was refused it because I wasn’t homeless and I wasn’t offending.

By then I knew going to die if I carried on so I did whatever it took to get help. Coming off it I had to go through a pain barrier. The body stops producing endorphins, the body’s natural painkillers, because it is receiving opiates instead.

I lost everything. I had to leave work because I was so ill. I lost my relationship, my career and my home – I lost everything I had built up over my writing career. I nearly lost my life.

I now run a charity dedicated to helping people cope with painkiller addiction. I haven’t come across anyone who has had such a complete breakdown like me. But I hear from lots of people, mainly women, who say they have kids to sort out and they cannot stop to have a pain condition. They think they have to keep going and so become trapped by the drugs they are taking.

What I am really hearing is the fact in the medical community there is still no support for dealing with these cases – no specific or very few specific resources to refer people too, so many are left hanging. We really need to engage NHS England in accepting that we need proper treatment services to deal with chronic pain as well as the addiction side.

It’s heartbreaking because it’s everyday people who are affected. We look at America and are horrified that opioid deaths are higher than deaths caused by car crashes. We do have a different system here, but estimates suggest hundreds of thousands of patients in the UK today are addicted to prescribed painkillers.

"Unnecessary" painkillers could leave thousands addicted, doctors warn

Almost untreatable superbug CPE poses serious threat to patients, doctors warn

Doctors are warning that the rise of an almost untreatable superbug, immune to some of the last-line antibiotics available to hospitals, poses a serious threat to patients.

The number of lab-confirmed cases of the bug, called carbapenemase-producing Enterobacteriaceae (CPE), rose from three to nearly 2,000 in the 12 years to 2015, according to Public Health England (PHE). But that may be far short of the real number because hospitals are not compelled to report suspected cases. PHE admits it does not know where the infections are coming from or how many people are dying.

Freedom of information requests made by the Bureau of Investigative Journalism reveal that at least 81 people infected with CPE have died since 2009 at 66 NHS trusts in England – although the bug may have been a complicating factor rather than the main cause of death in some cases.

But the real figure is almost certain to be much higher. Many trusts did not respond to the requests or were unable to supply complete data. Out of 136 NHS hospital trusts that were asked for the numbers of infections and deaths between 2009 and 2016, 97 responded but nearly half did not have data on CPE or could not extract the details.

In Manchester and London, dealing with CPE has cost NHS trusts almost £10m. There have also been confirmed outbreaks in Liverpool, Leeds, Sheffield, Birmingham, Nottingham, Colchester, Edinburgh, Belfast, Dublin and Limerick, among others.

Elsewhere, Italy had only sporadic cases of CPE in 2009 but by 2014, the bugs were rife across the country. “If you look at Italy they’ve suspended bone marrow transplant programmes,” said Dr Matthew Laundy, consultant medical microbiologist at St George’s University Hospitals NHS Foundation Trust. “If you’ve got no antibiotics to treat CPEs you’re stuck.”

Experts are calling for reports of suspected CPE infections to be made mandatory. The numbers revealed by the Bureau are “shocking,” said Val Edwards-Jones, emeritus professor of microbiology at Manchester Metropolitan University.

“It should absolutely be mandatory for trusts to report this,” she said. “If you go back to the 1990s MRSA [reporting] wasn’t mandatory. It was only when hospitals did proper surveillance and began looking at the bugs in the blood that we knew the scale of the problem. Then it was found that there were certain things that weren’t being done correctly.”

Dr Michael Cooper, a consultant microbiologist and director of infection control at the Royal Wolverhampton NHS Trust, said: “If something’s not mandatory, it’s the places doing well that take care to report. You don’t get figures from the trusts with their head in the sand, the poor performers.

“Public Health England have no idea how many people are dying, they’ve no outcome data. This is a serious mistake.”

CPE is carried harmlessly in the gut, but may kill if it enters the bloodstream through a wound of a patient who is already sick or frail, which makes it a real danger in hospitals. About 40-50% of patients with a CPE bloodstream infection die. CPE is not untreatable, but it is difficult as antibiotic combinations or older, more toxic drugs have to be used.

CPE, dubbed the “nightmare bacteria” by Tom Frieden, former head of the Centers for Disease Control and Prevention in the USA, has developed resistance to the carbapenems, a group of “last resort” antibiotics that are used in serious infections when other drugs will not work. They include KPC (Klebsiella pneumoniae carbapenemase) and NDM (New Delhi Metallo-beta-lactamase).

Experts have warned that antibiotic resistance is a major threat to the world and could turn the clock back on medical advances by making some surgery, such as heart transplants, impossible.

There are high levels of CPE in India, Bangladesh, Pakistan, the Middle East, south and Central America, China, southeast Asia, Taiwan, Japan, some countries in southern Europe and the USA. In February the World Health Organisation named carbapenem resistant bugs a “critical priority” for which new antibiotics are urgently needed.

In 2014, the medical directors of both Public Health England and NHS England took what they called “the unusual step” of writing to all NHS Trust chief executives, urging them to take action to prevent the spread of CPE.

“CPE represents one of the most serious emerging infectious disease threats that we currently face, and the failure to control their spread now, while we still have the opportunity, could have substantial human health and financial consequences,” wrote Dr Paul Cosford and Sir Bruce Keogh.

However, Professor Alan Johnson, head of the department of healthcare-associated infection and antibiotic resistance at PHE, said patients should be reassured that infections caused by CPE can usually be treated with other antibiotics. Fewer than 2% of E coli or Klebsiella bloodstream infections are resistant to carbapenems, he said.

“We carry out enhanced surveillance on carbapenem-resistant bacteria to determine the numbers and different types of CPE. Although reports of CPE have increased recently, part of this may reflect increased laboratory testing of many sample types other than blood stream infections, as awareness of CPE has grown,” he said.

Manchester

New figures show that four times as many people have died as had previously been reported in an outbreak in Manchester.

In 2009, the first cases of a type of CPE called Klebsiella pneumoniae carbapenemase were detected. In 2014, the hospital trust confirmed that 14 people had died from this infection, contracted within the hospital, in the previous four years.

But the Bureau’s research shows that there have been 61 deaths in the last seven years, including a six-year-old boy with leukaemia who caught the infection while undergoing a bone marrow transplant.

Many of those affected were very ill and had underlying medical problems and so it is not known whether the infection directly caused their death. Some may have died with a CPE infection rather than from it.

An investigation into the outbreak found in 2015 that CPE bacteria were living in the hospital kitchen sinks and handwash basins, which had drains that allowed splashback. Hugh Pennington, a leading microbiologist who chaired official inquiries into E coli outbreaks in 1996 and 2005, said such basins elsewhere in the NHS should be replaced. “It’s all about sound plumbing. It’s not rocket science. If your sink is going to spread the bug, get rid of it.”

Almost untreatable superbug CPE poses serious threat to patients, doctors warn

NHS services face "impossible" budget crisis, health trusts warn

Frontline NHS services face “mission impossible” in meeting next year’s targets, health trusts have said.

Longer waiting lists for operations and delays at accident and emergency departments in England loom under the present financial constraints, said NHS Providers, a trade association that represents acute, ambulance, community and mental health services.

Chief executive Chris Hopson said the government needed to “sit up and listen”, the BBC reported. “NHS trusts will strain every sinew to deliver the commitments made for the health service. But we now have a body of evidence showing that, with resources available, the NHS can no longer deliver what the NHS constitution requires of it.

“We fear that patient safety is increasingly at risk.”

NHS Providers predicted its members would receive £89.1bn in funding in 2017-18, an annual rise of 2.6% but less than the 5.2% demand is expected to grow by.

It warned the number of people waiting more than four hours in A&E would increase by 40% next year to 1.8 million, and the number waiting more than 18 weeks for routine operations would rise 150% to about 100,000.

The NHS is already under strain in the wake of the Brexit vote. The number of EU nationals registering as nurses in England has dropped by 92% since the referendum in June, and a record number are quitting the NHS.

Only 96 nurses joined the NHS from other European nations in December 2016 – a drop from 1,304 in July, the month after the referendum.

The service is also facing a long-term failure to hire enough people. Applications for nursing courses plummeted by almost a quarter in a year after the government axed bursaries for trainees in 2016. Numbers fell by 9,990 to 33,810 in 12 months, according to figures released in February by the university admissions service Ucas. Meanwhile, one in three nurses is due to retire in the next 10 years and there are 24,000 nurse jobs unfilled, Royal College of Nursing figures show.

NHS services face "impossible" budget crisis, health trusts warn

UK children with cancer could miss out on drug trials after Brexit, doctors warn

Leading doctors are warning that British children with cancer could suffer if they are no longer able to join Europe-wide trials of innovative new medicines as a result of the Brexit deal.

The Institute of Cancer Research (ICR) and the Royal Marsden NHS Foundation Trust say the best hope for some children with cancer is a clinical trial where a new drug is being tested. But because of the small number of children with the same cancers, the trials have to be run in many hospitals, often across Europe.

If the UK leaves the European Union and withdraws from the currently London-based European Medicines Agency which licenses new drugs, as expected, then pharmaceutical companies may choose to trial drugs just for children from countries in the EU. Children in the UK would lose out, and it could take years before they could get access to the newest treatments.

The ICR and the Marsden say EU regulations governing the way medicines are tested in children badly need reform to make companies trial more drugs in children, but the UK would be worse off without them.

“It is imperfect but it is all we have,” said Prof Louis Chesler, a consultant in paediatric oncology at the Marsden.

Children’s cancer is a very small field, he said. “The most effective way to run a clinical trial is to run a big one. If the regulations change and stop us working across European sites, that is a big problem for us,” he said.

The ICR and the Marsden, in their response to a European commission consultation on the future of drug regulation for children, are calling for changes so that drug companies cannot so easily obtain a waiver and duck the obligation to do trials in children once they have shown a drug works in adults.

A new analysis by the ICR shows that over the past five years (2012-2016) pharmaceutical companies were granted waivers from having to trial cancer drugs in children for 33 of 53 approved cancer treatments.

“By allowing pharmaceutical companies to use waivers to avoid trials in children so they can focus on adult treatments, the regulation is stifling progress and could be stopping children receiving a treatment that could save their lives,” said Chesler.

Prof Paul Workman, the chief executive of the ICR, said: “Children with cancer are currently missing out on the kind of innovative cancer treatments that are becoming increasingly common in adults because of outdated European rules that have failed to keep up with advances in science.

“We’ve been urging decision-makers to change the regulation for several years now, so that adult cancer drugs are tested in children whenever their mechanism of action suggests they could be effective.

“This is a real chance for reform to prevent the current out-of-date approach from being cemented for a decade. It could also be the last chance to make meaningful changes that apply across Europe, including the UK, before we leave the EU. It’s vital that whatever deal the UK does preserves access to Europe-wide clinical trials for children with cancer and avoids creating even longer delays in children accessing the latest cancer medicines.”

Dr Lynley Marshall, a consultant in child and adult cancer drug development at the Marsden, said families who are going through the trauma of caring for a child with cancer should not be alarmed. She pointed out that children with cancer in countries outside the EU, as far away as Israel and Australia, participate in some of the big treatment trials because of the difficulties of getting enough children with the same condition in one place.

She did not think fewer children in the UK with cancer would be included in trials. “I think it would be difficult to be categorical about it, but we will all be working very hard to ensure that there wouldn’t be,” she said.

UK children with cancer could miss out on drug trials after Brexit, doctors warn

Increased risk of 11 types of cancer linked to being overweight, researchers warn

Being overweight could increase the risk of a host of cancers, including those of the colon, breast, pancreas and ovary, researchers have warned following a wide review of more than 200 studies.

According to previous figures from two leading charities, almost three quarters of people are expected to be overweight by 2035, with 700,000 new cases of obesity-related cancer expected over the next 20 years.

The new study by an international team adds weight to the warning, revealing that there is currently strong evidence for a link between excess body fat and an increased risk of 11 cancers: colon, rectum, endometrium, breast, ovary, kidney, pancreas, gastric cardia, biliary tract system and certain cancers of the oesophagus and bone marrow.

“I think now the public and physicians really need to pay attention to obesity with respect to cancer,” said Marc Gunter, a co-author of the research from the International Agency for Research on Cancer. “Telling people to avoid being overweight not only reduces their risk of, say, diabetes and cardiovascular disease, it also reduces their risk of many different cancers.”

Published in the British Medical Journal, the study examined evidence from 204 previously published studies which each looked at combined results from multiple pieces of research probing the link between body fat and the development of particular cancers.

Of the 95 studies which looked at obesity measures on a continuous scale such as body mass index, 12 were found to offer strong evidence of an association, encompassing a total of nine different cancers.

Analysis of these studies revealed that as BMI (weight divided by height squared) increased, so too did the risk of developing certain cancers. For men, for every 5kg/m² increase in BMI, the risk of developing colorectal cancer rose by 9%, while among women forgoing HRT, the risk of developing postmenopausal breast cancer increased by 11%. The figures were even higher for cancer of the biliary tract system, with risk increasing by 56% for every 5kg/m² increase in BMI.

The authors note the remaining 83 such studies were of mixed quality. While 18% were deemed “highly suggestive” of a link between excess body fat and cancer, 20% had only weak evidence while 25% had no evidence for a link.

When studies that looked at other measures of obesity were included in the analysis, the total number of cancers for which there was strong evidence of a link to body fat came to 11.

While the new study does not shed light on how excess body weight is linked to an increased risk of various cancers, a number of explanations have previously been proposed. “We know that if you are overweight it causes lots of disruption of hormonal and metabolic pathways,” said Gunter, noting that excess fat has been linked to higher oestrogen levels, higher insulin levels and increased inflammation – all of which can affect cell division.

Dr Rachel Orritt, Cancer Research UK’s health information officer, said: “This research uses very strict criteria to evaluate the evidence and confirms that obesity increases the risk of cancer, linking many of the same cancer types that have been linked before.”

Being overweight, Orritt adds, is second only to smoking as the biggest preventable cause of cancer. “Whether it’s taking the stairs or switching to sugar-free versions of your favourite drinks, small changes can make a real difference, helping you keep a healthy weight and reducing your risk of cancer,” she said.

Dr Alison Tedstone, chief nutritionist at Public Health England, added that awareness was key. “Less than half the population realise that being obese increases the risk of cancer and, with almost two-thirds of adults carrying excess weight, this is worrying,” she said.

Paul Aveyard, professor of behavioural Mmedicine at the University of Oxford, agreed that the study highlighted the need for society to take steps to reverse the rise of obesity. “It is one more reason for people to be concerned about the excess body weight that they carry,” he said. “This risk isn’t confined just to people who are really overweight. All of us who carry excess fat, and that is most of us in this country, are at some degree of risk.”

Increased risk of 11 types of cancer linked to being overweight, researchers warn

Herbal supplements" illegal ingredients pose health risk, experts warn

Many herbal supplements, including for obesity and erectile dysfunction, contain hidden unlicensed pharmaceutical ingredients that could endanger people’s health, experts have warned.

The research team, from Queen’s University Belfast, Kingston University in London and the life sciences testing company LGC, concluded that not only do such supplements often make unverified claims as to their benefits but some have illegal ingredients which could pose a threat – potentially causing low blood pressure or an increased risk of heart attacks.

The substances are unlicensed medicines as they are appearing in products classified as food supplements. Among the most common substances identified was sibutramine, according to the study, published in the Journal of the Association of Public Analysts.

Sibutramine was licensed as the medicine Reductil until 2010, when it was withdrawn across Europe and the US due to an increased risk of heart attacks and strokes associated with the use of the drug.

Tadalafil and sulfoaildenafil were among the most frequently undeclared ingredients in products for erectile dysfunction. When taken with other medicines containing nitrates, they can lower blood pressure drastically and cause serious health problems.

Emeritus professor Duncan Burns, from Queen’s University’s Institute for Global Food Security, said: “We have found that these supplements are often not what customers think they are – they are being deceived into thinking they are getting health benefits from a natural product when actually they are taking a hidden drug.

“These products are unlicensed medicines and many people are consuming large quantities without knowing the interactions with other supplements or medicines they may be taking. This is very dangerous and there can be severe side effects.”

The research team analysed adverse findings recorded by the European Union’s rapid alert system for food and feed (RASFF) between 2009 and 2016 inclusive. The database is designed to inform member states who can then take appropriate action locally. Consumers can access the database but, unlike authorities in member states, they often cannot see the product names.

The experts believe the pharmaceutical ingredients are sometimes added accidentally but on other occasions deliberately in an attempt to enhance products.

They identified 63 instances of food supplements containing sibutramine between 2009 and 2016, including 47 after 2010, when Reductil was withdrawn. There were 29 instances of tadalafil being found in food supplements in the eight-year period examined and 68 of sulfoaildenafil and chemical substances similar to it.

People suffering from conditions such as diabetes and hypertension are frequently prescribed nitrate-containing medicines. Erectile dysfunction is often associated with these conditions, raising the prospect that patients may be tempted to try herbal supplements, which they do not know contain tadalafil or sulfoaildenafil, which can interact negatively with the nitrates.

Burns said: “People who take these products will not be aware they have taken these substances and so when they visit the doctor they may not declare this and it can be difficult to determine what is causing the side effects. It is a very dangerous situation.”

Another common substance was yohimbine, found in 30 supplements, which has been said to have aphrodisiac-like effects but has been known to increase blood pressure and induce anxiety.

Burns said the RASFF list was unlikely to be comprehensive “unless they went to every health food shop and every herbalist in the country”.

He advised consumers: “Be cautious about supplements you buy and use reputable websites. Discuss any concerns with your GP and always tell them what you’re taking.”

Herbal supplements" illegal ingredients pose health risk, experts warn

UK egg producers warn free range sector at risk due to bird flu controls

UK egg producers have warned that the future of the premium free range sector is at risk if the eggs lose their prized status because of the ongoing threat of bird flu.

Flocks of free range hens are being housed indoors because of the bird flu outbreak – and if they are unable to go back outside by the end of February the eggs would be downgraded to “barn produced”, the British Egg Industry Council (BEIC) has warned.

In early December last year the Department for Environment, Food and Rural Affairs (Defra) ordered that all free range hens – providing eggs or meat – should be housed to protect against the threat of the H5N8 influenza virus. At that time there were no cases in the UK but there were numerous reports of cases in other European countries. The so-called “housing order” was for 30 days.

Since then, cases of H5N8 have been found in the UK – on two turkey farms in Lincolnshire and in backyard flocks in Wales and North Yorkshire – as well as in a number of wild birds around the country. Chief veterinary officer Nigel Gibbens subsequently extended the housing order until the end of February. Bird flu has since been found in a flock of farmed pheasants in Lancashire, Gibbens confirmed this week.

Concern is now growing among free range producers because the extension will take the housing order to the end of the 12-week period – imposed by the European Union – beyond which free range birds will lose their status unless they are allowed outdoors. Mark Williams, chief executive of the BEIC, is calling for the 12-week cut-off to be extended.

“The egg industry is hoping that the risk of avian influenza from wild birds will dissipate to the level that free range hens can go back outside after that date, and are currently planning enhanced biosecurity measures to ensure that any risk to the hens’ health, particularly from contact with wild birds, is minimised,” Williams said.

“If the chief veterinary officer advises that free range hens need to continue to be housed for a further period (possibly one or two months) the industry is planning to put stickers on free range egg packs explaining that the birds are currently housed, accompanied by point-of-sale material in supermarkets and a website for further information, to ensure full transparency for consumers.”

Free range eggs currently represent 56% of UK retail egg sales – the highest proportion of any European country – whereas just 2% of eggs are from the barn system.

Williams said that if free range hens were unable to go back outside at the end of February, the viability of the free range sector would suffer if their eggs were to be downgraded to barn.

“There would not be sufficient barn packaging to enable a wholesale switch across the industry, particularly when it is unlikely to be required for more than a few weeks. There would also be a delay in the correct free range packaging being available again after the hens return outside.”

The BEIC said free range producers still incur the same costs for land and staff while birds are housed, and in some cases face increased costs to house their birds. Most free range production in the UK comes from small, independently-run family farms whose existence would be threatened by not being able to continue to sell their eggs as free range, with appropriate labelling, should the current housing order be extended.

Farmers’ leaders in other EU countries are pressing for the same extension, and the issue was raised by both Dutch and Belgian representatives at a meeting of the EU agriculture and fisheries council earlier in January.

Between October and January there were a total of 761 outbreaks of H5N8 in Europe – 51% in poultry and the rest in wild birds. Some 1.6m poultry birds were destroyed. As well as affecting 18 countries in Europe, H5N8 has also been found in Asia, Africa and the Middle East.

Public Health England advises that the threat to human health from avian flu remains low.

UK egg producers warn free range sector at risk due to bird flu controls

How colour-changing cats might warn future humans of radioactive waste

Plans for a new fleet of UK nuclear power plants are under way. Last month, for example, Hitachi and the Japanese government confirmed a plan to construct 5.4 gigawatts of generating capacity at UK sites. But what about the waste? And what happens when, in thousands of years, our descendants – who may not read any current human language – find a store, and put themselves in danger?

A panel of scientists and linguists asked this question in 1981 when the US Department of Energy commissioned them to find a method of ensuring that whatever is left of humanity in 10,000 years’ time is warned off the sites we’ve been filling with radioactive sludge.

The panel reasoned that since few people can read texts that are only 1,000 years old, written warnings guaranteed to be understood by future humanity could be difficult to create.

The answer may lie in “nuclear semiotics” – future-proof signs. Other options include hostile architecture, obelisks – or cats.

In 1984, writer Françoise Bastide and semiotician Paolo Fabbri suggested the answer could lie in breeding animals that “react with discoloration of the skin when exposed” to radiation. “[Their] role as a detector of radiation should be anchored in cultural tradition by introducing a suitable name (eg, ‘ray cat’).”

In short: cats that turn, say, green when near radioactive material. A legend, passed on through the millennia, would trigger a response in humans to get out as soon as possible.

The idea has recently gained fresh traction: the Ray Cat Solution movement, formed in 2015, is working to “insert ray cats into the cultural vocabulary”. They say it may be possible to harness some animals’ innate capacity to become fluorescent, or to absorb and emit light – but cats don’t have the physiology to do that. Another way would be to engineer cats to glow using enzyme interaction – a mechanism used to study cellular activity. Far fetched, but it could just work.

How colour-changing cats might warn future humans of radioactive waste

Injecting natural oils for muscle gain could be deadly, doctors warn

Bodybuilders seeking to enhance their physique by injecting natural oils risk lasting damage and even death, doctors have warned.

They fear that a case in west London in which a 25-year-old man suffered scarring and restricted function after injecting coconut oil may be the “tip of the iceberg”.

Instances have been recorded in recent years of bodybuilders using other oils, including sesame oil, walnut oil and paraffin, which are less costly than other synthetic compounds, in the hope of boosting muscle size and definition.

There has been little medical literature on the subject to date, but a paper published in BMJ Case Reports on Thursday says the practice is well documented among Arab and Middle Eastern communities and online.

The 25-year-old man was referred to Ealing hospital because of pain and loss of function in his right arm, into which he had injected the coconut oil over several months.

An ultrasound scan showed a rupture in his triceps – a rare condition in young patients – and multiple cysts within the arm muscles. Surgery to repair the rupture was successful but he was left with scarring and limited elbow flexion.

Dr Ajay Sahu, of London North West Healthcare NHS trust, who co-authored the report, said: “He has lost significant function in his tricep and he’s right-handed. If he had injected the coconut oil into one of his veins by mistake it could have been fatal. It could cause an embolism in the heart, the lungs or the brain. You need to think about the implications.”

Sahu said the case was difficult to diagnose because the patient did not initially admit what he had done, and Sahu was not aware at the time that injecting natural oils was something people did to try to build muscle.

He suggested resort to such drastic measures was symptomatic of increasing concern among young men about how they look.

“People do all sorts of things [to gain muscle] and these things are very unreported,” he said. “These people will never come to the doctor and say all the things they do. This is just the tip of the iceberg.”

Injecting natural oils for muscle gain could be deadly, doctors warn

Global health leaders failing women in Zika-hit areas, experts warn

Public health experts are warning that the failure of global health agencies to challenge political and religious resistance to contraception in Zika-affected countries in Latin America and the Caribbean is leading to a humanitarian crisis for women .

The World Health Organisation (WHO) and US Centre for Disease Control (CDC) recommended women in the region delay pregnancy or not have sex well before the Zika virus was definitively linked in April to the birth defect microcephaly. But family planning experts say that women are merely being told to avoid pregnancy without being given the means to do so and that such advice is insufficient in the face of a global epidemic.

“This is in a region where rates of violence against women are high and women do not always have the power or ability to say no to sex,” says Giselle Carino, director of the International Planned Parenthood Foundation’s western hemisphere region, which covers Zika-affected areas.

“Asking women not to get pregnant without ensuring they have the means to prevent unintended pregnancies puts them in an impossible catch-22 situation.”

Most Zika-affected countries in Latin America and the Caribbean are predominantly Catholic and have strong political and cultural barriers to women accessing and using contraception. In Haiti, only 34% of women have access to contraception, while in El Salvador, almost 90% of pregnancies are unplanned. Terminating pregnancies is another minefield: more than 97% of women of child-bearing age in Latin America and the Caribbean live in countries where abortion is restricted or illegal.

Although the Pope suggested earlier this year that contraception could be used – in a departure from Catholic teaching – to prevent infection with Zika, he tempered the advice by calling it a lesser evil. Abortion, he stressed, was still “an absolute evil”.

But international funding to provide contraception in the region has all but dried up, say family planning experts. In the US territory of Puerto Rico, where a Zika epidemic is raging, two-thirds of pregnancies are currently unintended [pdf] and nearly 140,000 women are estimated to not use contraception, according to the CDC. Yet Congress stalled for months to push through an emergency funding bill to combat Zika in the US and its territories, thanks to a provision that would have banned funding to a Puerto Rican Planned Parenthood affiliate that provides sexual health services, including contraception and abortion. Under US law, federal funds cannot be allocated for abortion.

As a result of such political in-fighting, countries most in need of family planning are at crisis point, says Carino: “The unfinished sexual and reproductive health and rights agenda has now become a humanitarian crisis in Latin America.”

Asking women not to get pregnant without ensuring they [can] prevent pregnancies puts them in an impossible situation

Giselle Carino, International Planned Parenthood Foundation

Perhaps as a result of the delicate balance in the region, the WHO, CDC and Pan American Health Organisation (which works in the Americas) have been seemingly loth to stress the significance of contraception in relation to the Zika virus. The CDC, tellingly, refers instead to the timing of a woman’s pregnancy as a “deeply personal and very complex decision” that should be taken with her partner and healthcare provider.

Such tempered language points to the fine line that global health agencies walk, says James Hodge Jr, professor of public health law and ethics at Arizona State University.

“These issues are deeply political and at times legally contested in some countries where access to contraceptives and abortions is greatly restricted, if not prohibited,” he told the Guardian. In Latin America, for example, “public health organisations can be reticent to engage in policies that directly contravene national laws or politics”. As a result, recommendations remain recommendations, not global health policy.

While the WHO has developed a Zika strategic response plan that would also include family planning and education, the $ 122m required to put it into practice is “drastically underfunded”, says Dr Babatunde Osotimehin, executive director of the UN population fund, UNFPA, and under-secretary general of the UN.

“Women of childbearing age and their partners in Zika-prone or affected areas [must] have full access to sexual and reproductive health supplies and services,” he says. “We already know that voluntary family planning is one of the most cost-effective investments in our futures, with some estimated benefits as high as $ 120 for every dollar invested. The Zika outbreak means that, for affected countries, that return on investment could be even higher.”

But Dr Vincent DeGennaro of the University of Florida, who runs a clinic supporting women’s health in Haiti, told the Guardian that the failure to put family planning at the heart of the response to Zika is contributing to a growing crisis.

“When we are in clinic and we offer women access to birth control they accept it like a hungry man eating food,” says DeGennaro. “The current policy on Zika is short-sighted and narrow. There are millions of women of reproductive age without access to contraception and the majority of pregnancies are unintended. We are failing women, and with the low cost of contraception, it’s hard to say it’s not deliberate.

“Why are we talking about Zika? Microcephaly. How do you prevent microcephaly? Prevent pregnancies,” DeGennaro adds. “I struggle to find a more urgent public health issue.”

Global health leaders failing women in Zika-hit areas, experts warn

Cancer deaths among women to rise 60% by 2030, new reports warn

Two reports have warned of an explosion in cancer deaths among women, with a toll, mainly from breast cancer, of around 5.5 million a year by 2030 – roughly the population of Denmark.

This represented a near 60% increase in less than two decades, said an analysis conducted by the American Cancer Society (ACS), released on Tuesday at the World Cancer Congress in Paris.

As the global population grows and ages, the highest toll will be among women in poor and middle-income countries, it said, and much of it from cancers which are largely preventable.

“Most of the deaths occur in young and middle-aged adults”, placing a heavy burden on families and national economies, said Sally Cowal, senior vice-president of global health at the ACS, which compiled the report with pharmaceutical company Merck.

A second report, published in the Lancet medical journal on Wednesday, said the number of women diagnosed with breast cancer alone could almost double to 3.2 million a year by 2030 from 1.7 million in 2015.

For cervical cancer, the number of diagnoses could “rise by at least 25% to over 700,000 by 2030”, mainly in low- and middle-income countries, said a statement from the Lancet.

Cancer is already killing one in seven women around the world, said the ACS report – the second highest cause of death after cardiovascular disease.

All four of the deadliest cancers – breast, colorectal, lung and cervical cancer – are mostly preventable or can be detected early, when treatment is more successful.

In poorer countries, a much smaller proportion of cancer cases are diagnosed and treated than in rich ones, while a much bigger group dies. The relative burden is growing for developing countries as people live longer due to better basic healthcare.

Women in these countries are also increasingly exposed to known cancer risk factors “associated with rapid economic transition”, said Cowal, “such as physical inactivity, unhealthy diet, obesity, and reproductive factors” including postponing motherhood.

“Due to these changes, cancers that were once common only in high-income countries are becoming more prevalent,” said the report entitled The Global Burden of Cancer in Women.

Beth Vyse: A breast cancer appointment is like Deal or No Deal

According to the International Agency for Research on Cancer, there were 6.7 million new cancer cases and 3.5 million deaths among women worldwide in 2012. Of these, 56% of cases and 64% of deaths were in less developed countries.

“These numbers are expected to increase to 9.9 million cases and 5.5 million deaths among females annually by 2030 as a result of the growth and ageing of the population,” said the ACS report.

The biggest concentration is in eastern Asia, with 1.7 million cases and a million deaths in 2012, mainly in China.

The highest ratio of cancer cases per population group are still reported in high-income countries in Europe, the Americas and Asia, but this was partly due to better access to screening and detection.

Deaths, however, were proportionally much higher in low- and middle-income countries with reduced access to diagnosis and treatment. The countries with the highest death rate were Zimbabwe, Malawi, Kenya, Mongolia and Papua New Guinea.

Breast and lung cancer are the two most common types in both rich and poor nations, with colorectal cancer the number three killer in developed countries and cervical cancer in less developed ones.

Cervical cancer can be staved off by vaccination against the cancer-causing human papillomavirus (HPV) and can be detected through regular Papanicolaou (pap) smear tests.

The Lancet report, comprised of three research papers, said a basic cancer control package could be introduced in low- and middle-income countries for as little as US$ 1.72 (£1.40) per person – the equivalent of just 3% of current health spending in these countries.

Universal HPV vaccination of all 12-year-old girls could prevent 420,000 deaths worldwide over their lifetime.

“The global community cannot continue to ignore the problem – hundreds of thousands of women are dying unnecessarily every year,” said Richard Sullivan of King’s College London, who co-authored the Lancet report.

“Not only are the costs of essential cancer services for women lower than expected, but scale-up of diagnostic, surgical and treatment services are a highly effective investment compared the devastating economic cost to countries, communities and families.”

Cancer deaths among women to rise 60% by 2030, new reports warn

More babies face health risks due to obese parents, experts warn

A growing number of babies worldwide are at risk of brain damage or having a stroke, heart attack or asthma in adulthood because their mother was obese, health experts have warned.

Leading doctors said dangerously overweight mothers were passing on obesity to their children as the result of “a vicious cycle” in which excess weight can seriously affect the health of parents and their offspring.

Four studies published in the Lancet Diabetes and Endocrinology make clear that the risks of maternal obesity include stillbirth, dangerously high blood pressure in pregnant women, diabetes in the mother or child, and complications during childbirth.

The scale of obesity in women of childbearing age and the consequent dangers to health were so great that urgent action was needed to ensure women were a normal weight before they conceived, the authors say.

Mothers being very heavily overweight could lead to their children having autism or attention deficit hyperactivity disorder or developing cancer in later life, the researchers say.

British women have the highest rates of obesity in Europe. One in five women in the UK who became pregnant were already obese, while in England, 26% of 35- to 44-year-old women were obese in 2013, as were 18% of those aged 24-35.

UK obesity rates

Rates are even higher elsewhere. In the United States, 32% of women of peak childbearing age, between 20 and 39, were obese in 2011-12, and 60% of American women were either overweight or obese when they conceived, according to one study.

Prof Lesley Regan, the president of the Royal College of Obstetricians and Gynaecologists, which represents 14,000 doctors working in Britain and worldwide who specialise in childbirth and women’s health, said: “Obesity has reached pandemic proportions globally and its origins start in the womb. In the UK, the prevalence of obesity is over 25% in both women and men. Around one in five pregnant women are obese, increasing their risk of miscarriage, stillbirth and neonatal death as well as gestational diabetes, blood clots, pre-eclampsia, more complicated labours and severe bleeding after the birth.”

The international team of experts behind the studies said they feared that the problem, which is worst in developed countries, would escalate further because one in five (21%) women in the world are projected to be dangerously overweight by 2025.

One of the research papers, which have reviewed hundreds of previous obesity studies, warned: “The long-term effects of maternal obesity could have profound public health implications.” Another concluded that maternal obesity was spreading so fast, especially in western countries, that governments should start treating it as a global public health priority.

One of the research reviews, led by Prof Keith Godfrey of Southampton University, detailed the range of serious health problems that excess maternal weight could have on a child and pointed out that fathers’ weight could also increase the risks.

“Increasing evidence implicates maternal obesity as a major determinant of offspring health during childhood and later adult life,” the review states, adding that it heightened the child’s risk of obesity, coronary heart disease, stroke, type 2 diabetes and asthma. Maternal obesity could also lead to poorer cognitive performance and increased risk of neurodevelopmental disorders, including cerebral palsy.

An unborn child’s brain could be damaged because “obesity in pregnancy is associated with complex neuroendocrine, metabolic, immune and inflammatory changes, which probably affect foetal hormonal exposure and nutrient supply,” Godfrey’s paper explains.

The key lies in “eipgenetic processes by which aspects of parental (both mother’s and father’s) lifestyle can affect the way the baby’s genes operate during development. These can change the person’s responses to the challenges of, for example, living in an ‘obesogenic’ environment,” it adds.

The National Institute for Health and Care Excellence advises women who may become pregnant to eat healthily, exercise for at least 30 minutes a day and try to maintain a healthy weight.

Each obese woman who gave birth in Britain cost the NHS £500 to £1,000 more than a mother of a normal weight, said Prof Rebecca Reynolds, of Edinburgh University.

However, the authors drew few firm conclusions in their search for ways to address and prevent maternal obesity and found limited evidence that specific interventions were effective.

“We know that there are going to be more and more obese people in years to come, so there will be passage of obesity from one generation to the next, even though no parent who is obese wants their child to suffer from it too,” said Prof Mark Hanson, of Southampton University, another co-author.

He recommended that overweight women be given more information and guidance from health professionals before they conceived or after they had given birth to help them lose weight, especially before they had any more children.

Bariatric surgery undertaken before an obese woman conceived could benefit both her and her baby’s health, the authors found, though anyone who has the operation should wait for up to 18 months afterwards before giving birth.

“Women who are overweight when entering pregnancy or who gain excess weight during pregnancy may well establish an inter-generational amplification of the obesity epidemic,” said Dr Tim Lobstein, director of policy at the World Obesity Federation.

“There is international agreement at United Nations level to halt the rising prevalence of obesity and diabetes across the globe. However, turning an ambitious target into practical action is proving elusive.

“There are well-recognised but well-embedded systemic problems to resolve, such as the increasingly commercialised food supply, the dominance of motorised transport, the development of dense and hazardous urban environments, or the enticements of sedentary screen-watching,” he said.

More babies face health risks due to obese parents, experts warn

Clean eating trend can be dangerous for young people, experts warn

Mental health experts are warning of the risks of the increasingly popular “clean eating” dietary trend, which is leaving a growing number of teenagers very thin and even at risk of dying when taken to extremes.

One nutritionist said she had been contacted by a girl as young as 12 and people had got in touch on social media saying they wanted to be healthier, giving details of their existing diets.

Rhiannon Lambert, a registered associate nutritionist in Harley Street, London, has encountered people who obsess over where food comes from and some clients who will not drink water from a tap, because they normally stick to a brand of bottled water.

“They develop particular habits, or won’t eat food when walking, because they think that food can only be processed when they’re sitting down,” she said. “All this interferes with general life and becomes an obsession.”

The extreme form of this is a psychological condition known as orthorexia nervosa, the Californian doctor Steven Bratman has said. Experts have described it as a “fixation with righteous eating”.

Clean eating is promoted by some food bloggers, who are increasingly felt by a number of medical experts to be having a negative impact on certain vulnerable young people.

Having strict rules can mean that some people ‘worry all day about eating a biscuit,’ one expert says. Photograph: Catherine Shaw for the Observer

“Young people lose sleep over this and cannot afford the lifestyle needed to maintain it,” Lambert said. “Health bloggers can be unqualified and offer dangerous advice. Not all of them want to impose their lifestyle on others, but lots of them do and they often give advice on clean eating with no scientific backing.

“The books come along, the products come along and these people are now role models whose every word will inspire impressionable young people. I have clients who think they have to be vegan to be successful.”

There are no official figures for the number of children and young people following a clean eating regime, because orthorexia is not recognised as a clinical diagnosis. But psychologists and nutritionists have reported a recent surge in the phenomenon among younger clients, especially girls, and believe that it is gaining in popularity.

The eating disorders charity Beat told the Guardian that it had recently seen a rise in the number of calls to its helpline from young people who have experienced problems as a result of following the trend.

Ursula Philpot, a dietitian at the British Dietetic Association, said a fixation with eating healthily had been a noticeable route into eating disorders for vulnerable individuals in the past couple of years.

She identified social media and the rise of healthy food trends and blogs as key drivers of the trend, but said it is difficult to blame them completely. “If it wasn’t health bloggers, then it could be something else that becomes the inroad, but it seems to be the route in now,” she said.

Orthorexia affects girls more than boys, although boys are much more affected than previously, she added.

The range of foods that people worry about eating has changed, Philpot said. “At the top of most people’s lists [of bad foods] is gluten and dairy. When you talk to young people more, you find out about their stringent rules – some will worry all day about eating a biscuit,” she said.

The condition starts out as an innocent attempt to eat more healthily, but those who experience it become fixated on food quality and purity, according to experts.

A Beat spokeswoman said: “We are concerned by the rising trend of ‘clean eating’ and the impact it could have on young people vulnerable to the development of an eating disorder. We are aware that contacts to our helpline are raising issues around orthorexia and clean eating.”

There may be several reasons for someone to take up clean eating, the spokeswoman said.

“Eating disorders are serious mental illnesses and their causes are many and complex. Research is telling us that they may be more biologically based than we previously thought, but social and environmental factors will also play a part in their development,” she said.

“Orthorexia does not have a clinical diagnosis and it would be for clinicians to determine whether it should, which may be helpful, because then it would have a clear clinical pathway of treatment.

“There is a view that it may be more closely connected to OCD due to the nature of the illness, although it does also share behavioural traits with anorexia. Anorexia has the highest mortality rate of any mental illness.”

Deanne Jade, the founder of the National Centre for Eating Disorders, a counselling network, has also seen an increase in orthorexia. “A lot of younger people don’t think they need therapy and that the solution to bulimia and anorexia is to eat clean, but this can become an obsession and there’s now more pressure than ever to be healthy.

“There are too many messages in the media and especially social media. What worries me is that a lot of people promoting these ideas have no knowledge of nutrition.

“I don’t know what the solution is, but a lot of the time getting people to recover from an eating disorder means getting them to relax their ideas about clean eating.”

Clean eating trend can be dangerous for young people, experts warn

Keep button batteries away from children, doctors warn parents

Parents are being warned to keep button batteries under lock and key as doctors report a sharp rise in the number of children admitted to hospital in the UK after swallowing the metal discs.

Doctors at Great Ormond Street hospital in London say about one child a month is admitted after swallowing a button battery – a dramatic increase on two years ago when just one child a year was admitted.

“On Tuesday when I was the on-call surgeon I removed two button batteries in two children in one day,” said Joe Curry, a consultant paediatric surgeon at Great Ormond Street.

The consequences of swallowing the device, doctors say, can be devastating, with the batteries often becoming lodged in the food pipe where they can burn through tissue and rapidly create a hole.

“If the battery is stuck in the upper oesophagus, and assuming the battery is ‘live’ when it goes in, you can start to see damage to the lining of the oesophagus within about 15 minutes,” said Curry. “We have seen rupture of the oesophagus within four hours.”

The upshot, doctors warn, can be life-changing injuries, or even death, with some children having to undergo more than 50 operations and procedures after such an incident.

“The damage to the oesophagus can be so devastating it can be immediately life-threatening because if the rupture of the oesophagus happens and the battery accidentally erodes into one of the main blood vessels in the chest, then you are at risk of immediate bleeding to death,” said Curry.

“If it erodes out of the oesophagus and it goes into the airway then it creates an opening between the oesophagus and the airway so every time the child eats or drinks, fluid and food floods into the lungs, damaging the lungs and producing life-threatening chest infections.”

Doctors at Great Ormond Street hospital say about one child a month is admitted after swallowing a button battery – up from one a year two years ago. Photograph: Peter Macdiarmid/Getty Images

Button batteries are commonly found in a range of electrical devices, from watches to hearing aids and calculators.

“The number of electronic devices that are existing in people’s homes that require these kinds of batteries is probably just increasing year on year and so the physical availability of them in the home is just increasing,” said Curry.

With children keen to explore objects, often putting things in their mouth, doctors warn that babies, toddlers and even older children are at risk of swallowing the batteries.

Now doctors at Great Ormond Street, Birmingham children’s hospital and Sheffield children’s hospital have joined forces to urge parents to make sure that button batteries, whether new or used, are kept out of children’s reach.

“Parents are very aware of things around the house like drain cleaners and other caustic substances which are dangerous for children and they are very careful about keeping them away from children, but I am not sure that the message is quite out there about how dangerous [button batteries] are,” said Curry.

“Part of the campaign is to make parents aware of it so they can treat them like they would any other dangerous or caustic substance in the household.”

Doctors say parents should remain vigilant to symptoms such as vomiting, choking, chest infections and difficulties in swallowing, and if they are concerned that a child has swallowed a battery they should immediately take them to A&E.

Katrina Phillips, the chief executive of the Child Accident Prevention Trust, said: “Button batteries are in so many products nowadays. Parents need to be ever more vigilant, especially with lithium cell batteries. Children under six are most at risk, but even older children can be fascinated by them.”

As well as keeping the batteries and devices that use them out of the reach of children, time is of the essence if children swallow a battery, and parents should immediately seek emergency help, Phillips said. “Don’t wait to see if symptoms develop as the damage may already have been done.”

Keep button batteries away from children, doctors warn parents