Health Assessments for Business - support before it happens

Basic questions regarding the health and lifestyle of your employees. The answers may have an impact on some of the tests and calculations used during the health screening and the resulting action plan.

We will analyse your employees current health and lifestyle and work with them through the results of their health assessment to see how we can help them achieve your goals with physical exercise, nutrition, work life balance, and with them taking ownership of your health.

The 12 month action plan we help your employees build will assist them on their journey of maintaining a healthy life, or improving their health and wellbeing.

A brief assessment of your employees current state of mind.

Your height and weight will be measured using a stadiometer and electronic scales.

The body mass index (BMI) or Quetelet index is a value derived from the mass (weight) and height of an individual. The BMI is defined as the body mass divided by the square of the body height, and is universally expressed in units of kg/m2, resulting from mass in kilograms and height in metres.

Waist to Hip Ratio (WHR) is the ratio of the circumference of the waist to that of the hips. This is calculated as waist measurement divided by hip measurement (W÷H). For example, a person with a 25″ (64 cm) waist and 38″ (97 cm) hips has a waist-hip ratio of about 0.66.

The WHR has been used as an indicator or measure of health, and the risk of developing serious health conditions. WHR correlates with fertility (with different optimal values for males and females).

This assessment measures basal metabolic rate (BMR). BMR refers to the energy requirements if one was to lie in bed all day at rest, to keep living, breathing and maintaining body weight. This is estimated at around 80% of daily energy requirements, where the additional 20% is for ‘normal’ daily activity and function. Increased exercise levels will increase energy consumption (kcal intake). This is heavily dependent on the size and composition of an individual so no comparison required.

This is an assessment of an individual’s metabolic efficiency. If metabolic age is greater or less than actual age, this would indicate inefficiency or efficiency of metabolism. This is influenced by the amount of body fat and muscle mass carried and its distribution in the body. To improve metabolic age, the same advice is given as BMR.

This is the estimated total mass of body fat divided by total mass, which includes both essential fat and stored fat. We use an ideal range for females as 24-33% and 15-22% for males. A body fat lower than these values will be highlighted as underweight, which isn’t always the case. A lean individual will have a high fat free mass and a low body fat.

This is the estimated total mass of body fat divided by total mass, which includes both essential fat and stored fat.

Visceral fat (VF) is stored internally around the organs and is not always apparent to the individual, along with the simultaneous increased health risks. Elevated VF levels are associated with increased risk of conditions such as CHD, CVD, stroke, type 2 diabetes and hypertension.

Individuals that carry excess body fat centrally will be more likely to have higher VF. This is frequently observed in males with a ‘beer belly’ who carry their weight around the waist and abdomen. Healthy ranges of VF are between 1 and 12 with 1 being ideal but this rating does go up to 59.

This is the weight of skeletal, smooth and cardiac muscle in the body. Muscle is the largest tissue in the body and is electrolyte-rich with a low resistance so is a dominant conductor.

Resistance training to gain muscle uses a lot of energy or kcal which can be a good method of fat loss. Increased muscle mass decreases sarcopoenia in older adults and enhances exercise performance. There is no comparison for muscle mass as it is highly variable, therefore explain the benefits of increased levels.

This is the estimated weight of total bone mass in the body. A bone density or DEXA scan would be necessary to accurately measure the state of bone health. Bone mass on the scales is recorded as kg with a conversion to pounds on the report.

The average adult male is approximately 65% water however; this varies considerably based on factors such as age, health, weight and gender. Healthy ranges for TBW are 45-55% and 50-65% for females and males respectively.

TBW impacts on many areas including regulation of body temperature, concentration, energy levels and removal of waste products. Drinks provide approximately 70-80% of our water, the remaining 20- 30% coming from food. The average adult male requires 2000ml per day and female 1600ml to achieve adequate intake (BDA fact sheets, 2015).

Alcohol and caffeine however, draw water from the body and increase the need for urination. When explaining the result, those with a high body fat % will nearly always have a low TBW. If there is a seemingly healthy individual with a low TBW, it may be advised they consume more water and cut down on caffeinated drinks.

Blood pressure (BP) is the pressure of circulating blood on the walls of blood vessels. When used without further specification, "blood pressure" usually refers to the arterial pressure in the systemic circulation.

Blood pressure is usually expressed in terms of the systolic (maximum during one heart beat) pressure over diastolic (minimum in between two heart beats) pressure and is measured in millimetres of mercury (mmHg), above the surrounding atmospheric pressure (considered to be zero for convenience).

Cardiovascular disease (CVD) is all diseases of the heart and circulation including coronary heart disease (CHD), angina, heart attack, congenital heart disease and stroke. It's also known as heart and circulatory disease and the cause is often atherosclerosis.

HDL % of total cholesterol is more indicative of your risk of cardiovascular disease than total cholesterol alone.
Below 20% indicates an increased risk of cardiovascular disease while above 20% indicates a lower than average risk.

Lung function

The lungs are vital for respiration and the exchange of carbon dioxide for oxygen to supply the body. The lungs are made up of small sacs called alveoli which are covered in capillaries for efficient gaseous exchange. It is important to ensure good lung function and this can be assessed using spirometry. Spirometry is a simple test that can assess a number of conditions and is often an early indicator before any other symptoms.

Lung age

Lung age compares the results to normal data for same age, gender, etc.

An electrical signal spreads from the top to the bottom of the heart stimulating the heart to contract. A healthy heart has an orderly progression of depolarisation (chemical change initiating a process). This stimulates the sinoatrial node to fire, spreading through the atria to the atrioventricular node, down the bundle of His Purkinje fibres and through the left and right bundle branches.

This pattern characterises the ECG trace, and to a trained cardiologist this holds great information about the size and position of the heart’s chambers, rhythm, function and presence of damage.

The Chester Step Test is an effective way to assess a person’s fitness levels by determining the rate of recovery following intense exercise. The test itself is called a sub-maximal test which requires the candidate to step up onto a step which is 30cm (12mm) in height.

Once on the step with both feet the candidate will then step back off the step before repeating the movements in time with a metronome. The Chester Step test is multi-staged which means that, with each level of increase, the speed in which the candidate has to step up and off the step increases.

Calcium

Calcium is the most common mineral in the body and one of the most important. The body needs it to build and repair bones and teeth, help nerves work, make muscles squeeze together, help blood clot, and help the heart to work. Vitamin D is essential to absorb calcium. The majority of calcium in the body is stored in bone, the rest is found in the blood. If the calcium result is abnormal, a Corrected Calcium calculation is carried out to provide further information.

Corrected calcium

Around half of the total calcium in your blood is bound by albumin. This estimates your calcium measurement if albumin levels were a specified normal value.

Osteoporosis is a slowly developing disease that can weaken bones therefore increasing the risk of breaking. It affects over three million people in the UK.

Urinalysis is one of the most commonly used tests in preliminary screening. It primarily tests the functions of the liver, kidney, urinary tract, but also indicates bladder infections, diabetes and dehydration. This is assessed through the following substances which can be abnormally present in urine:

• Blood
• Leucocytes
• Bilirubin
• Urobilinogen
• Specific gravity
• Ketones
• Protein
• Nitrate
• Glucose

The audiometry tests are designed to measure hearing through listening to beeps and tones and also examine the ear drum for any abnormalities.

Vision testing assesses visual acuity through a number of tests for near, distance and colour vision amongst others and whether this safe for work.

Blood glucose testing is the process used to measure the concentration of glucose in your employee's blood. A blood test involves pricking their finger with a small needle called a lancet, drawing a drop of blood from the finger and applying it to a test strip that has been engaged into a blood glucose meter.

Monitoring of blood glucose can be a beneficial part of diabetes detection and management. As part of the day-to-day routine it can help with necessary lifestyle and treatment choices as well as help to monitor for symptoms of hypo- or hyperglycaemia.

HbA1c or Haemoglobin A1c is also known as glycosylated haemoglobin and is a longer term measure of glucose levels in your blood than a simple blood glucose test. Glucose attaches itself to the haemoglobin in red blood cells, and as cells live for around 8 - 12 weeks, it gives us a good indication of the level of sugar in the blood over a 2 - 3 month period.

This is an important measure for diagnosing type 2 diabetes as well as understanding how well blood sugar levels are being controlled in someone with diabetes.

Cholesterol is an essential body fat (lipid). It is necessary for building cell membranes and for making several essential hormones. Cholesterol is manufactured in the liver and also comes from the food we eat. Excessive cholesterol is a risk factor for heart disease - doctors like to see levels below 5 mmol/L.

However, cholesterol is made up of both good (HDL) and bad (LDL) cholesterol so it is important to investigate a raised total cholesterol to see the cause. High levels of HDL cholesterol can cause a raised result but actually be protective against heart disease.

HDL cholesterol (high density lipoprotein) removes cholesterol from the bloodstream and transports it to the liver where it is broken down and removed from the body in bile. HDL cholesterol is commonly known as "good cholesterol". Raised levels are protective against heart disease, while low levels are associated with increased risk of a heart attack.

non-HDL cholesterol (non-HDL-C) has become a commonly used marker for a blood lipid pattern associated with increased risk of heart disease.

It is helpful to know your non-HDL cholesterol because your level of non-HDL may predict your risk of cardiovascular disease even better than your LDL (bad) cholesterol.

That’s because your non-HDL number tells you all the bad cholesterol circulating in your blood – not only your LDL cholesterol but also your levels of VLDL, IDL, and chylomicrons. All are linked with the “bad” protein – ApoB, which means all are plaque-producing and artery-clogging.

LDL Cholesterol (low density lipoprotein) carries cholesterol, triglycerides and other fats to various tissues throughout the body. Too much LDL cholesterol, commonly called "bad cholesterol", can cause fatty deposits to accumulate on artery walls potentially leading to atherosclerosis and heart disease.

Triglycerides are a type of fat (lipid) that circulate in the blood. After you eat, the body converts any excess calories into triglycerides which are then transported to cells to be stored as fat. Your body releases triglycerides to be used for energy.

Raised triglycerides are thought to be a risk factor for peripheral vascular disease (affecting the blood vessels which supply your arms and legs as well as organs below the stomach) as well a microvascular disease, affecting the tiny blood vessels around the heart.

Sodium

Sodium is both an electrolyte and mineral. It helps regulate the water (inside and outside the body's cells) and electrolyte balance of the body. Sodium is also important in how nerves and muscles work. Sodium in the blood is regulated by the kidneys. Too much sodium in the blood is often due to dehydration but can be a marker of the kidneys not working properly. Too little sodium is often caused by fluid retention (oedema) or too much sodium lost through vomiting and diarrhoea or excessive sweating.

Urea

Urea is waste product produced as the body digests protein and is carried by the blood to the kidneys, which filter the urea out of the blood and into the urine.The urea test shows how well the kidneys are working. A high amount of urea in the blood may indicate dehydration or that the kidneys are not working properly or simply that you consume a high protein diet. Low amounts of urea in the blood may indicate a low protein diet, over-hydration, malnutrition or liver failure.

Creatinine

Creatinine is a chemical waste molecule that is generated from muscle metabolism. Measurement of this is an indicator of the level of other waste products. Creatinine is an accurate marker of kidney function. Elevated creatinine can be caused by high intake of animal protein, taking creatine supplements and vigorous exercise but could also indicate that the kidneys are not working properly.

Low creatinine can be caused by a low protein diet, reduced muscle mass or merely efficient kidney function.

ALP

Alkaline Phosphatase (ALP) is an enzyme located mainly in the liver and bones. High levels can indicate bone or liver disease. Raised ALP is looked at in conjunction with other liver function tests to determine whether the problem lies in the liver or the bones. Pregnancy can also cause raised ALP and it is often elevated in growing teenagers.

AST

Aspartate Transferase (AST) is an enzyme created mainly by the cells of the liver and the heart. Any injury to the heart or liver, and other bodily tissues will cause AST to be released into the bloodstream. Levels can be raised following a heart attack, or from liver damage caused by alcohol, drugs or viruses (hepatitis). AST can be raised after vigorous exercise.

ALT

Alanine Transferase (ALT) is an enzyme which is produced by the liver and can indicate liver damage caused by alcohol, drugs or viruses (hepatitis). Small amounts of ALT are normal, but raised levels may mean that your liver is inflamed. Raised levels can also be caused by recent vigorous exercise.

CK

CK (Creatinine Kinase) is a muscle enzyme which measures muscle cell damage and death. CK levels tend to be higher in people with greater muscle mass. CK levels are measured to assess muscle damage, CK levels can rise rapidly after muscle trauma, but will subside as the damage repairs. Levels which continue to rise indicate that muscle damage is continuing. If you have been to the gym the day before your blood test you may well have raised levels of CK.

Gamma GT

Gamma GT is a liver enzyme which is raised in liver and bile duct diseases. It is used in conjunction with the ALP to distinguish between bone or liver disease. Gamma GT is used to diagnose alcohol abuse as it is raised in 75% of long term drinkers.

Bilirubin

Bilirubin is a product of haemoglobin breakdown. It is removed from the body via the liver, stored and concentrated in the gall bladder and excreted into the bowel. Raised bilirubin can cause the skin and whites of eyes to become yellow (jaundice) as the liver is unable to remove sufficient bilirubin from the blood. This can indicate liver damage. Bilirubin can also be raised due to a blocked bile duct as well as Gilbert's syndrome.

Iron

The Iron test measures how much iron is in your blood with the aim of identifying iron deficiency anaemia or iron overload syndrome (haemochromatosis) The symptoms of too much or too little iron can be similar: fatigue, muscle weakness, moodiness and problems concentrating. A raised result can mean that you have iron overload syndrome, an inherited condition where your body stores too much iron, or that you are over-supplementing or that you have a liver condition. A low result can mean that you are anaemic or are suffering from gastro-intestinal blood loss (or other blood loss). Anaemia is also very common in pregnant women.

T.I.B.C

Total Iron Binding Capacity (TIBC) is a measure of the amount of iron that can be carried through the blood. A raised TIBC result usually indicates iron deficiency whereas a low TIBC can occur with iron overload syndrome (haemochromatosis).

Transferrin

Transferrin is made in the liver and is the major protein in the blood which binds to iron and transports it through the body. Low levels of transferrin indicate iron deficiency while high levels indicate iron overload.

Uric acid

Uric acid is a waste product of protein digestion. High levels can lead to excess uric acid being deposited as crystals in the tissues of the body. When this occurs in joints it causes the painful condition known as gout. Uric acid levels are best tested 6 weeks after symptoms appear as they may not be raised at the beginning of an attack.

Total Protein

Total Protein represents the sum of albumin and globulin. It is more important to know which protein fraction is high or low than what the measure of total protein is.

Albumin

Albumin is made mainly in the liver and helps to keep the blood from leaking out of blood vessels. It also helps carry some medicines and other substances through the blood and is important for tissue growth and healing. Low albumin levels can indicate liver disease and can also be a marker for chronic ill-health, malnutrition and inflammation. It can also occur in kidney conditions such as nephrotic syndrome and diabetes. Raised levels are usually caused by dehydration.

Globulin

Globulin consists of different proteins and is made by the liver and the immune system. Certain globulins bind with haemoglobin while others transport metals, such as iron, in the blood and help fight infection.

Thyroid function

The thyroid is one of the largest endocrine glands in the body. It controls all of the chemical and hormonal processes in the body including how quickly the body uses energy, makes proteins, and how sensitive the body is to other hormones. It does this by secreting hormones, predominantly thyroxine (T3) and tetraiodothyronine (T4). Hormonal output is regulated by thyroid-stimulating hormone (TSH) secreted by the anterior pituitary. In some cases the thyroid does not function normally, it can either be over or under active, which is hyperthyroidism and hypothyroidism respectively. Hypothyroidism can occur from congenital thyroid abnormalities, autoimmune disorder, hormonal changes and thyroid removal. The most common symptoms are weight gain and fatigue, which can be caused by a variety of factors, so often goes undiagnosed.

Although called a vitamin, vitamin D is actually a hormone which is activated by sunshine on your skin. Vitamin D is essential for bone strength as it helps your intestines absorb calcium. However, it is thought that vitamin D also plays an important role in immune function, as well as in many chronic diseases and mental health.
Many people in the UK do not produce enough Vitamin D, especially in the winter months with fewer daylight hours. It is now recommended that you get 10 - 15 minutes of unprotected sun exposure every day to ensure you are producing enough vitamin D. In winter months, if your levels are found to be low, you may wish to take a supplement.

PSA Prostate Cancer (Total) (Male Only)

Prostate Specific Antigen (PSA) is a protein which is released into the blood by the prostate gland. An enlarged gland is often associated with higher levels of PSA. PSA levels can also rise with age, with prostatitis (infected prostate) or even vigorous exercise and ejaculation.

The PSA test in isolation is not considered by itself to be a totally accurate tool in diagnosing Prostate Cancer, as levels can be raised due to benign prostate disorders. Raised levels of PSA can lead to unnecessary biopsies and intervention which may decrease quality of life. However, a raised PSA level should always be investigated further.

It is useful to monitor PSA over time so that any change in what is normal for you can be investigated speedily.

Cancer antigen 125 (CA125) is a protein which is produced by cancer cells and which can be raised in cancers of the ovary, lung, breast, pancreas and gastrointestinal tract. As CA125 is also produced by normal cells it is important to know your base level and monitor regularly so that any change can be picked up early. A raised level is not necessarily a sign of cancer, just as a low level does not guarantee that cancer is not present. However, we recommend that all raised levels are investigated further.

Bowel cancer or colorectal cancer is classed as any cancer that originates in the colon (large intestine) or rectum (anal passage). The cancer itself, in most cases, begins growing in the innermost lining of a section of the bowel as a polyp or adenoma which if left untreated can develop into cancer through the muscle walls of the intestine. This can then spread into other organs such as the liver and respiratory system.

Cancer is an ever evolving topic and one which concerns a great number of individuals. Statistics suggest that more than 1 in 3 will develop some form of cancer at some stage in their life with the most common types being breast, lung, prostate and bowel. It is a condition that involves uncontrollable cell reproduction which can then spread and destroy tissues in other parts of the body (metastasis).

The first sign of breast cancer often is a breast lump or an abnormal mammogram. Breast cancer stages range from early, curable breast cancer to metastatic breast cancer, with a variety of breast cancer treatments. Male breast cancer is not uncommon and must be taken seriously.

The self examination kit supports in finding and locating any lumps.

Helicobacter Pylori

Helicobacter Pylori (H. Pylori) is a bacterium that infects the lining of the stomach and duodenum. It is one of the most common infections in the UK although it is becoming less common. H-Pylori is most likely acquired by ingesting contaminated food, water or through person to person contact. It is estimated that 40% of people in the UK become infected with H. Pylori at some stage. Once infected, unless treated, H. Pylori will remain in the body for life.

H. Pylori is the most common cause of stomach and duodenal ulcers, approximately 3 in 20 people infected with H. Pylori develop an ulcer. Stomach cancer risk is thought to be increased with long-term infection of H. Pylori. However, more than a quarter of people in the UK become infected with this bacterium, and the majority don’t develop stomach cancer. The increased risk is small, but may be greater if a patient who is infected with H. Pylori has a first-degree relative (mother, father, brother, sister or child) who has been diagnosed with stomach cancer.

Haemoglobin

Haemoglobin carries oxygen and gives the blood cell its red colour. This test measures the amount of haemoglobin in the blood and is a good measure of the blood's ability to carry oxygen throughout the body. A high haemoglobin result can mean increased red cell production to compensate for chronically low oxygen levels in the blood caused by living at altitude or lung disease. While it can also indicate "blood doping" other causes can include dehydration, smoking and bone marrow disorders. A low haemoglobin result indicates anaemia which can have many causes including pregnancy, blood loss, liver damage, iron deficiency and much more. A low haemoglobin level would be investigated in line with other symptoms and results.

HCT

HCT (hematocrit) measures the amount of space (volume) red blood cells take up in the blood. A high level can occur with pregnancy, living at altitude, dehydration as well as low availability of oxygen through chronic lung disease and even sleep apnoea. Low levels indicate anaemia.

RBC

Red Cell Count analyses the number of red cells in the blood. Red blood cells carry oxygen from the lungs to the rest of the body. They also carry carbon dioxide back to the lungs so that it can be exhaled. A high count (thicker blood) means there is a chance that the red blood cells will clump together and block tiny blood vessels. This also makes it difficult for your red blood cells to carry oxygen. A low count (anaemia) means that your body may not be getting the oxygen it needs and can be caused by nutritional deficiency (e.g. iron, folic acid, vitamin B12) over-hydration as well as bleeding and bone marrow disorders.

MCV

MCV (Mean Corpuscular Volume) shows the size of red blood cells. A high result may indicate a vitamin deficiency of folate or vitamin B12 and is often seen in alcohol excess associated with liver inflammation. A low result indicates anaemia, often caused by iron deficiency.

MCH

MCH (Mean Corpuscular Haemoglobin) is the amount of haemoglobin in an average red blood cell. Together with MCV and MCHC values this can help in the diagnosis of different types of anaemia.

MCHC

MCHC (mean corpuscular haemoglobin concentration) is the concentration of haemoglobin in an average red blood cell. A high level can indicate the presence of spherocytes (a type of red blood cell with too much haemoglobin) or a deficiency of folic acid and vitamin B12 in the diet.

White cell count

White blood cells are key to your body's immune or defence system. They fight infections and protect our body from foreign invaders such as harmful germs and bacteria. A raised WBC can indicate recent infection, inflammation, trauma and even stress. Your WBC can also be raised as a result of taking certain medications. A decreased WBC can result from a vitamin deficiency such as folate and vitamin B12, as well as liver disease and diseases of the immune system.

Neutrophils

Neutrophils are a type of white blood cell which are responsible for helping your body fight infection. When neutrophils are low you can be more vulnerable to illness and infection. Neutrophils can be raised after severe stress on the body from a bacterial infection, recent exercise or sudden kidney failure. Low neutrophils can be caused by a deficiency in vitamin B12 and folic acid, severe bacterial infection and some autoimmune diseases.

Lymphocytes

Lymphocytes are a type of white blood cell which fight bacterial and viral infections. They include T Cells, B Cells and Natural Killer Cells. Lymphocytes can be raised for many reasons but it is common for them to be raised after recent infection, particularly after flu. They can also be raised due to autoimmune disorders and some cancers. The most common cause for lymphocytes to be depleted is the common cold.

Monocytes

Monocytes are a type of white blood cell which engulf and remove pathogens and dead or damaged cells from our blood. The heat and swelling of inflammation is the result of the activities of these cells. Elevated monocytes can indicate chronic inflammatory disease, chronic infection, parasitic infection and cushings disease. Low levels can be due to autoimmune disorders such as lupus and rheumatoid arthritis as well as drugs which affect the bone marrow such as chemotherapy.

Eosinophils

Eosinophils are a type of white blood cell which have the function of removing parasitic infections as well as regulating inflammation to mark an infected site. Levels of eosinophils can be elevated if the amount of inflammation is greater than necessary to control the damage (e.g. asthma and allergies) as well as parasitic and fungal infections, autoimmune diseases and skin disorders. Low levels of eosinophils are not usually cause for concern and can be caused by the administration of steroids.

Basophils

Basophils are a type of white blood cell which protects your body from bacteria and parasites such as ticks. They produce histamine and heparin and can respond incorrectly causing allergies, asthma and other inflammatory conditions. An elevated basophil count can be due to inflammatory conditions such as Crohn's, ulcerative colitis and dermatitis, recent infection and hormone imbalance e.g. hypothyroidism. A low basophil count can be caused by pregnancy, stress and use of steroids.

Blood film report - included if results abnormal

A blood film report is an examination of the shape, size and number of blood cells under the microscope. Oxygen is carried less effectively by red blood cells if they are of abnormal size or shape, and this can result in anaemia. Too many or too few white blood cells can signify a blood disorder and can affect your body's ability to fight infection.

Platelet count

Platelets or Clotting Cells are the smallest type of blood cell and are important in blood clotting. When bleeding occurs, the platelets swell, clump together and form a sticky plug which helps stop the bleeding. If platelet levels are raised there is a risk of blood clots forming in blood vessels. If platelet levels are too low there is a risk of easy bruising and uncontrolled bleeding.

MPV

MPV (Mean Platelet Volume) is a measurement of the average size of platelets. New platelets are larger and an increased MPV occurs when increased numbers of platelets are being produced. MPV provides an indication of platelet production in your bone marrow.

C-reactive protein (CRP) is an inflammation marker used to assess whether there is inflammation in the body - it does not identify where the inflammation is located. High sensitivity CRP (hs-CRP) is a test which is used to detect low-level inflammation which is thought to damage blood vessels and can lead to a heart attack or stroke. Raised levels are a risk factor for cardio-vascular disease.

This is a personalised plan designed at the end of a screening based on the subsequent results. It will take into account medical history and current lifestyle to create realistic goals to improve overall health and wellbeing.