Younger women with non-alcoholic fatty liver disease are at almost five times greater risk of type 2 diabetes, according to new research. This far exceeded that observed in older women and men, who were around twice as likely to develop diabetes if they had the liver condition. The international study also shows for the first time how fatty liver disease can be used to improve risk prediction of type 2 diabetes. Southampton’s Professor Chris Byrne collaborated on the cohort study of over 245,000 people in South Korea. Researchers have published their findings in Hepatology. Progressive liver disease Non-alcoholic fatty liver disease (NAFLD) is the term for a range of conditions caused by a build-up of fat in the liver. It's usually seen in people who are overweight or obese, and is estimated to affect around a quarter of the world’s population. It has four stages, where the liver becomes progressively more damaged. It is known that NALFD can play a role in the development of type 2 diabetes. However the effects of sex and menopausal status on this association remain unclear. Korean cohort study This latest research analysed data from 245,054 adults in South Korea who started the programme without diabetes. The Kangbuk Samsung Health Study included 109,810 premenopausal women, 4,958 postmenopausal women and 130,286 men. Participants were followed for around five years, with 8,381 going on to develop type 2 diabetes. Prof Byrne worked with researchers from Kangbuk Samsung Hospital and the University of Edinburgh on the new findings. Increased risk factor Overall, a diagnosis of NAFLD was found to more than double the chances of someone developing new type 2 diabetes. The addition of NAFLD to conventional risk factors improved risk prediction for type 2 diabetes in both sexes, with a greater improvement in women than men. The analysis found that risk for developing type 2 diabetes was 4.6 times higher in premenopausal women with NAFLD. This compared to a 2.6 times higher risk for postmenopausal women and a 2.16 times higher risk for men. Prof Byrne, Professor of Endocrinology and Metabolism and Honorary Consultant Diabetologist & Metabolic Physician, said: “These striking findings suggest that premenopausal women diagnosed with NAFLD should be considered at high risk of type 2 diabetes, and this group should be targeted for diabetes prevention. “Our study also underscores the need for clinicians to be aware of a possible diagnosis of NAFLD and also to consider age- and sex-specific approaches for diabetes risk assessment and management.” The research was funded by the NIHR Southampton Biomedical Research Centre and Sungkyunkwan University.

Southampton researchers are looking for healthy women to take part in a new trial that could help prevent a common viral infection that can seriously harm newborn babies. Cytomegalovirus (CMV) is a common virus that is usually harmless. But if a pregnant woman has a CMV infection and passes it on to her unborn child, it can cause lifelong disabilities or even death. This is why researchers are inviting healthy women aged 16 to 40 to take part in an international trial of a new CMV investigational vaccine. The study is being run at University Hospital Southampton, together with St George's and St Bartholomew's Hospitals in London. Dr Chrissie Jones, Southampton lead for the trial, said: “A vaccine against CMV is a high priority to prevent the life-long problems for some children who catch CMV before they are born. We are inviting healthy women to participate in this CMV trial and hopefully make a difference to families in the future who will not have to experience the consequences of CMV infection.” What is cytomegalovirus? CMV is a common virus that can spread easily through an infected person’s saliva or other body fluids such as blood, urine, and breast milk. It is unusual for a CMV infection in a healthy person to cause illness, but when it does it can cause a flu-like illness, with a fever, muscles aches and fatigue. However, if a pregnant woman has a CMV infection, it may be passed on to her unborn child. This causes the baby to be born with a CMV infection, known as congenital CMV. It is the most common congenital viral infection. Although most infants who are born with congenital CMV are well, some can develop lifelong disabilities such as hearing loss, learning problems, or vision abnormalities and may even die. Preventing infection from young children There is currently no approved vaccine to prevent CMV infection. If such a vaccine could be developed, it may be able to prevent children being born with a CMV infection. The most common source of CMV infection in pregnant women is young children. Young children commonly catch CMV and can shed the virus in their saliva and urine for long periods of time. The researchers aim to recruit people who are aged 16 to 40 age and are generally healthy, who are not pregnant (as protection is needed before pregnancy) and agree to not become pregnant for 9 months. Those who are >= 20 years, must have contact with young children. The researchers aim to assess the safety of this investigational vaccine and how effective it is at preventing CMV infection. Southampton will be one of around 150 study sites in various countries, with around 6,900 healthy participants expected to take part overall. Taking part The trial is being delivered locally by the NIHR Southampton Clinical Research Facility based at University Hospital Southampton NHS Foundation Trust. To join this clinical trial, you must be: • A woman between 16-40 years of age • In good health • In close contact with at least one child five years of age or younger for at least eight hours a week, if aged 20 or older • Not pregnant or planning on becoming pregnant within the next nine months Participants will receive a total of three separate injections into the muscle in the upper arm over a period of six months. They will be randomly allocated to receive either the investigational vaccine or a placebo. Participation in the study will last about 30 months (two and a half years), and involve approximately 14 on-site visits. The study team will also contact participants for safety data, either by telephone or through receipt of electronic diary (eDiary) safety survey messages. Participants will be reimbursed for any reasonable expenses incurred as a result of taking part in this trial, and receive payments for completing some aspects, such as surveys. For more information, please contact UHS.RecruitmentCRF@nhs.net or call 02381204989.

People who eat a lot of acrylamide, found in unhealthy food like crisps and chips, have been shown to be more likely to break a bone. A team of researchers, including Prof Cyrus Cooper from the NIHR Southampton Biomedical Research Centre, studied the diet and fractures of thousands of people over eight years. Their results suggest that cutting down on highly processed ‘junk’ food could help people keep their bones stronger in later life and reduce their risk of fractures. What is acrylamide? Acrylamide is a component of unhealthy carbohydrate-rich foods that are deep fried, baked or roasted, such as crisps and chips. There is already evidence linking it with a higher risk of cancer, as well as poor outcomes in pregnancy and soon after birth. This study used data on 4,436 participants in the USA from the Osteoarthritis Initiative database, collected between February 2004 and May 2006. They ranged from 45 to 79 years of age, and all either had, or were at high risk of developing, knee osteoarthritis. Each participant answered questions on what they ate in a food frequency questionnaire. The researchers used this to estimate how much acylamide they consumed, and then recorded how many bone fractures they had in the following eight years. Linking the data A total of 789 osteoporotic fractures were recorded during the eight years. Those who ate a lot of acrylamide had significantly more fractures than those who ate very little acrylamide. The results are published in the journal Aging Clinical and Experimental Research. Prof Cyrus Cooper said: “The important findings from this study provide new evidence suggesting acrylamide could be bad for bone health. Cutting down on unhealthy food containing acrylamide may therefore be a good way to help prevent fractures in older age.”

Southampton’s LifeLab education programme has been given a new boost to help tackle obesity among primary school children in the city. The innovative programme has been awarded £200,000 by Southampton City Council to fund key work over the next three years. New modules shift the focus from secondary school students to primary school years. LifeLab is run in partnership between the University of Southampton, the NIHR Southampton Biomedical Research Centre (BRC) and University Hospital Southampton. Teaching toolkits The Early LifeLab programme aims to support behaviour change in children using a series of ‘teaching toolkits’. These make the science behind the need for healthy diet, physical activity and sleep accessible to children. It helps them to discover why these matter for themselves, supporting children and their families in making healthy choices. Professor Keith Godfrey, one of the LifeLab programme directors and a lead researcher in the NIHR Southampton BRC, said: “Childhood obesity in the UK is a major public health problem. In 2019/2020, nearly one in four children in the first year of primary school were overweight or obese. Over the course of the pandemic, levels of overweight and obesity in children have seen a sharp worsening, highlighting the need for new approaches.” Pandemic effects Dr Kath Woods-Townsend is the programme lead for Early LifeLab. She said: “Tackling obesity in children was already on our agenda at LifeLab pre COVID, but the pandemic and its effects have brought the issue even more to the fore. “Based on our well established and successful LifeLab programme for secondary school students, Early LifeLab has four modules across the primary phase that are delivered directly in schools. We know this is an effective setting to reach a large population of children across all communities, and we provide the tools teachers need to deliver health messages in an engaging way.” Building for the future All primary phase settings in Southampton can opt to take part in Early LifeLab. Participating schools will receive a fully-resourced “flight case”, which contains all the equipment, resources and teaching information needed to deliver the lessons. Debbie Chase, Director of Public Health at Southampton City Council, said: “The opportunity for children in the city to have access to the LifeLab resources is very much in line with our work in early health prevention and education messages. Programmes like this from LifeLab are essential in helping our community recover from the pandemic and build positive outcomes for the future.” COVID-19 Warriors LifeLab developed the successful COVID-19 Warriors programme in the height of the pandemic. This was supported by the Department of Health and Social Care. In collaboration with primary school pupils, LifeLab created a team of ‘COVID-19 Health Warriors’ and produced a series of short educational videos. They created a community that children, on completion of the programme, could join. The project was endorsed by the Royal Society for Public Health, who promoted it on their YouTube channel. Civic commitment The University of Southampton is committed to help and support communities in Southampton and the surrounding region. Its Widening Participation and Social Mobility team are contributing funding in addition to the Council. Kirsten Wythe, Head of Access in the Widening Participation and Social Mobility team, said: “We are delighted to have been able to provide funding to support the development of the resources, and the work to transform the LifeLab COVID-19 Warriors into Health Warriors with video content to reinforce the messages. We are looking forward to being part of the project as it grows.” Professor Mark E. Smith, President and Vice-Chancellor, said: “We are delighted to be leading this collaborative activity to overcome the challenges facing young children in local communities across Southampton. The University’s research, education, alumni and outlook are global, but we are rooted in our community and committed to forming closer links with local people and organisations.” Professor Jane Falkingham, Vice-President International & Engagement of the University of Southampton, added: “The University has played important local and national roles in supporting communities through the pandemic. Working with young people to support the city’s recovery from the pandemic will be critical in helping local communities thrive and we are delighted to be working with Southampton City Council on this important initiative.”

Women who trialled a new nutritional supplement during pregnancy tended to have shorter labours and were less likely to have severe bleeding. Major postpartum haemorrhage (PPH) is a birth complication where women lose a large amount of blood after giving birth. It accounts for almost a quarter of maternal deaths globally. New results from the NiPPeR trial suggest that taking a new supplement before and during pregnancy could lower this risk and reduce the occurrence of this potentially life-threatening emergency. The trial was led by Prof Keith Godfrey, Theme Lead for Nutrition, Lifestyle & Metabolism at the NIHR Southampton Biomedical Research Centre. Pregnancy outcomes The NiPPeR trial recruited 1,729 women aged 18 to 38 years in the UK, Singapore, and New Zealand who were planning a pregnancy between 2015 and 2017. Half the women drank a special combined myo-inositol, probiotics, and micronutrient supplement twice a day before and during pregnancy. The other half took a standard pregnancy supplement. The trial was set up with the primary outcome of seeing if the special supplement improved blood sugar control – which is used to diagnose gestational diabetes. While the researchers found no evidence the supplement helped prevent high blood sugar levels, they did see a reduction in major PPH, along with a previously reported reduction in preterm delivery. Quicker and safer births A new study, published in the American Journal of Obstetrics & Gynecology MFM, investigated this further. It found women who took the special supplement had a shorter duration of labour and lower blood loss. The second stage of labour, when the baby is delivered, was 20% shorter in these women. This meant there was less need for an assisted birth, where forceps or a ventouse suction cup are used to help deliver the baby. Estimated blood loss was 10% lower. Having a prolonged labour or an assisted birth both increase the risk of PPH. This is likely due to a higher risk of the womb muscles becoming too weak to contract enough to clamp the placental blood vessels shut after birth. The resultant bleeding, if not treated quickly, can be life-threatening. Prof Godfrey said: “These results have important implications that could save the lives of women across the world. Nutritional measures to reduce blood loss during childbirth could be particularly important for women in developing countries, where a large proportion of maternal deaths during childbirth are still caused by PPH.”

Olympian Iwan Thomas has thanked “amazing” staff at the Princess Anne Hospital for his son Teddy’s life-saving care in a BBC report for new clinical research in Southampton. Teddy suffered an infection called Group B streptococcus, also known as Group B strep. It affects two to four in 10 women and is usually harmless in adults. But it can be very dangerous to unborn and newborn babies. “When my son was born everything was amazing, but it quickly went downhill,” Iwan said. “I soon expected the worst. Teddy spent his first 10 days fighting for his life, and if it wasn’t for everyone at the Princess Anne Hospital, I wouldn’t have him here with me now. "I want to say a huge thank you for the amazing work they do. Teddy is now a bundle of energy. It’s all thanks to their continuing hard work that families like mine get to take their loved one home and see them become happy and healthy.” Group B strep vaccine Iwan returned to University Hospital Southampton with Teddy to report on the trial of a new Group B Strep vaccine for BBC Morning Live. The new vaccine is being developed by Danish company MinervaX. The hope is that, by giving it to pregnant women, it will protect their baby during pregnancy and birth. “It’s hugely exciting to see the progress of this new vaccine,” Iwan says. “If this work saves just one family from losing a child to this awful infection, then it will all have been worth it.” Dr Chrissie Jones, Southampton study lead, says: “A safe and effective Group B Strep vaccine would be a game-changer for newborn infants, both in the UK and globally. This is a significant infection in newborn babies, that can be life-threatening and can also cause long-term problems in those babies who recover from the infection. “A vaccine against Group B Strep would be a massive step forwards in our ability to protect newborn infants from serious infection. We are inviting pregnant women from the Southampton area to help us test this vaccine.” Taking part The MinervaX vaccine has already been given to non-pregnant and pregnant women in previous studies, with no safety concerns. It has been shown to induce a strong immune response even in people with low levels of pre-existing immunity to the bacteria. The next stage of the research is investigating the best time to offer the vaccine to pregnant women, to provide the most protection for their babies after birth. The study is being held in the NIHR Southampton Clinical Research Facility, part of University Hospital Southampton NHS Foundation Trust, and St George's University Hospitals NHS Foundation Trust in London. Women who are pregnant without complications can take part in the study. Participants will start the study at about 20 weeks of pregnancy and be followed through six months after delivery. There are 12 hospital visits in total including a screening visit. Volunteers can be reimbursed for travel costs. For more information on the study, please contact reprohealthresearcht@uhs.nhs.uk. Iwan’s report for BBC Morning Live is available for 11 months on BBC iPlayer (starts at 10:00): bbc.in/3ffx5s0

Southampton researchers have joined calls for a change in government approach so children are at the forefront of policy. Professor Keith Godfrey and Dr Kath Woods-Townsend have contributed to a new report published this week by the Children’s Alliance. The Family and Community Report combines expertise from academia, business and the voluntary sector to help enable better outcomes for children and young people. The national report highlights Southampton’s LifeLab programme as an effective model to build healthier communities. ‘Unheard, unseen and unprotected’ Representatives from business, the voluntary sector and academia joined politicians at the House of Commons’ Terrace Pavilion on Wednesday. The event promoted the new recommendations as part of a quartet of reports. It focussed on calls for the appointment of a Cabinet Minister for Children and Young People. Professor Keith Godfrey, Theme Lead for Nutrition, Lifestyle and Metabolism in the NIHR Southampton Biomedical Research Centre, said: “Unheard, unseen and unprotected, the current generation of infants and children face multiple issues that make it increasingly difficult for them to live their lives to their fullest potential. This new far-reaching report sets out a comprehensive package of measures that need to be prioritised by the new government. “These include presenting the case for ring-fenced funding for all local authorities to invest in community leisure and education projects and services focused on improving young lives and the wellbeing of the next generation. “This needs to be coupled with mandatory food and drink standards for early years settings, alongside nutrition training and support being added to the curricula for the early years workforce.” Learnings from LifeLab The third chapter of the Family and Community Report explores school and the curriculum. Its authors say young people need to be engaged with the world around them and given tools to apply across the curriculum and beyond. The chapter champions the LifeLab educational programme in Southampton, which educates young people for lifelong health. It has been established by the University of Southampton, the NIHR Southampton Biomedical Research Centre and University Hospital Southampton. Dr Kath Woods-Townsend, LifeLab Programme Manager, says: “Our mission is to empower children and young people, through scientific discovery, to understand the need to make positive lifestyle choices for themselves and for future children they may have. “We are proud to support this latest report from the Children’s Alliance and hope the LifeLab approach can provide a model to support children and young people across the UK.” Needs at the heart of policy The reports from Children’s Alliance were launched just two days after the announcement of a new Prime Minister. Baroness Frances De Souza, Honorary President of Children’s Alliance, welcomed the timing: “Sky high energy bills and a catastrophic cost of living crisis hot on the heels of a ‘once in a century’ pandemic mean that we cannot go on as before. Children and young people are consigned to the margins of a country they will one day lead and there has been no legislation about their health and wellbeing since 2010. “The new Prime Minister must stop the rot and appoint a Cabinet Minister for Children and Young People who will ensure that their needs are at the heart of policy in all Government Departments. Pilot schemes and locally commissioned ‘projects’ are poor excuses for decisive national leadership at a time of national emergency.”

Babies in the Southampton area will play a vital role in a new respiratory virus study combatting the leading cause of infant hospitalisation. RSV (Respiratory Syncytial Virus) affects 90% of children before the age of two. In recent months, there has been a resurgence of RSV following the easing of COVID-19 public health measures. The HARMONIE study will take place at University Hospital Southampton (UHS) NHS Foundation Trust. It is a collaboration between Sanofi and the National Institute for Health and Care Research (NIHR). The study is evaluating the efficacy of nirsevimab, a monoclonal antibody immunisation. The research will include newborn babies to babies 12 months old who are in, or are approaching, their first RSV season. International study More than 20,000 babies across three countries (United Kingdom, France and Germany) will take part in the new study, from August 2022 to March 2023. Dr Katrina Cathie, UHS consultant paediatrician and Southampton study lead, said: “RSV infection is very common and every year our wards are full of babies with breathing and feeding problems, with some becoming very unwell. It is exciting to know there is an antibody treatment that could protect babies in the near future. “The HARMONIE study is vital to assess the impact on hospitalisations due to RSV and we are asking all parents of babies under one year to consider taking part. There is a single study visit, no blood tests and further details are collected remotely via an app at intervals over a year.” Contagious infection RSV often causes only mild illnesses, like a cold. However, for some babies, it leads to more severe lung problems such as bronchiolitis and pneumonia. Nearly 80% of the children admitted to hospital with RSV are previously healthy. Nirsevimab is an investigational long-acting antibody aiming to protect all infants from birth entering their first RSV season with a single dose. Professor Andrew Ustianowski, National Specialty Lead for Infection at NIHR Clinical Research Network, said: “This study, supported by the NIHR across more than 100 sites, provides the UK with the opportunity to lead the way in a disease which impacts infants globally. “By carrying out this widespread study, we can help discover how babies can be protected from such a common, yet potentially debilitating virus. Previous smaller studies of the antibody injection being used has shown nirsevimab has a good safety profile in babies, which will hopefully provide parents with confidence to take part in the study.” Dr Bogdana Coudsy, Global Head of Medical for Vaccines at Sanofi, said: “Given RSV is a leading cause of hospitalisation in all infants, we are excited to start this research that puts the needs of participants, carers, and investigators at the heart of its development. This is an innovative study in design and execution, a model for the future, thanks to a hybrid digital design and close collaborative work.” Find out more about the study by visiting the HARMONIE website.

The number of teenage girls attending emergency departments with mental health issues rose during the COVID-19 pandemic. New Southampton research shows that more females aged 11-17 went to hospital with mental health issues than would be expected. There was a large reduction in teenage boys attending with mental health issues in the same period. Researchers say the figures highlight a need to better understand how to support teenage mental health, particularly around their exposure to digital media. Findings have been published in BMJ Journals’ Archives of Disease in Childhood. COVID-19 impact The study assessed the pandemic’s impact on medical, surgical, trauma and mental health conditions in children and young adults. It was led by Graham Roberts, Professor in Paediatric Allergy and Respiratory Medicine at the University of Southampton. Professor Roberts, a theme co-lead at the NIHR Southampton Biomedical Research Centre, said: “The impact of COVID-19 on older members of society is well-documented. But the impact of the pandemic on young people is less well-known. “There were concerns about the negative impact on young people, so we looked at the number of young people attending hospital emergency departments during the first year of the pandemic. We compared it to the number we would have expected to see if the pandemic hadn’t happened.” Five years of data The study took place at the University Hospital Southampton (UHS) emergency department and regional major trauma centre. Researchers analysed data from 166,459 presentations over five years from April 2016, focussing only on patients aged under 25. Overall, there was a 38.1% reduction in young people using the emergency department during the pandemic with no variation by sex, age, deprivation or ethnicity. However the research showed an increase in the number of 11-17-year-old females who attended with mental health issues during the first year of the pandemic. It also showed a large reduction in the number of males who attended with mental health issues. Concerning trend Professor Roberts said: “This may have been due to young females having fewer face-to-face interactions with friends, resulting in loneliness and worsened mental health. There are big differences in digital use between adolescent males and females. Boys tend to spend more time gaming, while girls spend more time on smartphones, social media and texting. “Greater digital media use can cause lower well-being, and loneliness is often associated with females and older adolescents. “This increase in mental health in young females is concerning. We need to consider how we support these adolescents, especially with the increased exposure to digital media during the pandemic.”

Babies who suffer from bronchitis, pneumonia and chest infections are more likely to develop asthma and lower lung function when they are older, according to new research. Lower respiratory tract infections are common in babies and evidence has suggested that they can affect the development of the respiratory and the immune systems. This leaves children prone to getting chronic respiratory diseases, such as asthma, later in life. An international research team have published new findings in the European Respiratory Journal. An international research team have published new findings in the European Respiratory Journal. Southampton expertise The study was led by experts at Erasmus MC University Medical Centre Rotterdam. It shows that children with early life respiratory infections have a higher risk of developing chronic obstructive respiratory diseases by the time they are at school. The research involved Southampton asthma specialist Professor Hasan Arshad. Professor Arshad is head of the asthma, allergy and clinical immunology service at University Hospital Southampton and a key contributor to the NIHR Southampton Biomedical Research Centre. He is a professor at the University of Southampton. Insights from 150,000 Researchers examined data from 150,000 children across Europe aged from six months to five-years-old. Professor Arshad explained: “Previous research has reported that early-life respiratory tract infections might affect the risk of wheezing or asthma in later life. Conclusive studies from general populations were lacking. Only a few focused on lung function. “Our research looks at data from a large number of children, including those from the Isle of Wight birth cohort. It shows a stronger link between early-life respiratory tract infections and the increased risk of developing chronic obstructive respiratory diseases later in life. “We found that children who had suffered lower respiratory tract infections had a higher risk of developing school-age asthma than those with upper respiratory tract infections.” Upper respiratory tract infections include croup, ear infections, throat infections, rhinitis and colds. Lower respiratory tract infections included bronchitis, bronchiolitis, pneumonia, and chest infections.

Southampton researchers have given new insight into the events underlying a chronic lung disease, generating a valuable new resource for scientists around the world. The study, published in Cell Reports, used a new technique called spatially resolved transcriptomics to generate a ‘map’ of human lung fibrosis tissue. This offers unprecedented insight into how lung fibrosis may develop. It has also identified new pathways that may underlie susceptibility to disease progression. Chronic lung disease Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive lung disease. Average life expectancy is just three to five years after diagnosis. The condition causes scarring in the lungs and makes breathing increasingly difficult. Treatment options are limited and researchers are intensely investigating how the disease progresses. A significant challenge has been that the structure of lung tissue is very complex. Where different cell types are located within the lung and how they change with fibrosis has been poorly understood. Spatial transcriptomics The development of spatially resolved transcriptomics was Nature’s method of the year in 2020. For the first time it allows assessment of gene expression signatures of cells within tissue without losing information about their physical location. Collaborative research The new study was driven by experts from the NIHR Southampton Biomedical Research Centre and the University of Southampton. Dr Joseph Bell, NC3Rs Fellow in Southampton, performed the study in collaboration with the Medicines Discovery Catapult (MDC), Cheshire. It also included expertise from University College Dublin. Dr Bell said: “Spatial transcriptomics has the potential to transform our understanding of complex diseases such as IPF. For the first time we have been able to identify all of the individual cell types within an area of lung tissue and understand how altered communication between each cell type may determine whether fibrosis develops.” The work was led by Southampton’s Dr Mark Jones, Associate Professor in Respiratory Medicine and Honorary Consultant Respiratory Physician, who said: “This has provided a unique snapshot of how lung fibrosis is developing. We see evidence of the very early events we think are underlying fibrosis development, as well as how the cellular environment may be promoting fibrosis progression. “This will inform new ways to target lung fibrosis as well as how to create better models of lung disease to study these new treatments.” Image: Visualised gene expression patterns within human lung fibrosis tissue.

A study with families in Southampton found 47 percent of six-year-olds did not meet the recommended daily guidelines for physical activity. The study was carried out pre-pandemic by researchers at the universities of Southampton and Cambridge. All families who took part were involved in the ongoing Southampton Women’s Survey. Children who are active are more likely to be active adults, reducing their risk of obesity and many lifestyle-related diseases later in life. They need to be active for their muscles and bones to develop properly. Being active also improves their ability to concentrate, boosts their mood and leads to better educational performance at school. Yet the results from this study, published in the Journal of Physical Activity & Health, suggest almost half of children are not active enough. Why do children need to be active? Physical activity is beneficial for children’s physical and mental health. They need to do a mix of aerobic exercise, which improves fitness, as well as exercises to strengthen their muscles and bones. Current UK guidelines recommend that children aged 5 to 18 years do, on average, an hour of moderate-to-vigorous physical activity each day. This could include playing in the playground, physical education (PE) lessons or after school sports clubs. Moderate intensity activities raise your heart rate, and makes you breathe faster and feel warmer. One way to tell if you're working at a moderate intensity level is if you can still talk, but not sing. It is also recommended that extended periods of sedentary behaviour, such as sitting watching TV or screen use, are kept to a minimum. Investigating young children’s activity Researchers from the MRC Lifecourse Epidemiology Centre at the University of Southampton and the MRC Epidemiology Unit at the University of Cambridge set out to investigate how much activity children do in their transition from preschool to primary school. They gave 712 six-year-olds from the Southampton Women’s Survey Actiheart accelerometers to wear. These attach to the chest, and measure heart rate and movement. The children wore them continually for an average of six days. Just over half of the children (53%) met the current UK recommended guidelines. Boys were more likely to reach the target than girls (63% of boys vs 42% of girls). On average, the six-year-olds did just over an hour (65 minutes) of moderate-to-vigorous physical activity each day. They did over 7.5 hours (457 minutes) of low-level physical activity, and were sedentary for more than five hours (316 minutes). When the researchers analysed activity levels by time of day, they found that girls engaged in less moderate-to-vigorous physical activity during the school day. Professor Keith Godfrey, from the NIHR Southampton Biomedical Research Centre, said: “These analyses indicate that new initiatives to promote physical activity must consider the lower activity levels in girls and at weekends. The time when children transition into formal schooling is an important opportunity to ensure a much higher proportion achieve recommended levels of activity.” Dr Esther van Sluijs, from the MRC Epidemiology Unit at Cambridge, said: “Using accelerometers, we were able to get a much better idea of how active children were and we found that just over a half of six-year-olds were getting the recommended amount of physical activity. But this means that almost half of British children in this age group are not regularly active, which we know is important for their wellbeing and their performance at school.” Comparing against activity at age four For some children, the researchers could look at back at data from when they were age four. Compared to age four, the children were more sedentary (on average, around 30 minutes more per day). But they also did an extra seven minutes of moderate-to-vigorous physical activity. Dr Kathryn Hesketh from the MRC Epidemiology Unit at Cambridge added: “This is something of a double-edged sword: children appear to do more moderate-to-vigorous physical activity when they start formal schooling, which is really positive, but they also spend more time sedentary. “This may in part be because of the structure of the school day, so we may want to look at ways to reduce sedentary time when children are younger, to prevent that behaviour becoming habitual.” This analysis was based on data collected up to 2012. Yet questionnaire findings from national surveys suggests children's activity levels has changed little up to 2020. During the COVID-19 pandemic were lower still. The work was largely supported by the Wellcome Trust and the Medical Research Council.